Pediatric Emergency Physicians' Knowledge, Attitudes, and Behaviors Regarding Confidential Adolescent Care.
Journal
Pediatric emergency care
ISSN: 1535-1815
Titre abrégé: Pediatr Emerg Care
Pays: United States
ID NLM: 8507560
Informations de publication
Date de publication:
14 Feb 2024
14 Feb 2024
Historique:
medline:
15
2
2024
pubmed:
15
2
2024
entrez:
14
2
2024
Statut:
aheadofprint
Résumé
More than 19 million adolescents seek care in the emergency department (ED) annually. We aimed to describe the knowledge, attitudes, and behaviors related to confidential adolescent care among pediatric ED physicians. We conducted a cross-sectional questionnaire of US physician members of the Pediatric Emergency Medicine Collaborative Research Committee survey listserv. The 24-item questionnaire assessed familiarity with adolescent confidentiality laws, attitudes toward providing confidential care, frequency of discussing behavioral health topics confidentially, and factors influencing the decision to provide confidential care. We dichotomized Likert responses and used χ2 to compare subgroups. Of 476 eligible physicians, 151 (32%) participated. Most (91. 4%) had completed pediatric emergency medicine fellowship. More participants reported familiarity with all sexual health-related laws compared with all mental health-related laws (64% vs 49%, P < 0.001). The median age at which participants thought it was important to begin routinely providing confidential care was 12 years; 9% thought confidential interviews should not be routinely conducted until older adolescence or at all. Their decision to provide confidential care was influenced by the following: chief complaint (97%), time (43%), language (24%), presence of family (23%) or friends (14%), and space (22%). Respondents reported moderate familiarity with adolescent confidentiality laws. Although they viewed confidential care as something they were comfortable providing, the likelihood of doing so varied. Barriers to confidential care were influenced by their assessment of adolescents' behavioral health risk, which may contribute to health inequity. Future efforts are needed to develop strategies that augment confidential ED care for adolescents.
Identifiants
pubmed: 38355126
doi: 10.1097/PEC.0000000000003130
pii: 00006565-990000000-00394
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Disclosure: The authors declare no conflict of interest.
Références
ASPE. Health Insurance Portability and Accountability Act of 1996. Available at: https://aspe.hhs.gov/reports/health-insurance-portability-accountability-act-1996. Accessed August 12, 2023.
Ford C, English A, Sigman G. Confidential health care for adolescents: position paper of the Society for Adolescent Medicine. J Adolesc Health. 2004;35:160–167.
Marcell AV, Burstein GR. Sexual and reproductive health care services in the pediatric setting. Pediatrics. 2017;140:e20172858.
Benjamin L, Ishimine P, Joseph M, et al. Evaluation and treatment of minors. Ann Emerg Med. 2018;71:225–232.
Pampati S, Liddon N, Dittus PJ, et al. Confidentiality matters but how do we improve implementation in adolescent sexual and reproductive health care? J Adolesc Health. 2019;65:315–322.
Miller MK, Chernick LS, Goyal MK, et al. A research agenda for emergency medicine–based adolescent sexual and reproductive health. Acad Emerg Med. 2019;26:1357–1368.
Ahmad FA, Jeffe DB, Carpenter CR, et al. Emergency department directors are willing to expand reproductive health services for adolescents. J Pediatr Adolesc Gynecol. 2019;32:170–174.
Samuels-Kalow ME, Boggs KM, Cash RE, et al. Screening for health-related social needs of emergency department patients. Ann Emerg Med. 2021;77:62–68.
Bi L, Solnick RE, Merchant RC. A systematic review of HIV screening programs conducted in pediatric emergency departments in the United States. BMC Emerg Med. 2022;22:75.
Cervantes PE, Seag DEM, Baroni A, et al. Universal suicide risk screening for youth in the emergency department: a systematic review. Psychiatr Serv Wash DC. 2022;73:53–63.
Wilson KM, Klein JD. Adolescents who use the emergency department as their usual source of care. Arch Pediatr Adolesc Med. 2000;154:361–365.
Klein JD, McNulty M, Flatau CN. Adolescents' access to care: teenagers' self-reported use of services and perceived access to confidential care. Arch Pediatr Adolesc Med. 1998;152:676–682.
Weisman J, Chase A, Badolato GM, et al. Adolescent sexual behavior and emergency department use. Pediatr Emerg care. 2020;36:e383–e386 Published online March 2018.
Chernick LS, Chun TH, Richards R, et al. Sex without contraceptives in a multicenter study of adolescent emergency department patients. Acad Emerg Med. 2020;27:283–290.
Langerman SD, Badolato GM, Rucker A, et al. Acceptability of adolescent social and behavioral health screening in the emergency department. J Adolesc Health. 2019;65:543–548.
Miller C, Tebb K, Williams J, et al. Chlamydial screening in urgent care visits: adolescent-reported acceptability associated with adolescent perception of clinician communication. Arch Pediatr Adolesc Med. 2007;161:777–782.
Miller MK, Hornberger L, Sherman AK, et al. Acceptability of sexual health discussion and testing in the pediatric acute care setting. Pediatr Emerg Care. 2013;29:592–597.
Reed JL, Punches BE, Taylor RG, et al. A qualitative analysis of adolescent and caregiver acceptability of universally offered gonorrhea and chlamydia screening in the pediatric emergency department. Ann Emerg Med. 2017;70:787–796.e2.
Vaughn LM, Sunny CE, Lindquist-Grantz R, et al. Successful suicide screening in the pediatric emergency department: youth, parent, researcher and clinician perspectives. Arch Suicide Res. 2020;24:124–141.
Gutman CK, Dorfman D, Meese H, et al. Identifying a golden opportunity: adolescent interest in contraceptive initiation in a pediatric emergency department. J Womens Health (Larchmt). 2020;29:622–626 Published online February 19, 2020.
Pickett ML, Goyal MK, Chernick LS. Time to address inequities in chlamydia screening among adolescents. Am J Public Health. 2022;112:7–8.
Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208.
Resnick MD, Litman TJ, Blum RW. Physician attitudes toward confidentiality of treatment for adolescents: findings from the upper Midwest regional physicians survey. J Adolesc Health. 1992;13:616–622.
Fleming GV, O'Connor KG, Sanders JM. Pediatricians' views of access to health services for adolescents. J Adolesc Health. 1994;15:473–478.
Rock EM, Simmons PS. Physician knowledge and attitudes of Minnesota laws concerning adolescent health care. J Pediatr Adolesc Gynecol. 2003;16:101–108.
Riley M, Ahmed S, Reed BD, et al. Physician knowledge and attitudes around confidential care for minor patients. J Pediatr Adolesc Gynecol. 2015;28:234–239.
Sharko M, Jameson R, Ancker JS, et al. State-by-state variability in adolescent privacy laws. Pediatrics. 2022;149:e2021053458 Published online May 9, 2022.
Hoffmann JA, Stack AM, Samnaliev M, et al. Trends in visits and costs for mental health emergencies in a pediatric emergency department, 2010–2016. Acad Pediatr. 2019;19:386–393.
Radhakrishnan L. Pediatric emergency department visits associated with mental health conditions before and during the COVID-19 pandemic — United States, January 2019–January 2022. MMWR Morb Mortal Wkly Rep. 2022;71:319–324.
Samuels-Kalow ME, Agrawal P, Rodriguez G, et al. Post-Roe emergency medicine: policy, clinical, training, and individual implications for emergency clinicians. Acad Emerg Med. 2022;29:1414–1421.
Vayngortin T, Gutman CK, Miller M. Post-Roe emergency medicine: important considerations for adolescents. Acad Emerg Med. 2023;30:687–688.
Martin S, Sandberg ES, Shumer DE. Criminalization of gender-affirming care—interfering with essential treatment for transgender children and adolescents. N Engl J Med. 2021;385:579–581.
Miller MK, Mollen CJ, O'Malley D, et al. Providing adolescent sexual health care in the pediatric emergency department: views of health care providers. Pediatr Emerg Care. 2014;30:84–90.
American Society of Anesthesiologists. Pregnancy testing prior to anesthesia and surgery. Available at: https://www.asahq.org/standards-and-guidelines/pregnancy-testing-prior-to-anesthesia-and-surgery. Accessed March 22, 2023.
Levy S, Siqueira LM; Committee on Substance Abuse. Testing for drugs of abuse in children and adolescents. Pediatrics. 2014;133:e1798–e1807.
Chernick LS, Bugaighis M, Britton L, et al. Factors influencing the conduction of confidential conversations with adolescents in the emergency department: a multicenter, qualitative analysis. Acad Emerg Med. 2023;30:99–109.
Johnson TJ. Intersection of bias, structural racism, and social determinants with health care inequities. Pediatrics. 2020;146:e2020003657.
Johnson TJ, Hickey RW, Switzer GE, et al. The impact of cognitive stressors in the emergency department on physician implicit racial bias. Acad Emerg Med. 2016;23:297–305.
Johnson TJ, Winger DG, Hickey RW, et al. Comparison of physician implicit racial bias toward adults versus children. Acad Pediatr. 2017;17:120–126.
Gutman CK, Holmes S, Balhara KS. Low-value care in pediatric populations: there is no silver lining. Acad Emerg Med. 2022;29:804–807.
Gutman CK, Newton N, Duda E, et al. Comparison of targeted and routine adolescent HIV screening in a pediatric emergency department. Pediatr Emerg Care. 2022;38:e1613–e1619 Published online June 9, 2022.
Goyal MK, McCutcheon M, Hayes K, et al. Sexual history documentation in adolescent emergency department patients. Pediatrics. 2011;128:86–91.
Goyal MK, Hayes KL, Mollen CJ. Racial disparities in testing for sexually transmitted infections in the emergency department. Acad Emerg Med. 2012;19:604–607.
Ahmad FA, Jeffe DB, Plax K, et al. Computerized self-interviews improve Chlamydia and gonorrhea testing among youth in the emergency department. Ann Emerg Med. 2014;64:376–384.
Reed JL, Dexheimer JW, Kachelmeyer AM, et al. Information technology–assisted screening for gonorrhea and Chlamydia in a pediatric emergency department. J Adolesc Health. 2020;67:186–193.
Pickett ML, Krentz C, Nimmer M, et al. Implementation of a tablet-based suicide screening tool in an emergency department. Am J Emerg Med. 2021;42:256–257.
Lion KC, Raphael JL. Partnering health disparities research with quality improvement science in pediatrics. Pediatrics. 2015;135:354–361.