Challenges of Providing Confidential Care to Adolescents in Urban Primary Care: Clinician Perspectives
- 1 January 2011
- journal article
- Published by Annals of Family Medicine in Annals of Family Medicine
- Vol. 9 (1), 37-43
- https://doi.org/10.1370/afm.1186
Abstract
Clinician time alone with an adolescent has a major impact on disclosure of risk behavior. This study sought to describe primary care clinicians' patterns of delivering time alone, decision making about introducing time alone to adolescents and their parents, and experiences delivering confidential services. We undertook qualitative interviews with 18 primary care clinicians in urban health centers staffed by specialists in pediatrics, family medicine, and adolescent medicine. The annual preventive care visit is the primary context for provision of time alone with adolescents; clinicians consider the parent-child dynamic and the nature of the chief complaint for including time alone during visits for other than preventive care. Time constraints are a major barrier to offering time alone more frequently. Clinicians perceive that parental discomfort with time alone is rare. Many clinicians wrestle with internal conflict about providing confidential services to adolescents with serious health threats and regard their role as facilitating adolescent-parent communication. Health systems factors can interfere with delivery of confidential services, such as inconsistent procedures for determining whether unaccompanied youth would be seen. Despite competing time demands, clinicians report commitment to offering time alone during preventive care visits and infrequently offer it at other times. Experienced clinicians can gain skills in the art of managing complex relationships between adolescents and their parents. Office systems should be developed that enhance the consistency of delivery of confidential services.Keywords
This publication has 24 references indexed in Scilit:
- SAFE TEENS: facilitators of and barriers to adolescent preventive care discussions.2008
- Forgone Health Care among U.S. Adolescents: Associations between Risk Characteristics and Confidentiality ConcernJournal of Adolescent Health, 2007
- Perspectives on Confidential Care for Adolescent GirlsAnnals of Family Medicine, 2006
- Predictors of Timely Initiation of Gynecologic Care among Urban Adolescent GirlsJournal of Adolescent Health, 2006
- Factors that influence adolescent reports of counseling by physicians on risky behaviorJournal of Adolescent Health, 2005
- Confidential Health Care for Adolescents: position paper for the society for adolescent medicine.2004
- Consultations with adolescents: the gap between their expectations and their experiencesActa Paediatrica, 2003
- Access to medical care for adolescents: results from the 1997 Commonwealth Fund Survey of the Health of Adolescent GirlsJournal of Adolescent Health, 1999
- Influence of physician confidentiality assurances on adolescents' willingness to disclose information and seek future health care. A randomized controlled trial.1997
- Don't ask, they won't tell: the quality of adolescent health screening in five practice settings.American Journal of Public Health, 1996