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Research ArticleOriginal Research

Challenges of Providing Confidential Care to Adolescents in Urban Primary Care: Clinician Perspectives

M. Diane McKee, Susan E. Rubin, Giselle Campos and Lucia F. O’Sullivan
The Annals of Family Medicine January 2011, 9 (1) 37-43; DOI: https://doi.org/10.1370/afm.1186
M. Diane McKee
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Susan E. Rubin
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Giselle Campos
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Lucia F. O’Sullivan
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    Table 1.

    Clinician Demographics (N = 18)

    VariablesNo.%
    Sex
        Female1478
        Male422
    Type
        Family medicine950
        Pediatrics528
        Adolescent medicine422
    Race/ethnicity
        African American, black, or Caribbean528
        Asian or Pacific Islander317
        Hispanic/Latino211
        White844
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    Table 2.

    Visit Characteristics (N = 215)

    VariablesNo.%
    a Annual visit for preventive care services (check-up or physical examination).
    b Scheduled visit for follow-up of previously identified condition.
    c Appointment obtained by calling for same-day access.
    d In 144 cases a parent/guardian attended the visit with adolescent.
    e Physician indicated parent left room without being asked in an additional 3 cases.
    Type of visit
    Annual preventive care visita8843.3
        Follow-upb5527.1
        Same-dayc3617.7
        Walk-in2411.8
        Not classified by physician125.6
    Adolescent’s reasons for visit
        Acute visit5827.0
        Preventative care examination7133.0
        Reproductive health mentioned at all4320.0
        Routine care or chronic disease management3516.3
        Other83.7
    Parent/guardian attended visit with adolescent14467.0
    Confidentiality explained to adolescent during visitd12083.3
    Confidentiality explained to parent during visitd6041.7
    Parent asked to leave roomd,e9364.6
    Identified needs requiring confidential care follow-up8539.6

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  • The Article in Brief

    Challenges of Providing Confidential Care to Adolescents in Urban Primary Care: Clinician Perspectives

    M. Diane McKee , and colleagues

    Background Adolescents with privacy concerns are less likely to talk openly with a clinician about important health issues. Many youth, however, do not have time alone with clinicians during medical visits. This study explores clinicians� perspectives on delivering confidential services to adolescent patients.

    What This Study Found Interviews with 18 primary care clinicians in urban health centers elicited clinician perspectives on the challenges of providing confidential services to adolescents. Despite competing time demands, clinicians reported a commitment to offering time alone during preventive visits, and to infrequently offering time alone during other types of visits depending on the chief complaint and parent-child dynamics. Clinicians cited time constraints as a major barrier to offering time alone more frequently, and they perceived parents were receptive to time alone. Many clinicians noted feeling conflicted about providing confidential services to adolescents with serious health threats and regard their role as facilitating adolescent-parent communication to optimize health outcomes.

    Implications

    • The authors call for the development of office systems to enhance the consistency of the delivery of confidential services to adolescents.
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The Annals of Family Medicine: 9 (1)
The Annals of Family Medicine
Vol. 9, Issue 1
1 Jan 2011
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Challenges of Providing Confidential Care to Adolescents in Urban Primary Care: Clinician Perspectives
M. Diane McKee, Susan E. Rubin, Giselle Campos, Lucia F. O’Sullivan
The Annals of Family Medicine Jan 2011, 9 (1) 37-43; DOI: 10.1370/afm.1186

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Challenges of Providing Confidential Care to Adolescents in Urban Primary Care: Clinician Perspectives
M. Diane McKee, Susan E. Rubin, Giselle Campos, Lucia F. O’Sullivan
The Annals of Family Medicine Jan 2011, 9 (1) 37-43; DOI: 10.1370/afm.1186
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