Challenges of providing confidential care to adolescents in urban primary care

Clinician perspectives

Melissa D. McKee, Susan E. Rubin, Giselle Campos, Lucia F. O'Sullivan

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

PURPOSE 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. METHODS We undertook qualitative interviews with 18 primary care clinicians in urban health centers staffed by specialists in pediatrics, family medicine, and adolescent medicine. RESULTS 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. CONCLUSION 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.

Original languageEnglish (US)
Pages (from-to)37-43
Number of pages7
JournalAnnals of Family Medicine
Volume9
Issue number1
DOIs
StatePublished - Jan 2011

Fingerprint

Primary Health Care
Preventive Medicine
Parents
Adolescent Medicine
Urban Health
Health
Disclosure
Risk-Taking
Decision Making
Communication
Medicine
Interviews
Pediatrics

Keywords

  • Adolescents
  • Confidentiality
  • Primary health care
  • Qualitative research

ASJC Scopus subject areas

  • Family Practice

Cite this

Challenges of providing confidential care to adolescents in urban primary care : Clinician perspectives. / McKee, Melissa D.; Rubin, Susan E.; Campos, Giselle; O'Sullivan, Lucia F.

In: Annals of Family Medicine, Vol. 9, No. 1, 01.2011, p. 37-43.

Research output: Contribution to journalArticle

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