Akinbami Lara J, Gandhi Hiren, Cheng Tina L
Infant and Child Health Studies Branch, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland 20782, USA.
Pediatrics. 2003 Feb;111(2):394-401. doi: 10.1542/peds.111.2.394.
Little is known about availability of services and confidential care for adolescents in primary care practices or how availability among pediatric practices compares to that among other primary care practices. The objective of this study was to assess self-reported availability of services for medically emancipated conditions and confidential care in primary care practices, to compare physician responses to those from office staff who answer appointment lines, and to compare availability in pediatric practices to other primary care practice types.
We conducted a telephone survey of randomly selected practices from the Washington, DC, metropolitan area in pediatrics (Peds), internal medicine (IM), and family medicine (FM). We asked staff who answer appointment lines about availability of services for medically emancipated conditions and confidential appointments for adolescents. Physicians received the same questions via a mail survey. Responses from office staff and physicians in the same practice were linked for comparison.
Of 434 practices contacted by telephone, 372 (86%) responded. Of the 615 physicians surveyed from these 372 practices, 264 (43%) from 170 practices responded to the mail survey. Peds practices were less likely than FM and IM practices to offer services for medically emancipated conditions and were less likely than FM practices to offer confidential services to adolescents. Office staff and physicians from FM and IM had higher agreement compared with Peds about availability of services for medically emancipated conditions. Agreement between office staff and physicians about provision of confidential appointments to adolescents was low among all practice types. However, having a written office policy on adolescent confidentiality was significantly associated with agreement between office staff and physicians about availability of confidential services.
Care for medically emancipated conditions and confidential services for adolescents are limited among primary care practices, especially among pediatric practices. All primary care practice types had significant disagreement between office staff and physicians about availability of confidential services to adolescents. Adolescents who call appointment lines are likely to receive inaccurate information about confidentiality policies. Establishing written office policies on adolescent confidentiality may help to improve access to confidential care for adolescents.
对于初级保健机构中青少年可获得的服务及保密护理情况，以及儿科机构与其他初级保健机构在这方面的情况对比，我们了解得很少。本研究的目的是评估初级保健机构中自我报告的针对医学上已获独立状况的服务及保密护理的可获得性，比较医生与接听预约电话的办公室工作人员的回答，并比较儿科机构与其他初级保健机构类型在这方面的可获得性。
我们对华盛顿特区大都市地区随机抽取的儿科（Peds）、内科（IM）和家庭医学（FM）机构进行了电话调查。我们询问接听预约电话的工作人员关于针对医学上已获独立状况的服务及青少年保密预约的可获得性。医生通过邮件调查收到相同的问题。同一机构的办公室工作人员和医生的回答进行关联以作比较。
在通过电话联系的434个机构中，372个（86%）做出了回应。在这372个机构调查的615名医生中，来自170个机构的264名（43%）回复了邮件调查。儿科机构比家庭医学和内科机构提供针对医学上已获独立状况服务的可能性更小，且比家庭医学机构为青少年提供保密服务的可能性更小。与儿科机构相比，家庭医学和内科机构的办公室工作人员和医生在针对医学上已获独立状况的服务可获得性方面的一致性更高。在所有机构类型中，办公室工作人员和医生在为青少年提供保密预约方面的一致性较低。然而，拥有关于青少年保密的书面办公室政策与办公室工作人员和医生在保密服务可获得性方面的一致性显著相关。
在初级保健机构中，针对医学上已获独立状况的护理和青少年保密服务有限，尤其是在儿科机构中。所有初级保健机构类型在办公室工作人员和医生关于为青少年提供保密服务的可获得性方面都存在显著分歧。拨打预约电话的青少年可能会收到关于保密政策的不准确信息。制定关于青少年保密的书面办公室政策可能有助于改善青少年获得保密护理的情况。
