Heilbrunn Department of Population and Family Health,
Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York.
Pediatrics. 2019 Feb;143(2). doi: 10.1542/peds.2018-1403. Epub 2019 Jan 16.
To identify modifiable factors that facilitate discussion of potentially sensitive topics between health care providers and young people at preventive service visits after Patient Protection and Affordable Care Act implementation.
We used data from a national internet survey of adolescents and young adults (13-26 years old) in the United States. Questionnaire construction was guided by formative research and Fisher's Information-Motivation-Behavioral Skills model. Those who had seen a regular health care provider in the past 2 years were asked about 11 specific topics recommended by national medical guidelines. Four multivariable regression models were used to identify independent predictors of discussions of (1) tobacco use, (2) drug and/or alcohol use, (3) sexually transmitted infections or HIV, and (4) the number of topics discussed.
Fewer than half of young people reported having discussed 10 of 11 topics at their last visit. Predictors were similar across all 4 models. Factors independently associated with health discussions included the following: ever talked with a provider about confidentiality (4/4 models; adjusted odds ratio [aOR] = 1.85-2.00), ever had private time with a provider (1 model; aOR = 1.50), use of health checklist and/or screening questionnaire at last visit (4 models; aOR = 1.78-1.96), and time spent with provider during last visit (4 models). Number of years that young men had seen their regular provider was significant in 1 model. Other independent factors were positive youth attitudes about discussing specific topics (3/3 models) and youth involvement in specific health risk behaviors (3/3 models).
Discussions about potentially sensitive topics between health care providers and young people are associated with modifiable factors of health care delivery, particularly provider explanations of confidentiality, use of screening and/or trigger questionnaires, and amount of time spent with their provider.
在《患者保护与平价医疗法案》实施后，确定可促进医疗服务提供者与青少年在预防保健就诊期间讨论潜在敏感话题的可改变因素。
我们使用了来自美国全国青少年和年轻人（13-26 岁）互联网调查的数据。调查问卷的构建以形成性研究和费舍尔信息-动机-行为技能模型为指导。那些在过去 2 年内看过常规医疗服务提供者的人被问及 11 项国家医疗指南推荐的特定话题。使用四个多变量回归模型来确定讨论以下四个话题的独立预测因素：（1）吸烟；（2）药物和/或酒精使用；（3）性传播感染或艾滋病毒；以及（4）讨论的话题数量。
不到一半的年轻人报告在最近一次就诊中讨论了 11 个话题中的 10 个。在所有 4 个模型中，预测因素都是相似的。与健康讨论相关的独立因素包括以下内容：曾经与提供者讨论过保密性（4/4 个模型；调整后的优势比[aOR] = 1.85-2.00），曾经与提供者有过私人时间（1 个模型；aOR = 1.50），上次就诊时使用健康检查表和/或筛查问卷（4 个模型；aOR = 1.78-1.96），以及上次就诊时与提供者相处的时间（4 个模型）。在 1 个模型中，年轻男性看常规提供者的年数也是一个显著的独立因素。其他独立因素是青少年对讨论特定话题的积极态度（3/3 个模型）和青少年参与特定健康风险行为（3/3 个模型）。
医疗服务提供者与年轻人之间关于潜在敏感话题的讨论与医疗服务提供的可改变因素相关，特别是提供者对保密性的解释、使用筛查和/或触发问卷以及与提供者相处的时间。
