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《初始生殖健康访视:ACOG 委员会意见,第 811 号》。

The Initial Reproductive Health Visit: ACOG Committee Opinion, Number 811.

出版信息

Obstet Gynecol. 2020 Oct;136(4):e70-e80. doi: 10.1097/AOG.0000000000004094.

Abstract

The primary goal of the initial reproductive health visit is to provide preventive health care services, educational information, and guidance, in addition to problem-focused care. The initial reproductive health visit should take place between the ages of 13 and 15 years. The scope of the initial visit will depend on the patient's concerns, medical history, physical and emotional development, and the level of care the patient is receiving from other health care professionals. All adolescents should have the opportunity to discuss health issues with a health care professional one-on-one, because they may feel uncomfortable talking about these issues in the presence of a parent or guardian, sibling, or intimate partner. Addressing confidentiality concerns is imperative because adolescents in need of health care services are more likely to forego care if there are concerns about confidentiality. Laws regarding confidentiality of care to minors vary by state, and health care professionals should be knowledgeable about current laws for their practice. Taking care to establish secure lines of communication can build trust with the patient and guardian, support continuity of care, ensure adherence to legal statutes, and decrease barriers to services. Obstetrician-gynecologists have the opportunity to serve as educators of parents and guardians about reproductive health issues. Preparing the office environment to include adolescent-friendly and age-appropriate reading materials, intake forms, and educational visual aids can make the general office space more inclusive and accessible. Resources should be provided for both the adolescent patient and the parent or guardian, if possible, at the conclusion of the visit. This Committee Opinion has been updated to include gender neutral terminology throughout the document, counseling topics with direct links to helpful resources, screening tools with direct links, addition of gender and sexuality discussion, and inclusion of trauma-informed care.

摘要

初始生殖健康访视的主要目标除了以问题为中心的护理外,还提供预防保健服务、教育信息和指导。初始生殖健康访视应在 13 至 15 岁之间进行。初始访视的范围将取决于患者的关注点、病史、身体和情感发育以及患者从其他医疗保健专业人员那里获得的护理水平。所有青少年都应该有机会与医疗保健专业人员一对一地讨论健康问题,因为他们可能在父母、监护人、兄弟姐妹或亲密伴侣在场的情况下感到不舒服谈论这些问题。解决保密性问题至关重要,因为需要医疗保健服务的青少年如果担心保密性,更有可能放弃护理。各州关于未成年人护理保密性的法律各不相同,医疗保健专业人员应该了解其执业所在州的现行法律。注意建立安全的沟通渠道可以建立与患者和监护人的信任,支持护理的连续性,确保遵守法律法规,并减少服务障碍。妇产科医生有机会担任父母和监护人关于生殖健康问题的教育者。准备一个包括青少年友好和适合年龄的阅读材料、入组表格和教育视觉辅助工具的办公环境,可以使一般办公空间更加包容和便于使用。如果可能,在访问结束时应为青少年患者和家长或监护人提供资源。本委员会意见已更新,在整个文件中使用性别中立术语,提供与有用资源直接链接的咨询主题、与直接链接的筛查工具、增加性别和性取向讨论以及纳入创伤知情护理。

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