Adolescent Medicine, An Issue of Primary Care: Clinics in Office Practice (eBook)

William B. Shore (Autor)

eBook Download: PDF | EPUB

2014 | 1. Auflage
348 Seiten
Elsevier Health Sciences (Verlag)
978-0-323-32340-6 (ISBN)

Infos

This issue of Primary Care: Clinics in Office Practice, devoted to Adolescent Medicine, is edited by Drs. William B. Shore, Francesco Leanza, and Nicole Chaisson. Articles in this issue include: Health Care Maintenance for Adolescents; Adolescent Growth and Development; Puberty; Current Concepts of Psychosocial Development; Body Image and Health: Eating Disorders and Obesity; Working with Families with Adolescents; Care for Adolescents with Developmental Delay; Sports Medicine; Sports Injuries; Teens and Technology; Care of Incarcerated Youth; Mental Illness in Adolescence; Substance Use/Abuse; Current Approach to Contraception and Pregnancy; Oral/Hormonal Contraception; Sexually Transmitted Infections; Teen Sexuality and GLBT Youth; and Bullying and Violence Prevention.

Textauszug

Adolescent Health Care Maintenance in a Teen-Friendly Clinic

Nicole Chaisson, MD, MPHa and William B. Shore, MDb∗[e-mail],     aDepartment of Family and Community Medicine, University of Minnesota Medical Center, Family Medicine Residency, 2020 East 28th Street, Minneapolis, MN 55407, USA; bDepartment of Family and Community Medicine, University of California, San Francisco, 995 Potrero, Building 80, Ward 83, San Francisco, CA 94110, USA

∗Corresponding author.

Adolescence is marked by complex physical, cognitive, social, and emotional development, which can be stressful for families and adolescents. Before the onset of puberty, providers should clearly lay the groundwork for clinical care and office visits during the adolescent years. This article addresses the guidelines and current legal standards for confidentiality in adolescent care, the most frequently used psychosocial screening tools, and current recommendations for preventive health services and immunizations. Through the creation of teen-friendly clinics, primary care providers are well positioned to offer guidance and support to teens and their parents during this time of transition and growth.

Keywords

Confidentiality

Psychosocial screening tools

Screening and prevention

Health maintenance

Teen-friendly clinic

Immunizations

Key points

• Primary care providers should be knowledgeable of confidentiality laws in their state and communities.

• Confidentiality practice guidelines should be reviewed with parents and adolescents.

• Adolescent psychosocial screening tools are effective in identifying adolescent strengths and high-risk behaviors.

• Every clinical encounter with adolescents is an opportunity to address screening and prevention.

Caring for teens in the primary care setting

Although access to primary care services is important for improving the health of adolescents, several decades of research within the United States and across the globe have documented the barriers that adolescents and young adults experience when trying to access these services.1 Both the World Health Organization and the Institute of Medicine have developed frameworks for the development of youth-friendly services to call attention to the need for improved access to adolescent health services.2,3 Primary care has the capacity to provide high-quality screening, assessment, and care management for teens in a confidential and supportive environment. Creating that environment is fundamental.

Communication with Teens and Their Families

The role of families and caregivers is important in adolescent care. Families can be an asset through providing a thorough medical history, supporting teen development and independence, clarifying expectations and setting limits, and ensuring ongoing access to care. Although limited research has been performed on partnerships between parents of teens and health care professionals, recent qualitative data describe both direct and indirect strategies to strengthen parent/provider relationships to influence adolescent health outcomes.4 Direct strategies include efforts that create improved communication and partnership between the provider and the parent, and indirect strategies increase the provider’s influence on parent/teen communication within the context of clinic visits.4 This research is built on the concept of triadic relationships; a third person can often stabilize and improve the relationship between the other 2 people. These strategies could be particularly useful for family medicine clinics, where providers are seeing both adolescents and their parents as patients, creating an opportunity for growth of a strong triadic relationship.5

Before the onset of puberty, primary care providers should clearly lay the groundwork for health care visits during the adolescent years. Parents and their preteen children should be informed that issues discussed individually, with adolescents or parents, are confidential, and that adolescents may be examined without the parents present.6 It is important for providers to acknowledge that the adolescent is the patient; they should greet the adolescent first and then ask to be introduced to the family. Providers should take time to talk with both parents and teens to build trust, develop rapport, and support their relationship, but consider noting that it is “clinic policy” to talk with teens alone for some of the visit to allow for more open conversation. A qualitative study using focus groups with mother/son dyads showed that regular, routine inclusion of time alone during adolescent visits starting in early adolescence could lead to greater parental comfort with this process and increased disclosure by the adolescent.7

During the interview, providers should practice listening more than speaking; open-ended questions should be used to probe deeper, especially when asking about difficult subjects. If concerns arise, refrain from lecturing—teens do not need another parent—rather, practitioners should be open and honest and criticize the activity, not the adolescent.8,9 When performing the physical examination, providers should remember to wash their hands within the view of the adolescent; previous research noted that teens ranked providers washing hands as the most important item that affects their decision to seek health care.10 During the physical examination, providers should also respect their patients’ privacy and modesty by making sure they are appropriately gowned, discussing and explaining each part of the physical examination, and asking about any discomfort with the examination.

Systems/Structure

A clinic does not have to be a “teen clinic” to be teen-friendly; this goal can be accomplished in many ways. The Adolescent Health Working Group (www.ahwg.net) developed a Provider Toolkit Series that provides guidelines for teen-friendly services.11 First and foremost, providers and staff should enjoy working with adolescents. Structurally, it can be useful to create a space in the waiting area or another part of the clinic that includes posters, educational resources, and magazines geared toward teens. If financially possible, providing access to a computer space or guest wireless access may be appreciated by the more tech-savvy teens.

When registering for clinic services, adolescents and their family should be presented with brochures describing the clinic’s policies regarding minor consent and access to confidential care. Clinics that care for adolescents should also advocate within their sponsoring institutions to ensure confidentiality is maintained after the clinic visit is complete. A qualitative study of clinician perspectives on adolescent care in urban primary care clinics found that, although clinicians were committed to offering preventive care during adolescents visits, systems issues must be developed that enhance consistency of delivery of confidential services that meet the recommended guidelines.8 Failure to meet those guidelines may contribute to skepticism among adolescent patients and their parents. Explanation of benefits notifications, patient satisfaction surveys, billing statements, or other forms of communication about the adolescent visits are often inadvertently sent to parents.12 Protection from these lapses should be paramount in teen care.

Minor consent and confidentiality

When working with adolescents in clinic, it is important to understand the state laws regarding minor consent for treatment and access to confidential care. The laws related to adolescent consent and confidentiality vary by state. Most states have up to 10 different minor consent rules and an equal number of potentially different confidentiality laws.13,14 Because of this complexity and the potential changes in these laws because of shifting political climates, it is important for providers to stay up to date. National organizations exist that monitor minor consent and confidentiality laws. The Center for Adolescent Health & the Law (www.cahl.org)13 and the Guttmacher Institute (www.guttmacher.org)14 are organizations that regularly monitor state laws regarding minor consent and access to confidential services. Both organizations provide updated state-by-state information.

Generally, parental consent is required to provide medical care for patients younger than 18 years. However, many states allow for exceptions to parental consent. These exceptions may be defined by the status of the minor or the category of care that is needed. Teens living separately from their parents and managing their own financial affairs and those who are married and/or have borne a child are often considered emancipated minors and are given the legal status to consent for their own care.15 Some states also define mature minors as teens 15 years of age or older and allow them to assent to care and treatment for minor,...

Produkt-Details

• Erscheint lt. Verlag: 28.9.2014
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Gesundheitswesen
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Allgemeinmedizin
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Pädiatrie
• ISBN-10: 0-323-32340-5 / 0323323405
• ISBN-13: 978-0-323-32340-6 / 9780323323406