Characteristics Associated with Confidential Consultation for Adolescents in Primary Care

Amy Lewis Gilbert, Allison L. McCord, Fangqian Ouyang, Dillon J. Etter, Rebekah Williams, James A. Hall, Wanzhu Tu, Stephen Downs, Matthew Aalsma

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objective: To examine how provider report of confidential consultation in the electronic health record is associated with adolescent characteristics, health risk factors, and provider training. Study design: This prospective cohort study was conducted as part of a larger study implementing computerized clinical decision support in 2 urban primary care clinics. Adolescents used tablets to complete screening questions for specified risk factors in the waiting room. Adolescent-reported risk factors included sexual activity, substance use, and depressive symptoms. Providers were prompted on encounter forms to address identified risk factors and indicate whether confidential consultation was provided. Provider types included adolescent medicine board certified pediatrics and general pediatrics. Differences in proportions of adolescents reporting risk factors by provider type were assessed using χ2 tests. Associations between adolescent characteristics, risk factors, and provider-reported confidential consultation were examined using logistic regression analyses. Results: The sample included 1233 English and Spanish-speaking adolescents 12-20 years of age (52% female; 60% black; 50% early adolescent). Patients seen by adolescent medicine board certified providers reported sexual activity, depressive symptoms, and substance use significantly more often than those seen by general pediatric providers. Among patients seen by board certified adolescent medicine providers, confidential consultation was provided to 90%. For those seen by general pediatric providers, confidential consultation was provided to 53%. Results of multiple logistic regression demonstrated that female sex, later adolescence, and clinic location were significantly associated with confidential consultation. Conclusions: Provider training is needed to reinforce the importance of confidential consultation for all adolescents.

Original languageEnglish (US)
JournalJournal of Pediatrics
DOIs
StateAccepted/In press - Jan 1 2018

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Primary Health Care
Referral and Consultation
Adolescent Medicine
Pediatrics
Sexual Behavior
Logistic Models
Clinical Decision Support Systems
Depression
Electronic Health Records
Tablets
Cohort Studies
Regression Analysis
Prospective Studies

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Characteristics Associated with Confidential Consultation for Adolescents in Primary Care. / Lewis Gilbert, Amy; McCord, Allison L.; Ouyang, Fangqian; Etter, Dillon J.; Williams, Rebekah; Hall, James A.; Tu, Wanzhu; Downs, Stephen; Aalsma, Matthew.

In: Journal of Pediatrics, 01.01.2018.

Research output: Contribution to journalArticle

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abstract = "Objective: To examine how provider report of confidential consultation in the electronic health record is associated with adolescent characteristics, health risk factors, and provider training. Study design: This prospective cohort study was conducted as part of a larger study implementing computerized clinical decision support in 2 urban primary care clinics. Adolescents used tablets to complete screening questions for specified risk factors in the waiting room. Adolescent-reported risk factors included sexual activity, substance use, and depressive symptoms. Providers were prompted on encounter forms to address identified risk factors and indicate whether confidential consultation was provided. Provider types included adolescent medicine board certified pediatrics and general pediatrics. Differences in proportions of adolescents reporting risk factors by provider type were assessed using χ2 tests. Associations between adolescent characteristics, risk factors, and provider-reported confidential consultation were examined using logistic regression analyses. Results: The sample included 1233 English and Spanish-speaking adolescents 12-20 years of age (52{\%} female; 60{\%} black; 50{\%} early adolescent). Patients seen by adolescent medicine board certified providers reported sexual activity, depressive symptoms, and substance use significantly more often than those seen by general pediatric providers. Among patients seen by board certified adolescent medicine providers, confidential consultation was provided to 90{\%}. For those seen by general pediatric providers, confidential consultation was provided to 53{\%}. Results of multiple logistic regression demonstrated that female sex, later adolescence, and clinic location were significantly associated with confidential consultation. Conclusions: Provider training is needed to reinforce the importance of confidential consultation for all adolescents.",
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AU - Hall, James A.

AU - Tu, Wanzhu

AU - Downs, Stephen

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