Using Maintenance of Certification as a Tool to Improve the Delivery of Confidential Care for Adolescent Patients

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• 作者：Margaret Riley ; MD ; FAAFP¹ ; ^{marriley@med.umich.edu} ; Sana Ahmed ; MD² ; Jennifer C. Lane ; MA³ ; Barbara D. Reed ; MD ; MSPH¹ ; Amy Locke ; MD ; FAAFP¹
• 关键词：Confidentiality ; Adolescent health services ; Privacy ; Informed consent by minors ; Maintenance of certification ; Quality improvement
• 刊名：Journal of Pediatric and Adolescent Gynecology
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：30
• 期：1
• 页码：76-81
• 全文大小：365 K
• 卷排序：30

文摘

Providing adolescents with confidential health care results in better social and health outcomes. We sought to assess if a medical board Maintenance of Certification Part IV project could improve the delivery of confidential care to minor adolescent patients seen in outpatient primary care practices.DesignParticipating physicians reviewed 3 months of charts for patients ages 12-17 years seen for well visits during a baseline time period, and after 2 Plan, Do, Study, Act intervention cycles to assess if they had met confidentiality standards. Participating physicians additionally completed an assessment tool on personal and clinic practices related to confidentiality.SettingNine academic and 3 private practice family medicine, pediatrics, and medicine-pediatrics sites.ParticipantsForty-four physicians.InterventionsProvider and staff deficits in knowledge of minor consent laws, resistance toward the idea of confidential care, and work flow issues around confidential screening were identified as primary barriers. Staff and provider trainings, scripts, and staff involvement in planning work flows were identified as key interventions.Main Outcome MeasuresImprovement in confidentiality standards met during minor adolescent well visits.ResultsParticipating physicians significantly increased the proportion of well visits in which they spent time alone with the patient (P = .001), explained minor consent laws (P < .001), and had the adolescent complete a confidential risk screening tool (P < .001), in addition to improving scores on their confidentiality assessment overall (P < .001).ConclusionsA medical board Maintenance of Certification Part IV project is an effective way to change physician practice and improve the delivery of confidential care to minor adolescents seen for well visits.