NEW YORK (Reuters Health) – Adolescents and young adults in the U.S. need better access to confidential healthcare and contraceptive services, according to research from the Guttmacher Institute.
“This study shows that confidential care really matters. Even after accounting for other factors, we still found that young women who have ever had sex were much less likely to receive contraceptive services if they were afraid that doing so meant their parents might find out. If young women are not getting the family planning services they need because they are fearful that their confidentiality isn’t guaranteed, that’s a real problem,” lead author Dr. Liza Fuentes told Reuters Health by email.
“This is the first nationally representative survey specifically assessing the relationship between confidentiality concerns and lower rates of contraceptive services,” she said. “Other studies have shown that young people value confidential healthcare, so it’s not surprising that these concerns were associated with a lower likelihood of receiving contraceptive services; however, what’s surprising is that even for young adult women aged 18 to 25, confidentiality concerns may be a deterrent to obtaining contraceptive care.”
Dr. Fuentes and colleagues analyzed data from about 2,300 young people (ages 15-25) in the 2013 to 2015 National Survey of Family Growth. They focused on respondents’ confidential reproductive healthcare concerns and the time the young people spent alone with a provider at their most recent healthcare visit, with an additional focus on contraceptive services for young women.
The findings were reported online November 20 in the Journal of Adolescent Health.
Among 15- to 17-year-olds, concerns about confidential reproductive health were less common for those covered by Medicaid than those on their parents’ private insurance (adjusted risk ratio, 0.61) and for the teens whose mothers had only a high school education (ARR, 0.68). Concerns about confidentiality were more common among teens who didn’t live with either parent than those who lived with both parents (ARR, 2.0). These differences were not evident among 18- to 25-year-olds.
Having time alone with a healthcare provider was reported by significantly more black 15- to 17-year-olds than white teens in that age range (58% vs. 43%; ARR, 1.57). But time alone with a provider was less common among girls covered by Medicaid than those on their parents’ private insurance (ARR, 0.72).
For 15-to 17-year-old boys, having time alone with their provider was less common among those living with neither parent (ARR, 0.48) and those with mothers who did not graduate college (ARR, 0.59).
Sexually experienced girls ages 15 to 17 who were concerned about confidentiality were less likely to have received contraceptive care within the past year, compared to those without confidentiality concerns (22% vs. 67%). The same was true for sexually experienced 18- to 25-year-old women (47% vs. 75%).
“These findings can help improve patient care by informing clinicians, parents, and policymakers about the important role of confidentiality in ensuring that young people get the contraceptive care they need; (the results) also support policies that guarantee adolescents and young adults confidential sexual and reproductive health services so they can obtain the healthcare they need,” Dr. Fuentes noted.
“The findings of this research are unfortunate but not surprising,” Dr. Terrill Bravender of the University of Michigan in Ann Arbor, told Reuters Health by email. “I find that many adolescent patients remain reluctant to seek contraceptive or other reproductive health services due to concerns about confidentiality. These concerns seem to be well-founded, particularly since fewer than half the teens surveyed reported spending time alone with their healthcare provider.”
“This is despite consistent recommendations from many organizations (including the American Medical Association, the American Academy of Pediatrics, and the Society for Adolescent Health and Medicine) that physicians should conduct a portion of the adolescent well visit without a parent in the room starting when the patient is 11 or 12 years old,” added Dr. Bravender, who was not involved in the study.
“The paper also addresses an important but little addressed (and often hidden) risk to confidentiality: the issue of the health insurance company’s ‘explanation of benefits’ or EOB,” he pointed out.
Various state laws and federal policies provide guidance on what health information healthcare providers may or may not disclose, and their violation may lead to civil or criminal penalties, Dr. Bravender explained.
“However, no such requirements exist for health insurance companies, whose EOBs are considered part of the private contract between the individual and not regulated by HIPPA and other policies and legislation. The details provided by health insurance companies in the EOBs may vary tremendously but often include information regarding visit diagnoses and lab tests ordered,” he cautioned.
“While the EOBs may play a role in managing healthcare expenditures and helping families understand where their healthcare dollars are being spent, the confidentiality breaches caused by these statements appear to have a significant impact on adolescents’ willingness to access needed healthcare, and may have a detrimental effect on their reproductive health,” Dr. Bravender added.
SOURCE: http://bit.ly/2ANGWjm
J Adolesc Health 2017.
Tidak ada komentar:
Posting Komentar