146 Provision of Adolescent Confidential Care in a Tertiary Care Setting
Authors: Agostino Holly 
Published: October 2021

Abstract

Primary Subject area
Adolescent Medicine

Background
Adolescents are more likely to seek care and disclose sensitive health information if confidentiality is assured. Several national societies endorse the need for confidential care at all health-related encounters with adolescents. Many adolescents have infrequent contact with the medical system other than unscheduled urgent care in pediatric hospitals. Little is known regarding the effectiveness and feasibility of providing confidential care to adolescents in a tertiary pediatric hospital setting.

Objectives
We sought to evaluate the frequency, quality and factors associated with the provision of confidential care to adolescent patients at a pediatric teaching hospital.

Design/Methods
We undertook a cross-sectional survey of adolescents presenting to an urban tertiary pediatric hospital from December 2019 to December 2020. Adolescents eligible for confidential care under Quebec legislation (aged 14-18) were recruited from a convenience sample either when presenting to the Emergency Department (ED) for low acuity visits (CTAS 3-5) or when hospitalized on the pediatric inpatient medical ward. Participants completed a standardized, self-administered electronic questionnaire regarding the confidential care provided at their initial ED or inpatient medical encounter. Multivariable logistic regression was used to identify factors associated with the provision of confidential care.

Results
A total of 406 adolescents completed the survey (335 ED; 71 inpatient). The majority of respondents identified as female (233, 57.4%), white/Caucasian (260, 64.0%) and presented to the hospital with a parent (367, 90.4%). Overall, confidential care was offered to 137 (33.7%) respondents, with 95 (69.3%) accepting confidential time alone with their doctor. Among participants receiving confidential care, 43.2% endorsed that the limits of confidentiality were not reviewed, 24.2% reported that their private issues were still discussed in front of family members and 15.8% had private information that they had wished to discuss but were not asked. When offered, there was no difference between hospitalized and ED patients declining confidential care (32/100 vs. 10/37; p=0.73). The most common reasons identified for declining private time were that it was deemed unnecessary (29/42, 69.0%), perceived risk of parental conflict (8/42, 19.0%), or concerns for violation of trust by the medical team (5/42, 11.9%). Multivariable analysis found inpatient location (aOR 2.28, 1.04-5.01), female gender (aOR 2.02, 1.21-3.38), age (aOR 1.67, 1.03-2.69), psychiatric diagnosis (aOR 8.10, 1.47-44.6), resident involvement (aOR 1.96, 1.09-3.53) and overnight assessment (aOR 0.23, 0.06-0.90) were all associated with the provision of confidential care, after adjusting for patient- and hospital-level covariates.

Conclusion
Survey results suggest inadequate provision of confidential care in an academic pediatric hospital. Adolescents receiving confidential care were not consistently explained to regarding the limits of confidentiality, and breaches were reported in a quarter of all cases. Confidentiality-specific education initiatives are necessary to improve the frequency and quality of confidential care for adolescents in tertiary care settings.