CONTEXT:
The
confidentiality of family planning services remains a high priority to
adolescents, but barriers to implementing confidentiality and privacy practices
exist in settings designed for teenagers who are medically underserved,
including federally qualified health centers (FQHCs).
METHODS:
A sample
of 423 FQHCs surveyed in 2011 provided information on their use of five
selected privacy and confidentiality practices, which were examined separately
and combined into an index. Regression modeling was used to assess whether
various state policies and organizational characteristics were associated with
FQHCs' scores on the index. In-depth case studies of six FQHCs were conducted
to provide additional contextual information.
RESULTS:
Among
FQHCs reporting on confidentiality, most reported providing written or verbal
information regarding adolescents' rights to confidential care (81%) and
limiting access to family planning and medical records to protect adolescents'
confidentiality (84%). Far fewer reported maintaining separate medical records
for family planning (10%), using a security block on electronic medical records
to prevent disclosures (43%) or using separate contact information for
communications regarding family planning services (50%). Index scores were higher
among FQHCs that received Title X funding than among those that did not
(coefficient, 0.70) and among FQHCs with the largest patient volumes than among
those with the smallest caseloads (0.43). Case studies highlighted how a lack
of guidelines and providers' confusion over relevant laws present a challenge
in offering confidential care to adolescents.
CONCLUSIONS:
The
organizational practices used to ensure adolescent family planning
confidentiality in FQHCs are varied across organizations.
- 1Department of Health, Educational Administration and Movement Studies, Central Washington University, Ellensburg, WA. tbeeson@cwu.edu.
- 2Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, DC.
- Perspect Sex Reprod Health. 2016 Feb 17. doi: 10.1363/48e7216.
AIM:
This
manuscript presents mental health practitioners' (MHPs) practice, attitudes and
justifications for breaching confidentiality when imprisoned patients disclose
suicidal thoughts or abuse by others.
METHODS:
24 MHPs
working in Swiss prisons shared their experiences regarding confidentiality
practices. The data were analysed qualitatively and MHPs' attitudes and course
of action were identified.
RESULTS:
Analysis
revealed paternalistic breaches of confidentiality. When patients reported
suicidal thoughts and abuse, MHPs believed that forgoing confidentiality is
necessary to protect patients, providing several justifications for it.
Patients were informed that such information will be transmitted without their
consent to medical and non-medical prison personnel. With reference to suicidal
attempts, MHPs resorted to methods that may reduce suicidal attempts such as
transfer to hospital or internal changes in living arrangements, which would
require provision of certain information to prison guards. In cases of abuse,
some MHPs convinced patients to accept intervention or sometimes overrode
competent patients' refusals to report. Also in the case of abuse, provision of
limited information to other prison personnel was seen as an acceptable method
to protect patients from further harm.
DISCUSSION:
Breaches
of confidentiality, whether limited or full, remain unethical, when used for
competent patients based solely on paternalistic justifications.
Institutionalising ethical and legal procedures to address suicidal and abuse
situations would be helpful. Education and training to help both medical and
prison personnel to respond to such situations in an appropriate manner that
ensures confidentiality and protects patients from suicide and abuse are
necessary.
- 1Institute for Biomedical Ethics, University of Basel, Basel, Switzerland Center for Legal Medicine, University of Geneva, Geneva, Switzerland.
- 2Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.
- J Med Ethics. 2015 Jun;41(6):496-500. doi: 10.1136/medethics-2013-101981. Epub 2015 Jan 13.
