RESUMEN
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.
Asunto(s)
Servicios de Salud del Adolescente/organización & administración , Medicina del Adolescente/métodos , Confidencialidad , Relaciones Médico-Paciente/ética , Atención Primaria de Salud/ética , Derivación y Consulta/ética , Encuestas y Cuestionarios , Adolescente , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Estudios Prospectivos , Factores de Riesgo , Adulto JovenRESUMEN
Since the 1950s, a significant amount of work has been done on behalf of the comprehensive health of young people in South America. This article focuses on the regional process of training health professionals to work with this age group. There are countries in which the growth of adolescent health training has been significant, others that have made progress but still have a narrower offer of teaching activities, and a few where only very basic and limited training is available. Latin American professional associations, scientific societies, and international organizations have also contributed to the education of the adolescent health work force. Although the training in the region has advanced in some countries to the point that there is specialization in adolescent medicine, much remains to be done. Certain regional conditions have contributed to the education of providers in adolescent care. The most important has been the existence of professionals who have been highly motivated to improve the health of young people. They have worked very hard and with great commitment to achieve this goal. There have also been important obstacles to educating professionals in adolescent care. Aside from the usual lack of funding, barriers have existed in the health care system and its providers, as well as the training entities and because of certain South American conditions. Finally, this article describes the regional adolescent medicine programs and the status of recognition of this specialty, and addresses the opportunities and challenges for adolescent health training.
Asunto(s)
Servicios de Salud del Adolescente , Medicina del Adolescente , Atención a la Salud/normas , Fuerza Laboral en Salud , Adolescente , Salud del Adolescente , Servicios de Salud del Adolescente/organización & administración , Servicios de Salud del Adolescente/normas , Medicina del Adolescente/educación , Medicina del Adolescente/métodos , Educación/organización & administración , Necesidades y Demandas de Servicios de Salud , Humanos , Mejoramiento de la Calidad , América del SurRESUMEN
This is a theoretical reflection, based on Michel Maffesoli's Comprehensive Sociology, which is concerned with the health care of adolescents in contemporary everyday life, and particularly with the phenomenon of urban tribes. These are understood as groups of people who have emotional ties, building a bond of sociality towards a common goal. This study focuses on the importance to take into account the lifestyle of adolescents and aims to raise awareness among health professionals about such issues, seeking for strategies tuned with reality and care needs in order to promote health, devising ways to improve caring, rethinking health policies for adolescents in contemporary society.
Asunto(s)
Conducta del Adolescente , Medicina del Adolescente/métodos , Grupos de Población , Posmodernismo , Psicología del Adolescente , Conducta Social , Actividades Cotidianas , Adolescente , Medicina del Adolescente/tendencias , Actitud Frente a la Salud , Brasil , Femenino , Objetivos , Procesos de Grupo , Política de Salud , Humanos , Relaciones Interpersonales , Masculino , Modelos Psicológicos , Apego a Objetos , Aceptación de la Atención de Salud , Población Urbana , ViolenciaRESUMEN
Trata-se de uma reflexão teórica, fundamentada na Sociologia Compreensiva de Michel Maffesoli. Tem como objetivo refletir sobre o cuidado com a saúde dos adolescentes no cotidiano contemporâneo, considerando um olhar sensível para o fenômeno das tribos urbanas. As tribos são compreendidas como estruturação de grupos de pessoas que se reúnem afetivamente, construindo um vínculo de socialidade com um objetivo comum. Esta reflexão enfoca a importância de se considerar a maneira de viver dos adolescentes e visa ampliar os horizontes dos profissionais da saúde, em busca de estratégias de atuação, sintonizadas com a realidade e as necessidades de cuidados para promover a saúde, delineando, assim, maneiras de cuidar afetivas e, portanto, mais efetivas, contribuindo para repensar as políticas de atenção à saúde dos adolescentes na contemporaneidade.
Se trata de una reflexión teórica, basada en la Sociología Comprensiva de Michel Maffesoli. Tuvo como objetivo reflexionar sobre el cuidado de la salud de los adolescentes en la vida cotidiana contemporánea, teniendo en cuenta un aspecto sensible en el fenómeno de las tribus urbanas. Estas son entendidas como la estructuración de grupos de personas que se reúnen afectivamente para la construcción de un vínculo de sociabilidad hacia una meta común. Esta reflexión, centrándose en la importancia de considerar el modo de vida de los adolescentes tiene como objetivo ampliar los horizontes de los profesionales de la salud en la búsqueda de estrategias de acción en sintonía con la realidad y necesidades de atención para promover la salud, delineando así formas de cuidar, contribuyendo a repensar las políticas de atención de la salud de los adolescentes en la sociedad contemporánea.
This is a theoretical reflection, based on Michel Maffesoli's Comprehensive Sociology, which is concerned with the health care of adolescents in contemporary everyday life, and particularly with the phenomenon of urban tribes. These are understood as groups of people who have emotional ties, building a bond of sociality towards a common goal. This study focuses on the importance to take into account the lifestyle of adolescents and aims to raise awareness among health professionals about such issues, seeking for strategies tuned with reality and care needs in order to promote health, devising ways to improve caring, rethinking health policies for adolescents in contemporary society.
Asunto(s)
Adolescente , Femenino , Humanos , Masculino , Conducta del Adolescente , Medicina del Adolescente/métodos , Psicología del Adolescente , Grupos de Población , Posmodernismo , Conducta Social , Actividades Cotidianas , Medicina del Adolescente/tendencias , Actitud Frente a la Salud , Brasil , Objetivos , Procesos de Grupo , Política de Salud , Relaciones Interpersonales , Modelos Psicológicos , Apego a Objetos , Aceptación de la Atención de Salud , Población Urbana , ViolenciaRESUMEN
We investigated the concordance between adolescents' perceived and impairment-related asthma control. Based on self-reported medication use, symptoms, and activity limitations, most overestimated their impairment-related control (73.8%). Providers should ask detailed, structured questions to get the most comprehensive picture of a patient's impairment-related control so they can ultimately improve disease outcomes.