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Enhancing Delivery of Confidential Care and STI Screening in Urban Health Centers

加强城市卫生中心的保密护理和性传播感染筛查

基本信息

批准号：
7577345
负责人：
MELISSA DIANE MCKEE
金额：
$ 25.53万
依托单位：
ALBERT EINSTEIN COLLEGE OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-03-01 至 2011-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7577345
关键词：
Address Adolescent Adoption Appointment Attention Awareness Caring Charge Chlamydia trachomatis Clinic Clinical Communities Confidentiality Counseling Data Development Disclosure Effectiveness of Interventions Ensure Environment Exposure to Failure Family Family dynamics Female Female Adolescents Focus Groups Fright Future Goals HIV Health Health Personnel Health Services Healthcare Improve Access Intervention Interview Legal Male Adolescents Manuals Minority Morbidity - disease rate Nature Neisseria gonorrhoeae Parents Phase Physician&apos s Role Physicians Pregnancy Pregnancy in Adolescence Preparation Preventive Primary Health Care Privacy Procedures Process Provider Randomized Controlled Trials Reporting Reproductive Health Research Rights Risk Risk Assessment Risk Behaviors Screening procedure Services Sex Behavior Sexual Development Sexual Health Sexuality Sexually Transmitted Diseases Site Surveys Testing Time Training Treatment Efficacy Urban Health Visit Work Youth abstracting base care seeking expectation experience health care service utilization improved intervention effect male meetings primary care setting primary outcome prospective sexually active therapy development willingness

项目摘要

DESCRIPTION (provided by applicant): Adolescents residing in impoverished urban environments are at considerable risk for pregnancy and sexually transmitted infections (STIs), including HIV, yet these health care needs are often not addressed. Delivery of recommended preventive services is inconsistent across practice settings, with sexual health services especially variable. Confidential health care is essential if adolescents' health care concerns are to be met. Despite the urgent need for confidential care, many youth report they have not spent time alone with health care providers, and few are aware of the right to confidential care. In preparation for a larger randomized controlled trial, our primary objective is to develop, implement and evaluate a practice-based pilot intervention to increase rates and timeliness of STI screening for sexually active urban adolescents by improved access to confidential services in urban primary care settings. In Phase I, we will gather formative data to complete development of the pilot intervention, through 1) meetings with a community advisory board to obtain input from the target community, 2) focus groups of adolescent boys and their parents (augmenting our previous qualitative work with adolescent girls and their parents), and 3) a prospective card study completed after visits with adolescents (male and female) followed by in-depth interviews of providers who treat adolescents in urban primary care. In Phase II, we will implement the intervention in urban practices, consisting of 3 components: 1) increasing adolescents' and parents' awareness of the need for and availability of confidential care; 2) training physicians to routinely and consistently provide confidential care and assess sexual health, while overcoming barriers associated with decisions to omit this service; and 3) implementing clinic level improvements in appointment, reception and billing procedures to create environments more conducive to confidential care. We will obtain preliminary estimates of the efficacy of the intervention to enhance exposure to confidential care, yield more thorough risk assessment (including adolescent disclosure of sexual activity to health care providers) and improve screening for STIs among sexually active youth. In addition, we will assess the feasibility of the intervention and barriers to adoption in different settings, as well as its acceptability to health care providers, staff, parents and adolescents. While our primary outcome is ultimately STI screening, we anticipate that increased exposure to confidential care will result in enhanced opportunities to address not only reproductive health but other sensitive health concerns of adolescents.Narrative Adolescents residing in impoverished urban environments are at considerable risk for pregnancy and sexually transmitted infections (STIs), including HIV, yet these health care needs are often not addressed. The overall goal of this project is to develop, implement and evaluate a practice-based intervention to improve urban adolescents' access to confidential care in urban primary care settings. We will obtain preliminary estimates of the effect of the intervention on adolescent risk assessment (including disclosure of sexual activity to health care providers) and screening for sexually transmitted infections among sexually active youth.

描述（由申请人提供）：生活在贫困城市环境中的青少年面临怀孕和性传播感染（sti）（包括艾滋病毒）的相当大的风险，但这些卫生保健需求往往没有得到解决。推荐的预防服务的提供在各个实践环境中是不一致的，性健康服务尤其多变。如果要满足青少年的保健关切，保密的保健是必不可少的。尽管迫切需要保密护理，但许多青年报告说，他们没有单独与卫生保健提供者相处过，而且很少有人知道保密护理的权利。为了准备更大规模的随机对照试验，我们的主要目标是制定、实施和评估一项基于实践的试点干预措施，通过改善城市初级保健机构的保密服务，提高性活跃的城市青少年性传播感染筛查的率和及时性。在第一阶段，我们将通过以下方式收集形成性数据，以完成试点干预措施的开发：1)与社区咨询委员会举行会议，以获取目标社区的意见；2)青少年男孩及其父母的焦点小组（扩大我们之前对青春期女孩及其父母的定性工作）；3)在访问青少年（男性和女性）后完成前瞻性卡片研究，随后对在城市初级保健中治疗青少年的提供者进行深入访谈。在第二阶段，我们将在城市实践中实施干预措施，包括三个组成部分：1)提高青少年和父母对保密护理需求和可获得性的认识；2)培训医生定期和一贯地提供保密护理和评估性健康，同时克服与决定不提供这项服务有关的障碍；3)在预约、接待和计费程序等方面提高诊所水平，创造更有利于保密护理的环境。我们将初步估计干预措施的效果，以提高获得保密护理的机会，进行更彻底的风险评估（包括青少年向卫生保健提供者披露性活动），并改进对性活跃青年的性传播感染筛查。此外，我们将评估干预措施的可行性和在不同环境中收养儿童的障碍，以及保健提供者、工作人员、家长和青少年对干预措施的接受程度。虽然我们的主要成果最终是性传播感染筛查，但我们预计，增加对保密护理的接触将增加机会，不仅解决生殖健康问题，而且解决青少年的其他敏感健康问题。生活在贫困城市环境中的青少年怀孕和感染包括艾滋病毒在内的性传播疾病的风险相当大，但这些保健需求往往得不到解决。该项目的总体目标是制定、实施和评估基于实践的干预措施，以改善城市青少年在城市初级保健机构获得保密护理的机会。我们将获得干预措施对青少年风险评估（包括向卫生保健提供者披露性活动）和性活跃青年中性传播感染筛查效果的初步估计。

项目成果

期刊论文数量（4）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Delivery of confidential care to adolescent males.

为青春期男性提供保密护理。

DOI：
10.3122/jabfm.2010.06.100072
发表时间：
2010
期刊：
Journal of the American Board of Family Medicine : JABFM
影响因子：
0
作者：
Rubin,SusanE;McKee,MDiane;Campos,Giselle;O'Sullivan,LuciaF
通讯作者：
O'Sullivan,LuciaF

Testing adolescents for sexually transmitted infections in urban primary care practices: results from a baseline study.

在城市初级保健实践中测试青少年的性传播感染：基线研究的结果。

DOI：
10.1177/2150131911401030
发表时间：
2011
期刊：
Journal of primary care & community health
影响因子：
3.6
作者：
Rubin,SusanE;Alderman,ElizabethM;Fletcher,Jason;Campos,Giselle;O'Sullivan,LuciaF;McKee,MDiane
通讯作者：
McKee,MDiane