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Current Pediatrics Reports

Published in:

01-09-2023

Confidential Telehealth Care for Adolescents: Challenges and Solutions Identified During the COVID-19 Pandemic

Author: Martha F. Perry

Published in: Current Pediatrics Reports | Issue 3/2023

Abstract

Purpose of review

To identify lessons learned about maintaining confidentiality for adolescent telehealth care during the COVID-19 pandemic.

Recent findings

Adolescents, parents, and providers recognize benefits of telehealth for confidential care while also identifying potential risks for confidentiality breach unique to the telehealth care setting.

Summary

Rapid implementation of telehealth care during COVID-19 presented an opportunity to test strategies that protect confidentiality for adolescents accessing care through telehealth. Policy, practice, and provider-level interventions are needed to ensure that adolescents can access confidential care through telehealth

Mehrotra A, Ray K, Brockmeyer DM, Barnett ML, Bender JA. Rapidly Converting to "Virtual Practices": Outpatient Care in the Era of COVID-19. In: NEJM Catalyst. 2020. https://catalyst.nejm.org/doi/abs/10.1056/CAT.20.0091. Accessed 10 Mar 2023.

Patel PD, et al. Rapid development of telehealth capabilities within pediatric patient portal infrastructure for COVID-19 care: barriers, solutions, results. J Am Med Inform Assoc. 2020;27(7):1116–20. https://doi.org/10.1093/jamia/ocaa065.CrossRefPubMedPubMedCentral

Omboni S, et al. The worldwide impact of telemedicine during COVID-19: current evidence and recommendations for the future. Connect Health. 2022;1:7–35. https://doi.org/10.20517/ch.2021.03.CrossRefPubMedPubMedCentral

Demeke HB, et al. Trends in use of Telehealth among health centers during the COVID-19 pandemic - United States June 26-November 6 2020. MMWR Morb Mortal Wkly Rep. 2021;70(7):240–4. https://doi.org/10.15585/mmwr.mm7007a3.CrossRefPubMedPubMedCentral

Villanti AC, Johnson AL, Ilakkuvan V, Jacobs MA, Graham AL, Rath JM. Social media use and access to digital technology in US young adults in 2016. J Med Internet Res. 2017;19(6):e196. https://doi.org/10.2196/jmir.7303.CrossRefPubMedPubMedCentral

Evans YN, Golub S, Sequeira GM, Eisenstein E, North S. Using telemedicine to reach adolescents during the COVID-19 pandemic. J Adolesc Health. 2020;67(4):469–71. https://doi.org/10.1016/j.jadohealth.2020.07.015.CrossRefPubMedPubMedCentral

North S. Telemedicine in the time of COVID and beyond. J Adolesc Health. 2020;67(2):145–6. https://doi.org/10.1016/j.jadohealth.2020.05.024.CrossRefPubMedPubMedCentral

• Barney A, Buckelew S, Mesheriakova V, Raymond-Flesch M. The COVID-19 pandemic and rapid implementation of adolescent and young adult telemedicine: challenges and opportunities for innovation. J Adolesc Health. 2020;67(2):164–71. https://doi.org/10.1016/j.jadohealth.2020.05.006. Barney et al were among the first to publish and share their experiences with rapid implementation of telehealth early on during the COVID-19 pandemic. They shared pitfalls and strategies that helped guide future research and implementation as practices worldwide initiated telehealth visits to preserve patient access during critical times throughout the pandemic.CrossRefPubMedPubMedCentral

• Wood SM, et al. Outcomes of a rapid adolescent Telehealth scale-up during the COVID-19 pandemic. J Adolesc Health. 2020;67(2):172–8. https://doi.org/10.1016/j.jadohealth.2020.05.025. Wood et al provide one of the first descriptive analyses of the experience with implementation of telehealthcare in an adolescent medicine specialty clinic. They provide data relating to show rates as well as demographics and diagnoses of patients seen using telehealth. They also provide a detailed table with specific examples of patient encounters sharing the challenges they faced, the problem-solving strategies used to address these challenges and the clinical outcome following these visits.CrossRefPubMedPubMedCentral

10.

• Carlson JL, Goldstein R. Using the electronic health record to conduct adolescent Telehealth visits in the time of COVID-19. J Adolesc Health. 2020;67(2):157–8. https://doi.org/10.1016/j.jadohealth.2020.05.022. This commentary by Carlson and Goldstein describes their experience with implementation of telehealth visits with a lens on the limitations and challenges the electronic health record systems present. They specificially discuss the confidential visit and some of the solutions to allow providers to be able to deliver confidential care.CrossRefPubMedPubMedCentral

11.

Totten AM, Womack DM, Eden KB, McDonagh MS, Griffin JC, Grusing S, Hersh WR. Telehealth: mapping the evidence for patient outcomes from systematic reviews. technical brief no. 26. (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. 290-2015-00009-I.) AHRQ Publication No.16-EHC034-EF. Rockville, MD: Agency for Healthcare Research and Quality; 2016. www.effectivehealthcare.ahrq.gov/reports/final.cfm.

12.

How to plan and conduct telehealth consultations with children and adolescents and their families. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO.

13.

Confidentiality in Adolescent Health Care: ACOG Committee Opinion, Number 803. Obstet Gynecol. 2020;135(4):e171–e177. https://doi.org/10.1097/AOG.0000000000003770.

14.

Ford CA, English A, Sigman G. Confidential health care for adolescents: position paper of the Society for Adolescent Medicine. J Adolesc Health. 2004;35(2):160–7. https://doi.org/10.1016/j.jadohealth.2004.03.002.CrossRefPubMed

15.

Coble YD, Estes EH, Head CA, et al. Confidential Health Services for Adolescents. JAMA. 1993;269(11):1420–4. https://doi.org/10.1001/jama.1993.03500110088042.CrossRef

16.

Marcell AV, Burstein GR, AAP Committee on Adolescence. Sexual and Reproductive Health Care Services in the Pediatric Setting. Pediatrics. 2017;140(5):e20172858.

17.

English A, Bass L, Dame BA, Eshragh F. State Minor Consent Laws: A Summary. 3rd ed. Chapel Hill, NC: Center for Adolescent Health and the Law; 2010.

18.

English A, Ford CA. The HIPAA privacy rule and adolescents: legal questions and clinical challenges. Perspect Sex Reprod Health. 2004;36(2):80. https://doi.org/10.1363/psrh.36.80.04.CrossRefPubMed

19.

Ford CA, Millstein SG, Halpern-Felsher BL, Irwin CEJ. Influence of physician confidentiality assurances on adolescents’ willingness to disclose information and seek future health care. A randomized controlled trial. JAMA. 1997;12:1029–34.CrossRef

20.

Fuentes L, Ingerick M, Jones R, Lindberg L. Adolescents’ and young adults’ reports of barriers to confidential health care and receipt of contraceptive services. J Adolesc Health. 2018;62(1):36–43. https://doi.org/10.1016/j.jadohealth.2017.10.011.CrossRefPubMed

21.

Grilo SA, et al. Confidentiality discussions and private time with a health-care provider for youth, United States, 2016. J Adolesc Health. 2019;64(3):311–8. https://doi.org/10.1016/j.jadohealth.2018.10.301.CrossRefPubMed

22.

Jones RK, Purcell A, Singh S, Finer LB. Adolescents’ reports of parental knowledge of adolescents’ use of sexual health services and their reactions to mandated parental notification for prescription contraception. JAMA. 2005;293(3):340–8. https://doi.org/10.1001/jama.293.3.340.CrossRefPubMed

23.

Gilbert AL, Rickert VI, Aalsma MC. Clinical conversations about health: the impact of confidentiality in preventive adolescent care. J Adolesc Health. 2014;55(5):672–7. https://doi.org/10.1016/j.jadohealth.2014.05.016.CrossRefPubMed

24.

Gray SH, Pasternak RH, Gooding HC, Woodward K, Hawkins K, Sawyer S, Anoshiravani A, Medicine, et al. Recommendations for electronic health record use for delivery of adolescent health care. J Adolesc Health. 2014;54(4):487–90. https://doi.org/10.1016/j.jadohealth.2014.01.011.CrossRefPubMed

25.

Bravender T, et al. Physicians’ assurances of confidentiality and time spent alone with adolescents during primary care visits. Clin Pediatr (Phila). 2014;53(11):1094–7. https://doi.org/10.1177/0009922813512022.CrossRefPubMed

26.

Committee on Adolescence; Council on Clinical and Information Technology; Blythe MJ, Del Beccaro MA. Standards for health information technology to ensure adolescent privacy. Pediatrics. 2012;130(5):987–90. https://doi.org/10.1542/peds.2012-2580.

27.

• Xie J, et al. Ensuring adolescent patient portal confidentiality in the age of the Cures Act Final Rule. J Adolesc Health. 2021;69(6):933–9. https://doi.org/10.1016/j.jadohealth.2021.09.009. Xie at al describe an elegant quality improvement initiative at their institution aimed at identifying patient portal access for adolescents that may be compromised due to parents or others having access to the patient portal. The study shows how pervasive inappropriate access to adolescent patient portals is and presents a model for addressing this problem at an institutional level.CrossRefPubMed

28.

Sharko M, Wilcox L, Hong MK, Ancker JS. Variability in adolescent portal privacy features: how the unique privacy needs of the adolescent patient create a complex decision-making process. J Am Med Inform Assoc. 2018;25(8):1008–17. https://doi.org/10.1093/jamia/ocy042.CrossRefPubMedPubMedCentral

29.

Bourgeois FC, DesRoches CM, Bell SK. Ethical challenges raised by OpenNotes for pediatric and adolescent patients. Pediatrics. 2018;141(6):20172745–12236.CrossRef

30.

Stablein T, Loud KJ, DiCapua C, Anthony DL. The catch to confidentiality: the use of electronic health records in adolescent health care. J Adolesc Health. 2018;62(5):577–82. https://doi.org/10.1016/j.jadohealth.2017.11.296.CrossRefPubMed

31.

Carlson J, Goldstein R, Hoover K, Tyson N. NASPAG/SAHM statement: the 21^st Century Cures Act and Adolescent Confidentiality. J Pediatr Adolesc Gynecol. 2021;34(1):3–5. https://doi.org/10.1016/j.jpag.2020.12.015.CrossRefPubMed

32.

• Davidson SK, Sanci L, de Nicolas Izquierdo C, Watson CJ, Baltag V, Sawyer SM. Best practice during teleconsultations with adolescents: a scoping review. J Adolesc Health. 2022;70(5):714–28. https://doi.org/10.1016/j.jadohealth.2021.11.012. This review examined exisiting literature describing and/or evaluating telehealth use with adolescents. The review describes all aspects of telehealth care, including some discussion of confidentiality and more importantly viable solutions for preserving this essential part of the adolescent visit when delivering care via telehealth.CrossRefPubMed

33.

Goldstein F, Glueck D. Developing rapport and therapeutic alliance during telemental health sessions with children and adolescents. J Child Adolesc Psychopharmacol. 2016;26(3):204–11. https://doi.org/10.1089/cap.2015.0022.CrossRefPubMed

34.

VonHoltz LAH, Frasso R, Golinkoff JM, Lozano AJ, Hanlon A, Dowshen N. Internet and social media access among youth experiencing homelessness: mixed-methods study. J Med Internet Res. 2018;20(5):e184. https://doi.org/10.2196/jmir.9306.CrossRefPubMedPubMedCentral

35.

American Academy of Pediatrics. Guidance on providing pediatric ambulatory services via telehealth during COVID-19. In: Critical Updates on COVID. 2020. https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections2/guidance-on-providing-pediatric-ambulatory-services-via-telehealth-during-covid-19/. Accessed 10 March 2023.

36.

Curfman A, et al. Telehealth: opportunities to improve access, quality, and cost in pediatric care. Pediatrics. 2022;149(3):e2021056035. https://doi.org/10.1542/peds.2021-056035.CrossRefPubMed

37.

• Wood SM, et al. Acceptability, feasibility, and quality of telehealth for adolescent health care delivery during the COVID-19 pandemic: cross-sectional study of patient and family experiences. JMIR Pediatr Parent. 2021;4(4):e32708. https://doi.org/10.2196/32708. Wood et al expand on their previous publication of telehealth implementation by evaluating the patient experience through a survey and interviews of adolescents and caregivers. This was the first study of this size specifically examining adolescent and caregiver acceptance of telehealth as well as challenges, such as technical difficulties or concerns about privacy. Adolescent and caregiver responses endorse telehealth as an acceptive care delivery option but also highlight limitations particularly adolescents' concerns about privacy. The authors offer some creative solutions to further optimize this care delivery model.CrossRefPubMedPubMedCentral

38.

Moorman LK. COVID-19 pandemic-related transition to telehealth in child and adolescent mental health. Fam Relat. 2022;71(1):7–17. https://doi.org/10.1111/fare.12588.CrossRefPubMed

39.

Hurtado ACM, Crowley SM, Landry KM, Landry MS. Telehealth contraceptive care in 2018: a quality improvement study of barriers to access and patient satisfaction. Contraception. 2022;112:81–5. https://doi.org/10.1016/j.contraception.2022.02.011.CrossRefPubMed

40.

Gessner M, Seeland G, Gonzalez DA, Dietrich JE. Telehealth Care in a Pediatric and Adolescent Gynecology Clinic During the COVID-19 Pandemic. J Pediatr Adolesc Gynecol. 2023;36(3):280–3. https://doi.org/10.1016/j.jpag.2022.12.003.CrossRefPubMed

41.

Hubach RD, O’Neil AM, Stowe M, Hamrick J, Giano Z, Currin JM. Preferred methods of HIV and sexually transmissible infection screening delivery among a rural sample of men who have sex with men. AIDS Patient Care STDS. 2020;34(11):470–6. https://doi.org/10.1089/apc.2020.0170.CrossRefPubMed

42.

Damian AJ, Stinchfield K, Kearney RT. Telehealth and beyond: promoting the mental well-being of children and adolescents during COVID. Front Pediatr. 2022;10(793167):2022. https://doi.org/10.3389/fped.2022.793167.CrossRef

43.

Carretier E, Bastide M, Lachal J, et al. Evaluation of the rapid implementation of telehealth during the COVID-19 pandemic: a qualitative study among adolescents and their parents. Eur Child Adolesc Psychiatry. 2023;32:963–73. https://doi.org/10.1007/s00787-022-02108-1.CrossRefPubMed

44.

• Allison BA, Rea S, Mikesell L, Perry MF. Adolescent and parent perceptions of telehealth visits: a mixed-methods study. J Adolesc Health. 2022;70(3):403–13. https://doi.org/10.1016/j.jadohealth.2021.09.028. This mixed methods study examines the adolescent and parent experience with telehealth using surveys and interviews. The authors specifically examine how the therapeutic alliance with the provider impacts satisfaction with the visit and perceived privacy and confidentiality during the visit. The findings suggest that the therapeutic alliance mediates perceived privacy and confidentiality indicating that telehealth implementation requires provider-patient relationship building in addition to more than logistical strategies to ensure adolesents experience the level of privacy and confidentiality they need.CrossRefPubMed

45.

Diaz MF, et al. Providing contraceptive health services to adolescents and young adults by telemedicine: a scoping review of patient and provider perspectives. J Pediatr Adolesc Gynecol. 2022;35(5):575–84. https://doi.org/10.1016/j.jpag.2022.05.003.CrossRefPubMed

46.

• Gilkey MB, Kong WY, Huang Q, Grabert BK, Thompson P, Brewer NT. Using telehealth to deliver primary care to adolescents during and after the COVID-19 pandemic: national survey study of US primary care professionals. J Med Internet Res. 2021;23(9):31240. https://doi.org/10.2196/31240. This national survey is the largest of its kind to describe primary care provider experiences with delivery of telehealthcare to adolescents during and after the pandemic. Findings indicate that providers see telehealthcare as a viable option even after the pandemic and suggest that offering it as an option to adolescents can improve access and reduce elements of stress to patients and families when attending visits in-person.CrossRef

47.

Goldstein RL, Anoshiravani A, Svetaz MV, Carlson JL. Providers’ perspectives on adolescent confidentiality and the electronic health record: a state of transition. J Adolesc Health. 2020;66(3):296–300. https://doi.org/10.1016/j.jadohealth.2019.09.020.CrossRefPubMed

48.

Kodjebacheva GD, Tang C, Groesbeck F, Walker L, Woodworth J, Schindler-Ruwisch J. Telehealth use in pediatric care during the COVID-19 pandemic: a qualitative study on the perspectives of caregivers. Children Basel. 2023;10(2):311. https://doi.org/10.3390/children10020311.CrossRefPubMedPubMedCentral

49.

American Academy of Pediatrics. Promoting telehealth campaign toolkit. In: Campaigns & Toolkits. 2023. https://www.aap.org/en/news-room/campaigns-and-toolkits/promoting-telehealth/. Accessed 10 Mar 2023.

Title: Confidential Telehealth Care for Adolescents: Challenges and Solutions Identified During the COVID-19 Pandemic
Author: Martha F. Perry
Publication date: 01-09-2023
Publisher: Springer US
Published in: Current Pediatrics Reports / Issue 3/2023
Electronic ISSN: 2167-4841
DOI: https://doi.org/10.1007/s40124-023-00288-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Confidential Telehealth Care for Adolescents: Challenges and Solutions Identified During the COVID-19 Pandemic

Abstract

Purpose of review

Recent findings

Summary

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose of review

Recent findings

Summary

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