Confidentiality is a top priority for many teens accessing family planning services, but organizational practices to ensure patient privacy are implemented unevenly at federally qualified health centers (FQHCs), which serve as safety net health care providers for low-income and medically underserved populations, including youth. According to "Privacy and Confidentiality Practices in Adolescent Family Planning Care at Federally Qualified Health Centers," by Tishra Beeson, of Central Washington University, et al., barriers to implementing privacy practices at these health centers include a lack of clear guidelines or protocols for providing confidential services to teens and confusion among staff about state laws requiring minors’ consent.
The authors analyzed survey data collected in 2011 from 423 FQHCs to determine the prevalence of five organizational practices meant to ensure confidentiality for adolescent patients. They examined the data for relationships between use of confidentiality practices and organizational characteristics of the health centers (including size, location, state policy climate and receipt of Title X funding). Researchers also conducted in-depth interviews with staff at six FQHCs to provide additional context to the survey data.
Among the 329 health centers that provided all relevant data, 93% employed at least one of the confidentiality measures covered in the survey, and 59% used three or more. However, only 5% used all of the practices. The most commonly employed measures were providing information to patients regarding adolescents’ right to privacy (81% of respondents) and limiting access to family planning and medical records to the patient and other formally designated individuals (84%). The least common measure (10%) was maintaining separate medical records for family planning. FQHCs that had the largest patient volumes used more confidentiality practices than ones with the smallest caseloads, and Title X–funded centers employed more of these practices than centers that did not receive Title X support. Interviews with health center staff revealed that Title X–funded centers provided specific staff training on patient confidentiality and had built-in protocols to ensure privacy for teen patients.
Previous studies have shown that teens are particularly likely to delay or avoid discussing sensitive health topics or returning for follow-up care when they do not trust that their private information is protected. Beeson et al. note that the absence of established protocols to ensure patient confidentiality may compromise teens’ privacy, potentially leading young people to avoid seeking medical care. They recommend that the Health Resources and Services Administration (the agency that oversees the FQHC program) develop guidelines and standards to ensure patient confidentiality at all FQHCs. The authors suggest that further research might solicit information from patients as well as service providers. They also note that additional research is needed to assess the impact of the Affordable Care Act on teens’ ability to access confidential family planning services.
"Privacy and Confidentiality Practices in Adolescent Family Planning Care at Federally Qualified Health Centers," by Tishra Beeson, of Central Washington University, et al., is currently available online in Perspectives on Sexual and Reproductive Health.