Provider knowledge of California confidentiality laws: Associations with self-confidence and training

1
Provider knowledge of California confidentiality
laws Associations with self-confidence and
training

• Kapphahn C, MD, MPH1, Rao S, MS, MPH2, Jesser C,
  MPH2, Ozer E, PhD3, Botkin L A, MD4, Luong NT,
  MPH2, Reedy A, MPH2, Olivas G, PhD2

1 Stanford University School of Medicine 2 Santa
Clara County Department of Public Health 3
University of California, San Francisco 4 Santa
Clara Valley Medical Center
2
Acknowledgements

• Adolescent Pregnancy Prevention Network, Santa
  Clara County Department of Public Health for
  sponsoring research
• Dr. Claire Brindis for invaluable input with
  project design and analysis

3
Objectives

• To evaluate knowledge of California adolescent
  confidentially laws among primary health care
  providers in a metropolitan county in N
  California
• To assess associations between knowledge of laws
  and provider training self-confidence

4
Methods

• An 8-page, pilot-tested survey was sent to all
  primary health care practitioners in county,
  including
• 1,436 physicians in family medicine, general
  practice, internal medicine, pediatrics, and
  OB/GYN
• 378 nurse practitioners / nurse midwives
• 142 physician assistants
• 14 dual NP/PA degrees
• 2 repeat mailings of full survey sent to
  non-respondents

5
Methods

• Logistic regression was used to assess
  associations between knowledge of CA
  confidentiality laws and
• Professional degree (MD, NP, PA)
• Training (General Practice, Family Medicine,
  Internal Medicine, Pediatrics, OB/GYN, Midwifery,
  Womens Health)
• Sex of provider
• Year of medical school graduation
• Provider self-confidence in reproductive health
  skills

6
Response rate

• Response rate varied by degree
• 39 for MD
• 53 for PA
• 76 for NP
• 79 dual degree NP/PA

7
Results

• 307 respondents met eligibility criteria
• spent gt 10 hours a week doing direct patient care
  in county
• personally provided preventative care
  reproductive health services to adolescents
• answered 1 or both knowledge questions

8
Provider Confidence

• Confidence in skills related to adolescent
  reproductive health care was high (scale 1-5,
  not at all to very confident)
• Treatment skills, mean 4.4
• Counseling skills, 4.2
• Screening skills, 4.0

9
Confidence in Application of California Law

• Personal self-confidence in ability to Apply
  California laws regarding confidential care to
  clinical situations involving reproductive
  health was lowest of 4 skill areas
• mean 3.5 (3 somewhat confident, 4 moderately
  confident).

10
Nurse Practitioners Confidence in Applying Laws

• On post hoc t-test, NPs were found to have
  greater confidence in their ability to apply
  confidentiality laws, with an average score of
  4.0 (scale 1-5) (SD1.2) vs. 3.3 (SD1.3) for
  providers with other degrees. (t
  statistic -4.3, plt0.001)

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Knowledge of CA Laws

• 22 knew that there is no lower age limit for
  adolescents to obtain contraception in California
  without parental consent.
• 12 knew lower age limit (12 years) for treating
  sexually transmitted infections without parental
  consent.
• Only 2 providers correctly answered both
  knowledge questions.

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Associations with Knowledge of California Laws

• Factors positively associated with correctly
  answering one or both knowledge questions
• NP degree (OR 11.7, 95 CI 3.1-44.8)
• MD degree (OR 5.3, 95 CI 1.4-19.4)
• Female sex (OR 1.9, 95 CI 1.0-3.9)
• Higher confidence in ability to apply laws (OR
  1.7, 95 CI 1.3-2.1)

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Associations with Knowledge of California Laws

• Factors negatively associated with correctly
  answering one or both knowledge questions were
  training in
• Internal Medicine (OR 0.5, 95 CI 0.2-1.1)
• Womens Health (OR 0.5, 95 CI 0.2-1.2)

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Conclusion

• Providers are personally confident in ability to
  provide reproductive health care to adolescents,
  but limited in their knowledge of California
  laws.
• Knowledge of confidentiality laws was associated
  with provider degree, training, and sex.