费城的青少年疫苗自我同意法规:提供者观点,实施障碍和对实践的影响
Marva M Schödel1, Gregory D Zimet2, Erika R Cheng3
1Department of Global Health, Indiana University, Richard M. Fairbanks School of Public Health, Indianapolis, Indiana.
概括
费城的青少年对免疫接种的自我同意法规被提供者所理解得很少,这阻碍了其使用. 提高意识,培训和系统调整对于青年人平等获取和更好地接种疫苗至关重要.
科学领域:
- 公共卫生 公共卫生
- 青少年健康 青少年健康
- 卫生政策 卫生政策
背景情况:
- 费城2007年青少年自我同意法规允许知情的青少年 (11-18岁) 授权免疫接种.
- 该法规的可见性和利用程度尚不清楚,尽管它有可能减少障碍和促进健康公平.
研究的目的:
- 探索医疗保健提供者对费城青少年自我同意法规的认识,实用性和实施挑战的观点.
- 确定青少年对免疫接种的自我同意有效实施的障碍和促进因素.
主要方法:
- 与13名位于费城的临床医生进行了半结构面试.
- 采访采用布劳恩和克拉克的六阶段方法进行主题分析,通过反射性备忘录和同行汇报来确保可信度.
主要成果:
- 供应商对法规的认识有限,讨论往往是假设性的.
- 在支持青少年自主权和保持父母信任之间出现了伦理紧张关系.
- 制度障碍 (EHR模板,诊所政策) 和沟通挑战 (缺乏培训) 阻碍了实施.
- 提供者认识到边缘化的年轻人的公平潜力,但注意到工作流的限制.
结论:
- 青少年自我同意法规由于意识低,道德问题和错误的系统而未得到充分承认和实施.
- 实施需要有针对性的传播,提供者培训,以及对电子健康记录和诊所工作流程的调整.
- 将自我同意权转化为公平获取和改善疫苗接种,需要系统支持和明确的公共卫生指导.
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