Lithuanian general practitioners' knowledge of confidentiality laws in adolescent sexual and reproductive healthcare: A cross-sectional study

Abstract

Background: In Lithuania, the legislation addressing confidentiality in adolescent healthcare is contradictory and vague. Previous studies have also revealed that medico-legal knowledge among physicians is poor, and attitudes play a correspondingly greater role than legal knowledge in ensuring the confidentiality of patients. Objective: To survey the knowledge of Lithuanian general practitioner (GPs) of legal issues surrounding confidentiality for minors in sexual and reproductive healthcare. Methods: A 41-item questionnaire was sent to a random sample of 607 GPs. Their legal knowledge was evaluated with respect to the provisions of the Lithuanian Law on the Rights of Patients and Compensation for Health Damage. The analysis included descriptive statistics and binary logistic regression to estimate odds ratios for the eight independent variables (age, gender, type, location, ownership, size, frequency of consultations, and existence of a written office policy). Results: The response rate was 73.5%. Of these respondents, 49.3% proved to be knowledgeable about legal standards protecting the confidentiality of adolescents in healthcare. Knowledgeability was found to be higher among GPs who had a written office policy that was based on the law. Respondents stated that the most important measure to improve confidentiality in adolescent healthcare would be the development of an explicit legal framework to address it. Conclusions: GPs' unfamiliarity with existing confidentiality regulations implies that there are ways to improve confidentiality in sexual and reproductive care beyond merely changing the law. This study suggests the need for a comprehensive strategy, including the development of professional guidelines and written office policies coupled with legal educational programmes directed at GPs.

Keywords

Adolescent health services confidentiality general practitioner Lithuania reproductive health

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References

Dickens B. , Cook R. Adolescents and consent to treatment. Int J Gynaecol Obstet 2005;89:179-84.

Sanci LA , Sawyer SM , Kang MS , Haller DM , Patton GC Confidential health care for adolescents: reconciling clinical evidence with family values. Med J Aust 2005;183:410-14.

Reddy DM , Fleming R. , Swain C. Effect of mandatory parental notification on adolescent girls' use of sexual health care services. JAMA 2002;288:710-14.

Franzini L. , Marks E. , Cromwell PF , Risser J. , McGill L. , Markham C. , et al. Projected economic costs due to health consequences of teenagers' loss of confidentiality in obtaining reproductive health care services in Texas. Arch Pediatr Adolesc Med 2004;158:1140-6.

Convention on the Rights of the Child. Adopted by United Nations General Assembly Resolution 44/25 of 20 November 1989, entered into force 2 September 1990. Available at: http://www.ohchr.org/english/law/crc.htm (accessed 22 May 2006 ).

Ellertson C. Mandatory parental involvement in minors' abortions: effects of the laws in Minnesota, Missouri, and Indiana. Am J Public Health 1997;87:1367-74.

Bradley D. HIPAA compliance efforts. Pediatr Emerg Care 2004;20:68-70.

Pacientų Teisių ir Žalos Atlyginimo Įstatymas [Law on the Rights of Patients and Compensation for Health Damage]. Lietuvos Respublikos Seimas [Parliament of Lithuanian Republic], Law No. I-1562, adopted 3 October 1996, revised 1 January 2005 (in Lithuanian).

Sveikatos Apsaugos Ministro Įsakymas: Del Nėštumo Nutraukimo Operacijos Atlikimo Tvarkos [Decree of Minister of Health: Regulation on the Performance of Abortions]. Lithuanian Ministry of Health, Decree No. 50, issued 28 January 1994 (in Lithuanian).

10.

Jaruseviciene L. , Levasseur G. , Liljestrand J. Confidentiality for adolescents seeking reproductive health care in Lithuania: the perceptions of general practitioners. Reprod Health Matters 2006;14:129-37.

11.

Darvall L. , McMahon M. , Piterman L. Medico-legal knowledge of general practitioners: disjunctions, errors and uncertainties. J Law Med 2001;9:167-84.

12.

Bartholomew TP , Carvalho T. General practitioners' competence and confidentiality determinations with a minor who requests the oral contraceptive pills. J Law Med 2005;13:191-203.

13.

Figueras J , McKee M , Cain J , Lessof S , editors. Health systems in transition: learning from experience. Copenhagen: WHO Regional Office for Europe; 2004. p 13-31.

14.

Pilietinių Iniciatyvų Centras [Center for Civic Initiatives]. Paciento teisė į privatumą: praktinės rekomendacijos [Patient's right to privacy: practical guidelines]. Vilnius: Kronta; 2005 (in Lithuanian).

15.

Balčiauskaite D. , Iždoniene J. , Baubinas H. Pirminės ambulatorinės asmens sveikatos priežiūros paslaugos ir ju apmokėjimas Lietuvoje 1998-2002 metais [Primary health care services and their reimbursement in Lithuania during the years 1998-2002]. Vilnius: Sveikatos Drauda [Health Insurance]; 2003. No. 4 (in Lithuanian).

16.

Jenkins P.

A parent's right to know?

Healthc Counsell Psychother J 2004;15:26-7.

17.

Family Planning and Sexual Health Association of Lithuania. Strong families and a strong country: why reproductive health care and sexuality education make sense in Lithuania. Vilnius: Family Planning and Sexual Health Association of Lithuania; 2005.

18.

Beh HG , Pietsch JH Legal implications surrounding adolescent health care decision-making in matters of sex, reproduction, and gender. Child Adolesc Psychiatr Clin North Am 2004;13:675-94.

19.

Birmontiene T. Changes in the Lithuanian health law and the influence of the Netherlands civil code. Eur J Health Law 2002;9:381-95.

20.

Barr DA , Schmid R. Medical education in the former Soviet Union. Acad Med 1996;7:141-5.

21.

Center for Reproductive Reproductive Rights. Implementing adolescent reproductive rights through the Convention on the Rights of the Child (briefing paper). New York: Center for Reproductive Reproductive Rights ; 1999.

22.

Petchey R. , Farnsworth W. , Heron T. The maintenance of confidentiality in primary care: a survey of policies and procedures. AIDS Care 2001;13:251-6.

23.

Akinbami LJ , Gandhi H. , Cheng TL Availability of adolescent health services and confidentiality in primary care practices. Pediatrics 2003;111:394-401.

24.

Feron JM , Cerexhe F. , Pestiaux D. , Roland M. , Giet D. , Montrieux C. , et al. GPs working in solo practice: obstacles and motivations for working in a group? A qualitative study. Fam Pract 2003;20:167-72.