1 Stanford University School of Medicine 2 Santa Clara County Department of Public Health

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, Women’s 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 > 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) (SD=1.2) vs. 3.3 (SD=1.3) for providers with other degrees. (t statistic -4.3, p<0.001)

11. 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.

12. 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)

13. 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) • Women’s Health(OR 0.5, 95% CI 0.2-1.2)

14. 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.