51. “No Disrespect to Your Videos, Ma'am”: Teens' Impressions of Provider Training Videos
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health maintenance visit bears further exploration, regardless of the setting of the PPE. Sources of Support: None. 50. THE INFLUENCE OF PRIMARY CARE PROVIDER TYPE ON ADOLESCENT VISITS TO THE EMERGENCY DEPARTMENT Amy L. Weiss, MD, MPH 1 , Alexandra C. Rucker, MD 2 . 1 USF Health College of Medicine; 2 Children’s National Medical Center Purpose: Adolescents frequently rely on emergency departments (EDs) for medical care, rather than using primary care providers (PCPs). Previous studies have examined ED use by young children and adults, but no recent studies have looked specifically at adolescents’ use of the ED. Our objectives were to characterize a population of adolescents presenting to a large, urban children’s hospital ED and to examine if the type of PCP or primary clinic (academic, community, or private) they reported attending influenced their triage level or reason for presenting to the ED rather than to their PCP. Methods: Adolescents ages 12 to 21 and their parents/guardians were approached in either the ED waiting room or patient care rooms and invited to participate. Age-eligible patients were ex- cluded if they required immediate emergent care, were under 18 and not accompanied by a consenting adult, or could not complete the survey in either English or Spanish. We used a brief, online, 21-question survey to assess key characteristics of the PCP prac- tice and the adolescents’ relationship to the PCP as well as their main reason for presentation to the ED instead of to the PCP. Demographic data and triage information were collected from participants’ electronic medical records. PCPs were classified by study staff as academic, community, or private based on the pro- vider or clinic name supplied by each participant. Descriptive statistics were performed. Results: Of the 203 total participants from August 2010 to February 2011, 60% (n 121) were female and 80% (n 162) were Black/ African American, with a median age of 15 years (S.D. 2.37). Two- thirds (66%, n 134) had a form of public insurance (Medicaid, CHIPs, etc), and 40% (n 82) were triaged as non-urgent. Nearly all (93%, n 189) reported that they had a PCP or primary clinic, and most were able to state a provider or clinic name. Forty-six percent (n 94) had a private PCP, 23% (n 46) had an academic PCP, and 21% (n 42) had a community-based PCP. Those with an academic PCP were slightly more likely (p 0.051) to be triaged as urgent com- pared to those with a community PCP. There were no other signifi- cant differences in triage level among groups of participants by PCP type. When asked to choose their main reason for presenting to the ED instead of to the PCP, those with private PCPs most commonly reported PCP instructions to go to the ED (31%, n 29) compared to those with academic and community PCPs who most frequently presented to the ED due to perceived illness requiring immediate care (37%, n 17 and 40%, n 17 respectively). Conclusions: Nearly all adolescents in this study were able to identify a PCP or primary clinic during their ED visit, most fre- quently from a private office setting. However, those with private PCPs most commonly reported being sent to the ED by their PCPs. Further research is needed examining why private PCP offices divert adolescents to the ED—perhaps discomfort in caring for this age group, issues with time constraints in the outpatient setting, or inadequate reimbursement. Sources of Support: None. 51. “NO DISRESPECT TO YOUR VIDEOS, MA’AM”: TEENS’ IMPRESSIONS OF PROVIDER TRAINING VIDEOS Taylor Starr, DO, Constance D. Baldwin, PhD, Laura P. Shone, DrPH, MSW. University of Rochester School of Medicine and Dentistry Purpose: The art of providing health care to adolescents is grounded in effective communication, and feedback from adolescents them- selves can help providers improve their communication skills. Phy- sicians for Reproductive Choice and Health (PRCH) developed a series of videos to complement its evidence based didactic curriculum that is widely used to train providers. While the videos were developed with input from teens, formal evaluation of them by teens has not been reported. We conducted a study to elicit adolescents’ feedback about the Standardized Patient Videos. Methods: We identified a diverse sample of urban youth in peer education groups from two community organizations, and con- ducted three focus groups with English-speaking adolescents, 14 to 21 years old (n 38; 9-17 participants per group). During each focus group, our content expert facilitator showed four videos and used a semi-structured discussion guide to facilitate discussion following each of the clips. The participants were asked to address two overar- ching research questions: “What did the provider do well?” and “What might the provider have done better or differently?” The focus group responses were audio recorded, transcribed, and coded line- by-line to identify common words, phrases and ideas; these were consolidated into emergent themes across all focus groups. Results: Our results included a range of both expected and unex- pected themes. Some themes raised by the teens were intended teaching points in the videos. Teens’ comments on provider patient boundaries, for example, drew attention to the process of asking “too many personal questions” without explaining why, and conveying judgment, which the teens interpreted as the interviewer “acting like she’s her mama.” The teens also identified key issues in provider- patient communication such as avoidance of “big words,” being ap- proachable, maintaining confidentiality, and being responsive to the patient’s specific requests. The dominant unexpected theme, which was the subject of heated debate, focused on how the attire and race of the standardized patients might perpetuate stereotypes: “Oh yeah, with them shorts on. She’s lookin’ like a little hoochie mama.” “All I’m saying is that’s how people have stereotypes. . .it makes black women look bad.” The adolescents also recognized how challenging it can be to avoid stereotypes altogether: “What race do ya’ll want them to be anyway? It’s like, there’s going to be stereotypes for every people.” Conclusions: The teens’ responses to standardized patient videos generally affirmed that their content was appropriate for this popu- lation, and raised issues that were important to them. A strength of the videos is that many of the themes that the teens identified correspond with the main teaching points highlighted in the PRCH facilitation guide. Our most striking finding was that teens are very conscious of stereotypes, and are concerned that training videos may perpetuate them. Our results demonstrated that when we design images in teaching materials to train providers who care for adoles- cents, careful consideration of ethnic diversity, appropriate dress, and other factors that may convey stereotypical judgments is impor- tant. Sources of Support: HRSA/MCHB LEAH training grant #T71MC00012 Division of Adolescent Medicine, Department of Pediatrics, Golisano Children’s Hospital at Strong Memorial Hospital. S45 Poster Abstracts / 52 (2013) S21–S113
Transcript of 51. “No Disrespect to Your Videos, Ma'am”: Teens' Impressions of Provider Training Videos
health maintenance visit bears further exploration, regardless of thesetting of the PPE.Sources of Support: None.
50.
THE INFLUENCE OF PRIMARY CARE PROVIDER TYPE ONADOLESCENT VISITS TO THE EMERGENCY DEPARTMENTAmy L. Weiss, MD, MPH1, Alexandra C. Rucker, MD2.1USF Health College of Medicine; 2Children’s National Medical Center
Purpose: Adolescents frequently rely on emergency departments(EDs) for medical care, rather than using primary care providers(PCPs). Previous studies have examinedEDuse by young children andadults, but no recent studies have looked specifically at adolescents’use of the ED. Our objectives were to characterize a population ofadolescents presenting to a large, urban children’s hospital ED and toexamine if the type of PCP or primary clinic (academic, community,or private) they reported attending influenced their triage level orreason for presenting to the ED rather than to their PCP.Methods: Adolescents ages 12 to 21 and their parents/guardianswere approached in either the ED waiting room or patient carerooms and invited to participate. Age-eligible patients were ex-cluded if they required immediate emergent care, were under 18and not accompanied by a consenting adult, or could not completethe survey in either English or Spanish. We used a brief, online,21-question survey to assess key characteristics of the PCP prac-tice and the adolescents’ relationship to the PCP as well as theirmain reason for presentation to the ED instead of to the PCP.Demographic data and triage information were collected fromparticipants’ electronic medical records. PCPs were classified bystudy staff as academic, community, or private based on the pro-vider or clinic name supplied by each participant. Descriptivestatistics were performed.Results: Of the 203 total participants from August 2010 to February2011, 60% (n � 121) were female and 80% (n � 162) were Black/African American, with a median age of 15 years (S.D. 2.37). Two-thirds (66%, n�134) had a formof public insurance (Medicaid, CHIPs,etc), and 40% (n � 82) were triaged as non-urgent. Nearly all (93%,n � 189) reported that they had a PCP or primary clinic, and mostwere able to state a provider or clinic name. Forty-six percent (n �
94) had a private PCP, 23% (n � 46) had an academic PCP, and 21%(n � 42) had a community-based PCP. Those with an academic PCPwere slightly more likely (p � 0.051) to be triaged as urgent com-pared to those with a community PCP. There were no other signifi-cant differences in triage level among groups of participants by PCPtype. When asked to choose their main reason for presenting to theED instead of to the PCP, those with private PCPs most commonlyreported PCP instructions to go to the ED (31%, n � 29) compared tothose with academic and community PCPs who most frequentlypresented to the ED due to perceived illness requiring immediatecare (37%, n � 17 and 40%, n � 17 respectively).Conclusions: Nearly all adolescents in this study were able toidentify a PCP or primary clinic during their ED visit, most fre-quently from a private office setting. However, those with privatePCPs most commonly reported being sent to the ED by their PCPs.Further research is needed examining why private PCP officesdivert adolescents to the ED—perhaps discomfort in caring for thisage group, issues with time constraints in the outpatient setting,or inadequate reimbursement.Sources of Support: None.
51.
“NO DISRESPECT TO YOUR VIDEOS, MA’AM”: TEENS’IMPRESSIONS OF PROVIDER TRAINING VIDEOSTaylor Starr, DO, Constance D. Baldwin, PhD, Laura P. Shone, DrPH,MSW.
University of Rochester School of Medicine and Dentistry
Purpose: The art of providing health care to adolescents is groundedin effective communication, and feedback from adolescents them-selves can help providers improve their communication skills. Phy-sicians for Reproductive Choice andHealth (PRCH) developed a seriesof videos to complement its evidence based didactic curriculum thatis widely used to train providers. While the videos were developedwith input from teens, formal evaluation of them by teens has notbeen reported. We conducted a study to elicit adolescents’ feedbackabout the Standardized Patient Videos.Methods: We identified a diverse sample of urban youth in peereducation groups from two community organizations, and con-ducted three focus groups with English-speaking adolescents, 14 to21 years old (n � 38; 9-17 participants per group). During each focusgroup, our content expert facilitator showed four videos and used asemi-structured discussion guide to facilitate discussion followingeach of the clips. The participants were asked to address two overar-ching research questions: “What did the provider do well?” and“Whatmight the provider have done better or differently?” The focusgroup responses were audio recorded, transcribed, and coded line-by-line to identify common words, phrases and ideas; these wereconsolidated into emergent themes across all focus groups.Results: Our results included a range of both expected and unex-pected themes. Some themes raised by the teens were intendedteaching points in the videos. Teens’ comments on provider patientboundaries, for example, drew attention to the process of asking “toomany personal questions” without explaining why, and conveyingjudgment, which the teens interpreted as the interviewer “acting likeshe’s her mama.” The teens also identified key issues in provider-patient communication such as avoidance of “big words,” being ap-proachable, maintaining confidentiality, and being responsive to thepatient’s specific requests. The dominant unexpected theme, whichwas the subject of heated debate, focused on how the attire and raceof the standardized patientsmight perpetuate stereotypes: “Oh yeah,with them shorts on. She’s lookin’ like a little hoochiemama.” “All I’msaying is that’s howpeople have stereotypes. . .itmakes blackwomenlook bad.” The adolescents also recognized how challenging it can beto avoid stereotypes altogether: “What race do ya’ll want them to beanyway? It’s like, there’s going to be stereotypes for every people.”Conclusions: The teens’ responses to standardized patient videosgenerally affirmed that their content was appropriate for this popu-lation, and raised issues that were important to them. A strength ofthe videos is that many of the themes that the teens identifiedcorrespond with the main teaching points highlighted in the PRCHfacilitation guide. Our most striking finding was that teens are veryconscious of stereotypes, and are concerned that training videosmayperpetuate them. Our results demonstrated that when we designimages in teaching materials to train providers who care for adoles-cents, careful consideration of ethnic diversity, appropriate dress,and other factors that may convey stereotypical judgments is impor-tant.Sources of Support: HRSA/MCHB LEAH training grant #T71MC00012Division of Adolescent Medicine, Department of Pediatrics, GolisanoChildren’s Hospital at Strong Memorial Hospital.
S45Poster Abstracts / 52 (2013) S21–S113
