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