1. Provider knowledge of California confidentiality laws: Associations with self-confidence and training Kapphahn C, MD, MPH 1, Rao S, MS, MPH 2, Jesser C, MPH 2, Ozer E, PhD 3, Botkin L A, MD 4, Luong NT, MPH 2, Reedy A, MPH 2, Olivas G, PhD 2 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.