Tracey A. Wilkinson|Ashley Meredith|Thomas L. Vielott|Jamie J. Stewart|Jasmine Kaur|Carolyn G. Meagher|Mary A. Ott
21. Assessment of Adolescent Decision-Making Capacity For Pharmacist Access To Hormonal Contraception
Indiana University|Purdue University System|Indiana University|Purdue University System|Indiana University|Indiana University|Indiana University
multiple states allow pharmacists prescribe combined hormonal contraception many cases pharmacy access restricted unavailable minors due part concerns minors decisionmaking capacity objective examine adolescents decisionmaking capacity contraception simulated pharmacist prescribing process part larger study minor access contraception pharmacy setting recruited 53 females ages 1421 primary care subspecialty clinics neurology rheumatology cardiology oversampled contraindications participants underwent simulated pharmacist prescribing process included completion selfscreener medical contraindications providing participant menu available options based upon screener method specific counseling simulation followed validated semistructured capacity assessment using macarthur competency assessment tool treatment maccatt tool assesses four components decisionmaking 1 understanding treatment 2 appreciation decision affect young person personally 3 logical reasoning balancing risksbenefits 4 making voluntary choice questions openended followup probes elucidate decisionmaking processes interviews scored 20 using predetermined scoring rubric higher score indicating greater level decisionmaking capacity predictors included demographics health literacy rapid assessment adult literacy medicine realm socioeconomic status family affluence scale ii sexual behavior presence chronic illness children special health care needs questionnaire quantitative data analyzed using correlation ttests anova multiple regression done sufficient variation outcome openended questions analyzed qualitatively using thematic analysis identify key concepts related decisionmaking capacity opinions regarding contraception pharmacy access 53 participants 58 primary care clinics 42 subspecialties 70 18 years age 38 african american 36 white 11 latina participants scored high maccatt little variation scores 188 19 correlation hypothesis variables examining differences age 18 showed differences subscores understanding 55 v 56 appreciation 39 vs 40 reasoning 77 vs 76 choice 16 vs 16 bivariate analysis neither age ethnicity clinic type insurance family affluence sexual activity chronic illness statistically significant total maccatt scores one variable found significantly associated medical literacy p0001 key themes included stigma around contraception use sexual activity found discussing heavy painful menstrual cycles strategy acceptable contraceptive useboth parents larger community participants found pharmacy access convenient discreet option however raise concerns pharmacists knowledge understanding chronic illness furthermore participants preferred clinical provider due already established relationship knowledge medical history minors demonstrated high levels decisionmaking capacity regarding contraception comparable young adults data support expansion pharmacy access hormonal contraception adolescents ages