CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
Confidentiality plays a pivotal role in healthcare delivery, ensuring the privacy and security of patient information. Healthcare providers are obligated to maintain the privacy of a patient's personal health information unless the patient provides consent for its release (Bord et al., 2018).
Confidentiality in medicine serves two primary purposes. Firstly, it respects the privacy of patients, ensuring that they do not feel embarrassed or vulnerable in their interactions with healthcare providers. Secondly, it fosters an environment conducive to open and honest communication between doctors and patients. However, maintaining confidentiality becomes challenging in modern, technology-driven healthcare, especially in the context of multidisciplinary care teams.
In general practice, various members of the primary healthcare team, including general practitioners, nurses, receptionists, and secretaries, have legitimate reasons to access patient medical records. Additionally, individuals such as employees of family health services authorities and researchers may also require access. Guidelines have been established to determine when confidentiality, both in terms of medical records and in a general sense, can be waived.
While some studies have specifically addressed patient access to medical records, few have delved into patients' broader expectations and attitudes regarding medical record confidentiality, beyond the issue of access. Instead of assuming what is in the best interest of patients, healthcare providers should be aware of the standards established by patients themselves to establish a shared understanding of what constitutes confidentiality. Patients' expectations of confidentiality may be heightened by the Patient's Charter, which asserts that "every citizen has the right to access their health records, and those working for the NHS [National Health Service] are legally bound to maintain the confidentiality of their contents."Top of FormBottom of Form
Undoubtedly, the most visible aspect of the healthcare system is the delivery of medical treatment (European Observatory on Health Systems and Policies, 2021). Present-day healthcare distribution centers around the patient, who navigates a complex network of doctors, medical equipment, and various system components (Dyro, 2004).
Healthcare provision is among the most personal services offered in society, requiring numerous personnel to access sensitive patient data. To receive proper, safe, and efficient care, patients must be comfortable sharing personal information. In return, healthcare professionals are obligated to safeguard and preserve the confidentiality of patient records (American College of Healthcare Executives, 2021).
The concept of preserving patient confidentiality and privacy dates back to ancient times, with physicians expected to uphold this principle as part of their professional duties. The Hippocratic Oath, an ancient Greek medical pledge, underscores the importance of confidentiality, stating: "What I may see or hear in the course of the treatment or even outside of the treatment with regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about" (Reich, 1995).
The importance of confidentiality and privacy in modern Western medicine remains undiminished, and medical oaths continue to emphasize the significance of confidentiality. For example, the Geneva Declaration of the World Medical Association states, “I will respect the secrets which are confided in me, even after the patient has passed away” (Moskop et al., 2005). In the United States, various state and federal statutes, as well as common law principles, outline physicians' responsibilities to protect patient confidentiality (Liang, 2000).
Nigeria also has laws safeguarding the confidentiality of medical data, requiring doctors to uphold the highest level of confidentiality regarding information they obtain while caring for a patient. The "Rule of Professional Conduct for Medical and Dental Practitioners, Code on Medical Ethics in Nigeria" (NMA Guideline) (1995), published by the Nigerian Medical and Dental Association (NMA), governs the behavior of doctors and dentists (Oragwu et al., 2020).
This code aims to uphold the confidentiality of medical records as they provide a historical account of a patient's diagnoses and treatments, which is essential when prescribing treatment. Even in cases involving life-threatening and contagious diseases such as the COVID-19 pandemic, specific rules place the responsibility on medical personnel to ensure patient privacy (Rules 8, 9, 24, and 44). Additionally, Section 26 of the National Health Act (2014) in Nigeria obligates medical professionals to maintain patient medical records' privacy.
The significance of confidentiality in healthcare cannot be overstated. Patients are more likely to share personal health information with healthcare professionals, which fosters trust and confidence in the healthcare system. By respecting patient privacy and building trust, healthcare providers can encourage patients to seek treatment and be open and truthful. Confidentiality is especially critical in situations where sensitive topics such as reproductive health, sexual health, and mental health are involved, preventing private information from being disclosed to family or employers without the patient's consent (Bord et al., 2018).
Confidentiality is highly valued by teenagers seeking medical attention, particularly when it concerns their reproductive health or substance abuse. They are less likely to seek care if they believe health services lack confidentiality (Weddle and Kokotailo, 2005).
The Institute of Medicine (2009) found that as the perceived negative consequences of a breach in confidentiality increase, people may be less inclined to disclose information essential for their mental health and substance abuse treatment. This underscores the importance of protecting health information confidentiality to ensure people access and benefit from high-quality care.
Maintaining the security of patient health information is critical because a breach in patient data security could have severe financial implications. Information leaks can result in job loss, loss of health insurance, or housing, as well as social and psychological harm. Disclosing a person's HIV or other sexually transmitted diseases, for example, may lead to social exclusion and other adverse effects. Security vulnerabilities may also expose individuals to the risk of identity theft (Pritts, 2008).
Regrettably, there has been limited research on the impact of patient health information confidentiality in the Nigerian healthcare system, as indicated by the lack of available information. Therefore, this study aims to assess the impact of patient health information confidentiality at Aminu Kano Teaching Hospital.
1.2 Statement of the Problem
According to Taiwo (2013), over the years, there ave been reported breaches in patients’ health records. Neglecting the safeguarding of patient medical information can erode the trust patients have in their primary healthcare providers, which is a particularly significant issue when it comes to data concerning conditions that are socially stigmatized, like sexually transmitted diseases (STDs), mental health disorders, substance abuse, and reproductive health. Consequently, patients might be hesitant to share sensitive details crucial for delivering top-quality healthcare. Furthermore, unauthorized access to patient data could lead to medical or financial identity theft, in addition to undermining patient independence.
1.3 Objectives of the Study
The main objective of the study is to assess the confidentiality of patients’ health records among health professionals. Specific objectives of the study are:
- To examine various measures put in place to protect patients’ records by health care professionals in UUTH.
- To examine the challenges of patients’ record confidential in UUTH.
- To proffer solutions to enhancing patients’ record confidentiality in UUTH.
1.4 Research Questions
To guide the study and achieve the objectives of the study, the following research questions were formulated:
- What are the measures put in place by health care professionals in protecting patients’ data in UUTH?
2. What are the challenges faced by health care professionals in managing confidentiality of patients’ records?
3. What are the solutions to managing better patients’ record confidentiality by health professionals in UUTH?
1.5 Research Hypothesis
The following research hypothesis was developed and tested for the study:
- Ho: Patients’ Record Confidentiality management in UUTH is poor.
- Hi: Patients’ Record Confidentiality management in UUTH is Good.
1.6 Significance of the Study
The study is important for many reasons. The following are the major stakeholders this paper through its practical and theoretical implications and findings will be of great significance:
Firstly, the paper will benefit major stakeholders and policy makers in the health sector. The various analysis, findings and discussions outlined in this paper will serve as a guide in enabling major positive changes in the industry and sub-sectors.
Secondly, the paper is also beneficial to the organizations used for the research. Since first hand data was gotten and analysed from the organization, they stand a chance to benefit directly from the findings of the study in respect to their various organizations. These findings will fast track growth and enable productivity in the organisations used as a case study.
Finally, the paper will serve as a guide to other researchers willing to research further into the subject matter. Through the conclusions, limitations and gaps identified in the subject matter, other student and independent researchers can have a well laid foundation to conduct further studies.
1.7 Scope of the Study
The study is delimited to University of Uyo Teaching Hospital in Uyo Local Government Area of Akwa Ibom State. Findings and recommendations from the study reflects the views and opinions of respondents sampled in the area. It may not reflect the entire picture in the population.
1.8 Limitations of the Study
The major limitations of the research study are time, financial constraints and delays from respondents. The researcher had difficulties combining lectures with field work. Financial constraints in form of getting adequate funds and sponsors to print questionnaires, hold Focus group discussions and logistics was recorded. Finally, respondents were a bit reluctant in filling questionnaires and submitting them on time. This delayed the project work a bit.
1.9 Organization of the Study
The study is made up of five (5) Chapters. Chapter one of the study gives a general introduction to the subject matter, background to the problem as well as a detailed problem statement of the research. This chapter also sets the objectives of the paper in motion detailing out the significance and scope of the paper.
Chapter Two of the paper entails the review of related literature with regards to corporate governance and integrated reporting. This chapter outlines the conceptual reviews, theoretical reviews and empirical reviews of the study.
Chapter Three centers on the methodologies applied in the study. A more detailed explanation of the research design, population of the study, sample size and technique, data collection method and analysis is discussed in this chapter.
Chapter Four highlights data analysis and interpretation giving the readers a thorough room for the discussion of the practical and theoretical implications of data analyzed in the study.
Chapter Five outlines the findings, conclusions and recommendations of the study. Based on objectives set out, the researcher concludes the paper by answering all research questions set out in the study.
1.10 Definition of Terms
- Assessment: The process of evaluating and analyzing the various aspects of patients' records confidentiality to ensure compliance with legal, ethical, and regulatory standards.
- Patients' Records: A comprehensive collection of documents and information that pertains to an individual's medical history, including diagnosis, treatment, and other healthcare-related data.
- Confidentiality: The ethical and legal duty to protect and maintain the privacy of patients' personal and medical information, preventing unauthorized access, use, or disclosure.
- Healthcare Professionals: Individuals who work in the healthcare industry, such as doctors, nurses, pharmacists, and allied healthcare workers, responsible for providing medical care and treatment to patients.
- Legal Standards: Rules and regulations set forth by relevant laws, such as the Health Insurance Portability and Accountability Act (HIPAA) in the United States, governing the protection and confidentiality of patient records.
- Ethical Standards: Moral principles and guidelines that healthcare professionals should follow, emphasizing the importance of respecting patients' privacy and maintaining the confidentiality of their records.
- Regulatory Standards: Rules and requirements established by healthcare organizations, government agencies, or professional bodies to ensure the appropriate handling of patients' records and data.
- Compliance: Adherence to the established legal, ethical, and regulatory standards concerning patient record confidentiality, including the implementation of policies and practices to safeguard this confidentiality.
- Unauthorized Access: Any attempt to view, use, or disclose patients' records by individuals who do not have legitimate and lawful reasons to access such information.
- Privacy Breach: The inadvertent or intentional release of patients' confidential information, in violation of legal and ethical standards, resulting in potential harm to the patient and legal consequences for the healthcare professional and organization.
