Adolescent Primary Care Visit Patterns

Abstract

PURPOSE Many clinical preventive care services are recommended for adolescents. Little is known about whether most adolescents have a suffi cient number of preventive care services visits over time to receive those services. We wanted to measure how frequently adolescents who are insured either through private insurance or government programs have preventive vs nonpreventive care visits. METHODSWe conducted a retrospective descriptive analysis based on claims data from a large health plan in Minnesota with about 700,000 members. All study patients were aged 11 to 18 years between January 1, 1998, and December 31, 2007. Our outcome measure was rates of preventive and nonpreventive care visits.RESULTS One-third of adolescents with 4 or more years of continuous enrollment had no preventive care visits from age 13 through 17 years, and another 40% had only a single such visit. Nonpreventive care visits were more frequent in all age-groups, averaging about 1 per year at age 11 years, climbing to about 1.5 per year at age 17 years. Differences in rates between government insurance and commercial insurance were small. In older adolescence, girls had more preventive care visits and more nonpreventive care visits than did boys.CONCLUSIONS Most adolescents come in infrequently for preventive care visits but more often for nonpreventive care visits. We recommend using the same approach in adolescence for preventive care that is being used in adults: the nomissed-opportunities paradigm. All visits by adolescents should be viewed as an opportunity to provide preventive care services, and systems should be set up to make that possible, even in busy practices with short encounters with a clinician.

In This Issue: Access, Vulnerability, and Science

“…The study by Nordin et al reinforces the observation that access and care continuity can be illusive, particularly for certain types of patients. 6 They use data from a large regional health system to describe the use of preventive services by adolescents and reinforce our perception that adolescents rarely use physician offi ces for preventive care during their teenage years. Our door may be open, but adolescents don't enter for a variety of reasons.…”

Achieving Quality Health Services for Adolescents

“…48,51 One analysis based on claims data from a 700 000-member health plan in Minnesota revealed that one-third of adolescents with 4 or more years of continuous enrollment had no preventive care visits from age 13 through 17 years, and another 40% had only a single preventive care visit. 52 National surveys with past-year preventive visit measures show significant variation across adolescents (43% to 81%) and young adults (26% to 58%). 53 Those with behavioral health diagnoses are especially lacking in access to care, as fewer than half of all adolescents with psychiatric disorders received care within the past year.…”

Adverse Childhood Experiences and Resilience: Addressing the Unique Needs of Adolescents

“…[27][28][29] Furthermore, those from disadvantaged backgrounds are at the highest risk of not having regular health maintenance visits or receiving needed mental health care. 27,[29][30][31] Many adolescents also tend to engage in health behaviors that place them at risk for the leading causes of morbidity and mortality. 32 As adolescents begin to gain greater independence and assume individual responsibility for daily health habits, develop new social relationships, and individuate from their parents, these changes bring new opportunities and challenges for improving health and preventing disease.…”