Assessing Health System Provision of Adolescent Preventive Services: The Young Adult Health Care Survey

Bethell, Christina; Klein, Jonathan D.; Peck, Colleen

doi:10.1097/00005650-200105000-00008

Cited by 83 publications

(80 citation statements)

References 39 publications

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“…Physicians and health care staff only reported providing counseling/education during 39% of "general medical/physical examination" adolescent visits. 45 The counseling/ education rates for exercise (22%) and STI/HIV screening (5%) were ϳ2 and 7 times lower, respectively, than rates reported in the Bethell et al 43 survey of adolescents enrolled in managed care, which suggests that discussions perceived to be counseling/education by adolescents may not be coded as counseling/education CPSs by providers.…”

Section: Adolescent Health Care Visits and Cps Deliverymentioning

confidence: 81%

“…Despite the observation that adolescents are more likely to receive CPSs during preventive care visits, rather than acute-care visits, national and state-based surveys of adolescents and providers have shown that adolescents frequently do not receive recommended CPSs during either type of visit. 35,39,43,44 Of the students who reported a preventive visit within the past year in the national 1999 Youth Behavioral Risk Surveillance survey, only 43% of girls and 26% of boys reported discussing STIs, HIV, or pregnancy prevention during that visit. 39 Consistent with the Youth Behavioral Risk Surveillance survey data, in a survey of adolescents enrolled in managed care in 3 states, Bethell et al 43 noted that the average proportion of those who reported screening and counseling during well and acute-care visits was 50% for weight, diet, and exercise, 36% for sexual activity and STIs, and 18% for other risky behaviors (eg, smoking and alcohol use).…”

Section: Adolescent Health Care Visits and Cps Deliverymentioning

confidence: 99%

“…35,39,43,44 Of the students who reported a preventive visit within the past year in the national 1999 Youth Behavioral Risk Surveillance survey, only 43% of girls and 26% of boys reported discussing STIs, HIV, or pregnancy prevention during that visit. 39 Consistent with the Youth Behavioral Risk Surveillance survey data, in a survey of adolescents enrolled in managed care in 3 states, Bethell et al 43 noted that the average proportion of those who reported screening and counseling during well and acute-care visits was 50% for weight, diet, and exercise, 36% for sexual activity and STIs, and 18% for other risky behaviors (eg, smoking and alcohol use). Screening and counseling rates were higher among adolescents who reported having had private time with the physician or who were engaging in risky behaviors, compared with those who did not meet privately or engage in risky behaviors.…”

Section: Adolescent Health Care Visits and Cps Deliverymentioning

confidence: 99%

“…During health care visits, other barriers include adolescent anxiety and concerns about confi-dentiality, lack of private time with providers, and concern about reporting risky behavior to providers. 43,49,50 …”

Section: Barriers To Delivery Of Cpss During Adolescent Health Care Vmentioning

confidence: 99%

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Adolescent Immunizations and Other Clinical Preventive Services: A Needle and a Hook?

et al. 2008

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Advances in technology have led to development of new vaccines for adolescents, but these vaccines will be added to a crowded schedule of recommended adolescent clinical preventive services. We reviewed adolescent clinical preventive health care guidelines and patterns of adolescent clinical preventive service delivery and assessed how new adolescent vaccines might affect health care visits and the delivery of other clinical preventive services. Our analysis suggests that new adolescent immunization recommendations are likely to improve adolescent health, both as a "needle" and a "hook." As a needle, the immunization will enhance an adolescent's health by preventing vaccine-preventable diseases during adolescence and adulthood. It also will likely be a hook to bring adolescents (and their parents) into the clinic for adolescent health care visits, during which other clinical preventive services can be provided. We also speculate that new adolescent immunization recommendations might increase the proportion and quality of other clinical preventive services delivered during health care visits. The factor most likely to diminish the positive influence of immunizations on delivery of other clinical preventive services is the additional visit time required for vaccine counseling and administration. Immunizations may "crowd out" delivery of other clinical preventive services during visits or reduce the quality of the clinical preventive service delivery. Complementary strategies to mitigate these effects might include prioritizing clinical preventive services with a strong evidence base for effectiveness, spreading clinical preventive services out over several visits, and withholding selected clinical preventive services during a visit if the prevention activity is effectively covered at the community level. Studies are needed to evaluate the effect of new immunizations on adolescent preventive health care visits, delivery of clinical preventive services, and health outcomes. Pediatricians have a unique opportunity to influence adolescents and their families by helping young people build a strong foundation of good health that will continue into their adult lives.American Academy of Pediatrics (AAP) 1 D ELIVERING PREVENTIVE services to US adolescents* is a public health priority. 2,3 Although most US adolescents are healthy, millions of adolescents initiate behaviors and lifestyles that can adversely affect their immediate and long-term health. 4 Potentially modifiable adolescent behaviors include failure to use seat belts, unsafe operation of motor vehicles, carrying weapons, using alcohol and other drugs, unprotected sex, inactivity, and overeating. These behaviors are directly linked to injuries and death, as well as to sexually transmitted infections (STIs), unintended *The definition of "adolescent" differs across studies and organizations; in this report, an adolescent is a person aged 11 to 18 years, unless otherwise specified.www.pediatrics.org/cgi

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Section: Adolescent Health Care Visits and Cps Deliverymentioning

confidence: 81%

Section: Adolescent Health Care Visits and Cps Deliverymentioning

confidence: 99%

Section: Adolescent Health Care Visits and Cps Deliverymentioning

confidence: 99%

Section: Barriers To Delivery Of Cpss During Adolescent Health Care Vmentioning

confidence: 99%

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Adolescent Immunizations and Other Clinical Preventive Services: A Needle and a Hook?

et al. 2008

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“…44 Two-thirds of adolescents report at least one of five health risks (smoking, drinking, having sex, feeling depressed, or not wearing seatbelts), but few report being assessed or counseled about them. 45 In three Medicaid managed care plans, only a quarter of girls who had had sexual intercourse in the past year were screened for chlamydia, despite the recommendation to screen all such girls. 46 Care of chronic illnesses also exhibits gaps.…”

Section: Voltage Drop 3: Access To Covered Services and Providersmentioning

confidence: 99%

Access And Quality In Child Health Services: Voltage Drops

Schuster

2004

Health Affairs

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Children require a health care system that promotes healthy development for all children while reaching out to the neediest. Barriers to care have been described as "voltage drops"-resistance points at which patients drop from the system like voltage from an electrical current. We examine the size and nature of these drops, ranging from insurance access to service quality, with respect to children. We find critical policy needs (such as expanded insurance opportunities, increased care coordination, and improved quality measurement) at all system levels. Comprehensive access to insurance and services does not guarantee that children will receive high-quality (safe and effective) care. C h i l d h o o d i s a u n i q u e p e r i o d of rapid growth and development char-acterized by dependency, vulnerability, and, for a disproportionate number of children, poverty. The U.S. health care system, best suited to acute care for adults, struggles to accommodate vulnerable populations (such as the elderly or mentally ill). Children require a protective, preventive system-one that helps families anticipate upcoming needs, monitors problems as they arise, and coordinates services. Developing such a system is a critical health policy frontier.It is essential to understand where the current system succeeds and fails for children. John Eisenberg and Elaine Power adopted the term "voltage drops." Just as an electrical system loses voltage when current passes through resistance, the health care system loses people as they confront barriers in seven areas: access to insurance coverage, enrollment in available insurance plans, access to covered services/providers, choice of plans/providers, consistent access to primary care, access to referral services, and delivery of high-quality care. 1 For children, evidence is scant regarding one drop, the impact of plan/provider choice. The other six drops, however, clearly have policy implications that are the focus of this paper. How large are these drops for children, and how might they be reduced?

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Use of Inexpensive Technology to Enhance Adolescent Health Screening and Counseling

Gaffney¹,

Hedberg²,

Gladstone³

2009

Arch Pediatr Adolesc Med

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To describe the health issues reported using a personal digital assistant (PDA) to conduct screening at adolescent well visits, and to determine the effect of a PDA screening tool on the content and quality of the clinical interaction. Design: The PDA screening tool was used to record adolescent health risk behaviors, and cross-sectional exit surveys were administered before and after PDA introduction. Setting: Five primary care practices in New England. Participants: The PDA screening was completed by 1052 youth aged 11 to 19 years. In addition, youth seen before (n=65) and after (n=98) PDA screening implementation completed exit surveys. Intervention: Adolescents completed the PDA screening immediately before the well visit. Branching questions explored risk behaviors in more depth, including motivation to change. Physicians viewed the summarized findings before the adolescent health visit. Main Outcome Measures: Health risk behaviors based on PDA data. Exit surveys assessed the quality of the visit and of any discussion of nutrition, exercise, screen time, tobacco use, alcohol and other drug use, and mood. Results: Multiple risk behaviors (n = 3-9) were reported by 30% of 11-to 14-year-olds and 45% of 15-to 19-year-olds. Exit surveys showed that, with PDA use, the proportion of visits that included discussions of health risk behaviors increased for fruit/vegetable intake (60.4% vs 41.7% without PDA use; P=.03), tobacco use (54.9% vs 40.0%; P = .07), and alcohol use (53.9% vs 38.0%; P =.05). With PDA use, more adolescents rated the visit as confidential (83.7% vs 61.5%; P=.002), more thought they were listened to carefully (87.8% vs 64.6%; PϽ.001), and more were very satisfied (87.8% vs 63.1%; PϽ.001). Conclusion: Use of a PDA-based screening tool enhances physician counseling and improves adolescents' perceptions of the well visit.

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Assessing Health System Provision of Adolescent Preventive Services: The Young Adult Health Care Survey

Cited by 83 publications

References 39 publications

Adolescent Immunizations and Other Clinical Preventive Services: A Needle and a Hook?

Adolescent Immunizations and Other Clinical Preventive Services: A Needle and a Hook?

Access And Quality In Child Health Services: Voltage Drops

Use of Inexpensive Technology to Enhance Adolescent Health Screening and Counseling

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