Health Maintenance Deficits in a Fully Insured Population of Adolescents With Chronic Medical Conditions

Abstract

The current national monitoring of routine wellness care and vaccine uptake does not provide data on health maintenance among pediatric populations with chronic medical conditions. In this case-control study that analyzes wellness visits and vaccine uptake among adolescents, ages 16 to 18 years, we identified 938 without (controls) and 74 with (cases) 1 of 12 specific chronic medical conditions. The PPSV23 (23-valent pneumococcal polysaccharide vaccine) is recommended by the Advisory Committee on Immunization Practices for these 12 conditions and served as a measure of uptake for medically indicated vaccines. Our controls were twice as likely as cases to have a documented well visit in the past year, and there was a significantly higher proportion of controls than cases vaccinated with Tdap (tetanus toxoid, reduced diphtheria toxoid, acellular pertussis), MCV-4 (quadrivalent meningococcal conjugate), and HPV (human papillomavirus), all P < .05. More than 60% of cases failed to receive PPSV23. Adolescents with chronic medical conditions are at high risk of neglecting routine health maintenance.

Adolescents With Inflammatory Bowel Disease Have Decreased Rates of Health Maintenance Visits

“…Studies of adult IBD demonstrate that higher provider connectedness (between the gastroenterologist and PCP) and continuity of care are associated with better IBD outcomes (11,12). Although it has previously been shown in a small study by Sainato et al (3) that children with chronic medical conditions have less follow‐up with their PCP than healthy controls, that study included only 15 children with gastrointestinal disease. Our study is the first to focus on IBD and highlights an important health care outcome.…”

“…Guidelines recommend counseling on smoking cessation, alcohol avoidance, and sexual education during health maintenance examination (HMEs) with the primary care physician (PCP) as well as routine immunizations. However, children with chronic diseases have less routine HME than their healthy peers (3).…”