Problems Unique to Adolescents Overlooked in Delivery of Clinical Preventive
Services
AJPM article also calls for increased effectiveness research
WASHINGTON, Oct. 26 /PRNewswire-USNewswire/ -- Too little attention is paid to
improving the delivery of clinical preventive services to adolescents by
addressing problems unique to that population, says a new study commissioned
by Partnership for Prevention.
Most of the clinical preventive services that are recommended for adolescents
also don't have good evidence to support their effectiveness, say authors of
the study, which appears in the current online edition and the November print
edition of the American Journal of Preventive Medicine.
The review article, "Clinical Preventive Services for Adolescents," is freely
available to the public electronically at
www.ajpm-online.net/article/S0749-3797(09)00490-5/abstract. It sheds light on
the lack of attention that's been given to preventive health and wellness
recommendations for adolescents between the ages of 11 and 17.
"We need to encourage both more clinical effectiveness research on clinical
preventive services for adolescents and changes in the ways medical practices
serving adolescents approach improving delivery rates," said Leif I. Solberg,
MD, the study's chief author who is Associate Medical Director for Care
Improvement Research, HealthPartners Medical Group.
"It's important that healthcare providers use every medical encounter, not
just 'well-child visits,' which not all adolescents receive regularly, to
address their clinical preventive services needs," Solberg said.
The study reviewed 28 counseling services and 31 screening services
recommended by at least one of five national groups that issue comprehensive
preventive care recommendations for teens. Only seven non-immunization
services were given A or B recommendations from the U.S. Preventive Services
Task Force (USPSTF), which uses a rigorous approach to assess the
effectiveness of both the service itself and the benefits of delivering the
service in a clinical setting. Those seven included cervical cancer (Pap
test), Chlamydia (girls), depression, tobacco, and for persons at increased
risk of gonorrhea, syphilis, and HIV.
Of the seven effective recommended services, five involve sexual health,
including STIs (sexually transmitted infections) and cervical cancer (Pap
test). Of this limited set of services, only Chlamydia screening and Pap tests
are recommended for all sexually active young women and also have been judged
to also be high value, according to the National Commission on Prevention
Priorities.
However, even among STI screening services for which there is good evidence,
too little attention is paid to improving delivery of these services by
addressing problems unique to adolescents. Those problems include:
-- The time typically allocated for routine adolescent exams is quite
short
and is unlikely to be extended, given Medicaid's recent reductions in
preventive visit reimbursements relative to other services.
-- Many clinicians feel that adolescents are less likely to heed their
recommendations because they believe adolescents are less interested
in
their long-term health than adults and more likely to engage in risk
behaviors.
-- Delivery of clinical services to adolescents tends to be driven by
tradition, expert opinion, and the very limited needs of particular
required preventive visits (e.g., school or sports physicals)
"Despite these problems and the fact that most adolescents are healthy, more
than 70% of adolescent morbidity and mortality is the result of risk
behaviors, such as alcohol use, unsafe sex and violence," the authors wrote.
"The clinical setting presents an opportunity to identify risky behaviors
early and to steer adolescents in the right direction."
Partnership for Prevention is a non-profit membership organization of
business, non-profit and government leaders working to make evidence-based
prevention a national priority. Its initiatives include the National Chlamydia
Coalition, which seeks to address the continued high burden of Chlamydia
infection -- especially among women age 25 and younger -- and to reduce rates
of Chlamydia and its harmful effects among sexually active adolescent and
young adults. More information is available at http://www.prevent.org/ncc .
Funding for the review article was provided by the Division of STD Prevention
at the Centers for Disease Control and Prevention.
SOURCE Partnership for Prevention
Damon Thompson of Partnership for Prevention, +1-202-625-1600,
dthompson@prevent.org
