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Guidelines for Adolescent Preventive Services: the GAPS in practice
Anne Gadomski1, Shannon Bennett, Margaret Young
1Bassett Research Institute, Bassett Healthcare, Cooperstown, NY 13326, USA. gadomski@usa.net
Design:
Pre- and post-Guidelines for Adolescent Preventive Services (GAPS) comparison of outcomes gathered via chart audit.
Setting:
A rural hospital-based general pediatric clinic.
Participants:
Adolescents who underwent annual examinations between April 1, 1998, and March 31, 2001. A random sample of 441 medical records was reviewed.
Intervention:
Training in the GAPS model and use of the questionnaire began in April 1998.
Main Outcome Measures:
Detection of, discussion of, and referrals for GAPS-related risk behavior.
Results:
The medical records of 162 younger adolescents (aged 11-15 years) and 279 older adolescents (aged 16-19 years) were audited. Detection of risk behaviors increased from 19% at baseline to 95% with the initial GAPS and 87% with the periodic GAPS. The most prevalent risk factor was having a rifle or gun in the home (younger adolescents, 47% and older adolescents, 39%). The mean number of risk behaviors and health concerns documented was higher in the initial GAPS (4.8 and 1.3, respectively) than in the periodic GAPS (3.8 and 0.7) (P =.01 and.006). The GAPS questionnaires detected lower levels of risk behavior compared with a local Youth Risk Behavior Survey. Controlling for sex, age, and clinician, discussion of psychosocial topics increased during the study period; however, there was considerable variation among clinicians regarding the topics addressed. The GAPS-related referral rate did not change significantly.
Conclusion:
The GAPS model increases clinicians' detection and discussion of risk behaviors.