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Preventive counseling at adolescent ambulatory visits
Cynthia M Rand1, Peggy Auinger, Jonathan D Klein
1Department of Pediatrics and Strong Children's Research Center, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA. cynthia_rand@urmc.rochester.edu
Summary
Adolescent counseling on diet, exercise, STDs, and smoking is more frequent during acute care visits than well visits, yet still falls short of national recommendations. There is a significant need to improve adherence to guidelines for adolescent preventive care.
Area of Science:
- Adolescent Medicine
- Preventive Healthcare
- Public Health
Background:
- Adolescent well visits are crucial opportunities for preventive counseling.
- Current guidelines recommend comprehensive counseling on diet, exercise, STDs, pregnancy, smoking, and injuries.
- The frequency and predictors of this counseling at adolescent visits require evaluation.
Purpose of the Study:
- To identify factors predicting counseling on key health topics during adolescent well visits.
- To compare counseling rates at adolescent well visits versus acute care visits.
Main Methods:
- Analysis of combined 1997-2000 National Ambulatory Medical Care and National Hospital Ambulatory Medical Care Surveys.
- Inclusion of patients aged 11-21 years.
- Logistic regression to identify predictors of counseling at well visits; bivariate analyses to compare acute vs. well visit counseling.
Main Results:
- Counseling was more frequent during acute visits for diet, exercise, HIV/STDs, and family planning compared to well visits.
- Pediatric clinicians were more likely to provide counseling across multiple topics than other specialists.
- Black adolescents received less exercise counseling; older adolescents received more counseling on sensitive issues.
Conclusions:
- Adolescent counseling on critical health issues is more prevalent during acute visits than well visits, despite recommendations.
- Current counseling rates, even at acute visits, do not meet the needs of all adolescents.
- Physician adherence to national guidelines for adolescent preventive care requires significant improvement.