Preventive counseling at adolescent ambulatory visits

被引:63
作者
Rand, CM
Auinger, P
Klein, JD
Weitzman, M
机构
[1] Univ Rochester, Sch Med & Dent, Dept Pediat, Rochester, NY 14627 USA
[2] Univ Rochester, Sch Med & Dent, Strong Childrens Res Ctr, Rochester, NY 14627 USA
[3] AAP Ctr Child Hlth Res, Rochester, NY USA
关键词
counseling prevention; adolescent;
D O I
10.1016/j.jadohealth.2005.02.008
中图分类号
B844 [发展心理学(人类心理学)];
学科分类号
040202 ;
摘要
Purpose: To evaluate factors that independently predict counseling for diet, exercise, sexually transmitted diseases (STDs), pregnancy, smoking, and injuries at adolescent well visits, and compare these rates to the frequency of counseling at adolescent acute visits. Methods: The 1997-2000 National Ambulatory Medical Care and National Hospital Ambulatory Medical Care Surveys were combined for patients aged 11-21 years. Acute visits were identified by ICD-9 code for: sexual health, obesity, asthma, injury, and well care. Bivariate analyses were used to determine differences in relevant counseling provided at acute visits compared with well visits. Logistic regression was used to assess factors that predict counseling on each of the above topics at well adolescent visits. Results: Of 23,378 adolescent ambulatory visits, 1508 (6.5%) were for well care. Only 0.8% of visits were for obesity, 3.7% for sexual health, 2.6% for asthma, and 13% for injuries. Counseling was more frequent at acute than well visits for diet (72% vs. 28%), exercise (52% vs. 23%), human immunodeficiency virus/sexually transmitted diseases (HIV/STD; 14% vs. 6.2%), and family planning (FP) (24% vs. 10%), (all p values < .05). Pediatric clinicians were more likely than other specialists to provide counseling for diet (OR 2.3), HlV/STD (OR 2.7), FP (OR 2.9), tobacco use (OR 2.8), and injury prevention (OR 4.7). Blacks received less exercise counseling than Whites (OR 0.4), and counseling about sensitive issues (STDs, family planning) occurred more often in older adolescents (OR 1.3). Conclusions: Despite recommendations, more counseling occurs at acute rather than well visits, and still does not reach all those adolescents in need. There remains much room for improvement in physicians' adherence to national guidelines for adolescent care. (c) 2005 Society for Adolescent Medicine. All rights reserved.
引用
收藏
页码:87 / 93
页数:7
相关论文
共 41 条
[41]  
HEDIS 2002 GUIDELINE