Most teens do not get recommended preventive care, UCSF study finds

The majority of adolescents in the United States do not obtain the appropriate level of preventive health care services, despite broad professional consensus recommending annual doctor visits for this age group, according to a new study led by researchers at the University of California, San Francisco. Using data from the Medical Expenditure Panel Survey – a major national survey of families and medical providers about key healthcare issues – the researchers examined several aspects of preventive care for adolescents, including the extent to which they had received care in the past year, whether they received counseling about various health issues, and whether they had any time alone with their provider. Findings indicated that only 38 percent of children 10 to 17 years old had a preventive visit in the past year. “The results were pretty shocking to us,” said Charles Irwin, MD, the study’s first author and director of the Division of Adolescent Medicine at UCSF Children’s Hospital. “With so many adolescents not receiving the recommended preventive care, it is clear we need to develop new strategies that will help increase the delivery of services.” Findings from the study are published in the March 30, 2009, online edition of “Pediatrics,” the official journal of the American Academy of Pediatrics. Preventive health care is particularly important during adolescence since many health-promoting and damaging behaviors originate during this life stage. Clinical guidelines issued by the American Medical Association, the American Academy of Pediatrics, and other leading medical and governmental organizations have long recommended all adolescent-aged children have an annual preventive visit, explained Sally Adams, RN, PhD, a senior author of the paper and specialist in the Division of Adolescent Medicine at UCSF. A typical preventive checkup includes a physical examination, any necessary shots or immunizations, and screenings for various conditions and behaviors. The researchers assessed the extent to which doctors counseled patients or their parents about six specific health-related issues. Those issues included: receiving dental care, eating healthfully, getting regular exercise, wearing a seatbelt, wearing a bicycle helmet, and being exposed to secondhand smoke. Less than half of the adolescents who had a preventive visit were advised about each of these issues, and only 10 percent were advised about all six. “We really need to encourage physicians to make this type of counseling routine, otherwise we might lose an opportunity to make a difference in these kids’ lives,” Adams said. In addition, the study looked at whether income level and insurance status were associated with the extent to which adolescents received preventive care. Findings indicated that significantly smaller percentages of adolescents from low- and middle-income families had a preventive visit in the past year, compared with those from high-income families, with 32 percent, 36 percent, and 48 percent of each group reporting a visit, respectively. Similarly, adolescents who were privately insured were more likely to have received preventive care in the past year than those who were publicly insured or uninsured. “Health care professionals must continue advocating for programs that increase the number of adolescents who are insured, because insurance is key to gaining access to preventive care,” Adams said. The researchers also looked at whether adolescents had any time alone with their doctors during preventive exams. According to Irwin, experts recommend children have some one-on-one time with their doctors beginning at 12 years of age in order to establish a closer relationship and to discuss potentially sensitive issues like sexual activity and drug use. Despite this recommendation, less than half of the adolescents surveyed who had a preventive visit reported having any time alone with their doctor. “That one-on-one time is really important because it helps build a solid relationship between doctors and their patients. By learning how to communicate about their health needs early on, kids will be in a better position to discuss any issues of concern that come up in the future,” Irwin said. The MEPS is a nationally representative survey conducted annually by the U.S. Department of Health and Human Services Agency for Healthcare Research and Quality. In this study, MEPS data from 2000 to 2004 were pooled to produce a total sample of 8464 adolescents. Additional co-authors of the paper were M. Jane Park, MPH, of the UCSF Department of Pediatrics, and Paul Newacheck, DrPH, of the Philip R. Lee Institute for Health Policy Studies at UCSF. One of the nation’s top children’s hospitals, UCSF Children’s Hospital creates an environment where children and their families find compassionate care at the healing edge of scientific discovery, with more than 150 experts in 50 medical specialties serving patients throughout Northern California and beyond. The hospital admits about 5,000 children each year, including 2,000 babies born in the hospital. UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care.