Preventive Care for Adolescents: Few Get Visits and Fewer Get Services
Preventive Care for Adolescents: Few Get Visits and Fewer Get Services
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DOI：
10.1542/peds.2008-2601
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发表时间：
2009-04-01
期刊：
影响因子：
8
通讯作者：
Newacheck, Paul W.
中科院分区：
文献类型：
--
作者：
Irwin, Charles E., Jr.;Adams, Sally H.;Newacheck, Paul W.
OBJECTIVE.青少年的专业指南建议每年进行预防性访问，并对健康相关行为进行筛查和预期指导。本研究的目的是检查预防服务的接受，包括在接受服务的差距，通过使用一个全国代表性的抽样调查。使用数据从2001-2004年的医疗支出小组调查（年龄10-17岁，N = 8464），我们研究了收到预防保健访问和几项措施的内容，根据照顾者的报告，在青少年谁收到了预防保健访问在过去的12个月。护理结果的内容包括身体参数测量（身高、体重和血压）;接受预期指导（牙科护理、安全带、头盔、锻炼、健康饮食和二手烟暴露）;对于12至17岁的青少年，青少年在最近一次访问期间是否有时间与他们的提供者单独相处，这是保密服务的代表。我们进行了逻辑回归分析，以检验基于种族/民族、收入和保险状况的结果差异。38%的青少年在过去12个月内接受过预防保健。低收入和全年无保险的状态与不接受这种访问的风险较高。大多数青少年的身高（87%），体重（89%）和血压（78%）进行了评估。在贫困和没有保险的青少年中，身高和体重的比率较低。预期指导率要低得多，从安全带、头盔和二手烟的31%到健康饮食的49%。只有10%的人在所有6个领域都得到了解决。多变量分析产生了一些差异，在收到预期的指导。40%的人有时间与他们的供应商独处。西班牙裔和最低收入的青少年最不可能有独处的时间。很少有青少年接受预防性访问;在接受这种访问的青少年中，提供建议的预期指导的比例非常低。需要制定战略，改进向青少年提供建议的预防服务。儿科2009; 123：e565-e572
OBJECTIVE. Professional guidelines for adolescents recommend annual preventive visits with screening and anticipatory guidance for health-related behaviors. The objective of this study was to examine receipt of preventive services, including disparities in services received, by using a nationally representative sample of adolescents.METHODS. Using data from the 2001-2004 Medical Expenditure Panel Survey (ages 10-17; N = 8464), we examined receipt of preventive care visits and several measures of the content of care, based on caregiver's reports, among adolescents who received a preventive care visit during the past 12 months. Content of care outcomes included physical parameters measurement (height, weight, and blood pressure); receipt of anticipatory guidance (dental care, seat belts, helmets, exercise, healthy eating, and secondhand smoke exposure); and, for 12- to 17-year-olds, whether adolescents had time alone with their provider during their most recent visit, a proxy for confidential services. We conducted logistic regression analyses to test for disparities in the outcomes on the basis of race/ethnicity, income, and insurance status.RESULTS. Thirty-eight percent of adolescents had a preventive care visit in the previous 12 months. Low-income and full-year uninsured status were associated with higher risk for not receiving this visit. Most adolescents had height (87%), weight (89%), and blood pressure (78%) assessed. Rates for height and weight were lower in poor and uninsured adolescents. Anticipatory guidance rates were much lower, ranging from 31% for seat belts, helmets, and secondhand smoke to 49% for healthy eating. Only 10% had all 6 areas addressed. Multivariate analyses yielded few disparities in receipt of anticipatory guidance. Forty percent had time alone with their providers. Hispanic and the lowest-income adolescents were the least likely to have time alone.CONCLUSIONS. Few adolescents received a preventive visit; among those who received this visit, provision of recommended anticipatory guidance was very low. Strategies are required to improve delivery of recommended preventive services to adolescents. Pediatrics 2009; 123: e565-e572