Research on Clinical Preventive Services for Adolescents and Young Adults: Where Are We and Where Do We Need to Go?
Research on Clinical Preventive Services for Adolescents and Young Adults: Where Are We and Where Do We Need to Go?
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DOI：
10.1016/j.jadohealth.2016.10.005
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发表时间：
2017-03
期刊：
影响因子：
--
通讯作者：
Ozer EM
中科院分区：
文献类型：
--
作者：
Harris SK;Aalsma MC;Weitzman ER;Garcia-Huidobro D;Wong C;Hadland SE;Santelli J;Park MJ;Ozer EM
我们回顾了有关系统和访问级别的策略，以提高青少年和年轻人的临床预防服务提供和质量的研究。尽管在推荐的青少年服务方面达成了专业共识，为年轻人提供服务有了强有力的证据基础，而且《平价医疗法》的规定改善了获得服务的财政机会，但预防服务的接受仍然不是最佳的。需要进一步开展研究，借鉴将传统诊所和社区诊所联系起来的成功模式，以改善所有青年获得护理的机会。为了优化临床诊疗，以临床医生为重点的改善预防性服务提供的有前途的战略包括筛查和决策支持工具，特别是在纳入电子病历系统并得到培训和反馈支持的情况下。虽然结果喜忧参半，但干预措施已从增加服务提供转向展示行为改变。对新兴技术的研究，如游戏平台，移动的手机应用程序和可穿戴设备，表明有机会扩大临床医生的覆盖范围;然而，现有的研究是基于有限的临床环境和人群。需要改进监测系统和开展进一步研究，以审查预防服务的促进者，并确保干预措施在青年人接受预防性护理的各种临床环境中、在包括青年人在内的多种人群中以及在获得优质护理机会较少的弱势人群中有效。
We reviewed research regarding system- and visit-level strategies to enhance clinical preventive service delivery and quality for adolescents and young adults. Despite professional consensus on recommended services for adolescents, a strong evidence base for services for young adults, and improved financial access to services with the Affordable Care Act’s provisions, receipt of preventive services remains suboptimal. Further research that builds off successful models of linking traditional and community clinics is needed to improve access to care for all youth. To optimize the clinical encounter, promising clinician-focused strategies to improve delivery of preventive services include screening and decision support tools, particularly when integrated into electronic medical record systems and supported by training and feedback. Although results have been mixed, interventions have moved beyond increasing service delivery to demonstrating behavior change. Research on emerging technology—such as gaming platforms, mobile phone applications, and wearable devices—suggests opportunities to expand clinicians’ reach; however, existing research is based on limited clinical settings and populations. Improved monitoring systems and further research are needed to examine preventive services facilitators and ensure that interventions are effective across the range of clinical settings where youth receive preventive care, across multiple populations, including young adults, and for more vulnerable populations with less access to quality care.
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