Preventive counseling at adolescent ambulatory visits
Preventive counseling at adolescent ambulatory visits
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DOI：
10.1016/j.jadohealth.2005.02.008
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发表时间：
2005-08-01
影响因子：
7.6
通讯作者：
Weitzman, M
中科院分区：
文献类型：
--
作者：
Rand, CM;Auinger, P;Weitzman, M
目的：评估独立预测饮食、运动、性传播疾病 (STD)、怀孕、吸烟和青少年健康就诊时受伤咨询的因素，并将这些比率与青少年急性就诊时的咨询频率进行比较。方法：将 1997-2000 年国家门诊医疗保健和国家医院门诊医疗保健调查合并起来，针对 11-21 岁的患者。急性就诊按 ICD-9 代码确定：性健康、肥胖、哮喘、受伤和护理。使用双变量分析来确定急性就诊时提供的相关咨询与正常就诊相比的差异。使用逻辑回归来评估预测青少年良好就诊时就上述每个主题进行咨询的因素。结果：在 23,378 名青少年门诊中，1508 名 (6.5%) 接受良好护理。只有 0.8% 的就诊是因为肥胖，3.7% 是因为性健康，2.6% 是因为哮喘，13% 是因为受伤。急性期咨询在饮食（72% vs. 28%）、运动（52% vs. 23%）、人类免疫缺陷病毒/性传播疾病（HIV/STD；14% vs. 6.2%）和计划生育（FP）（24% vs. 10%）方面的咨询频率更高（所有 p 值 < .05）。儿科临床医生比其他专家更有可能提供饮食（OR 2.3）、HIV/STD（OR 2.7）、FP（OR 2.9）、烟草使用（OR 2.8）和伤害预防（OR 4.7）方面的咨询。黑人接受的运动咨询比白人少（OR 0.4），有关敏感问题（性传播疾病、计划生育）的咨询更多地发生在年龄较大的青少年中（OR 1.3）。结论：尽管有建议，但更多的咨询是在急症而不是健康就诊时进行的，而且仍然没有惠及所有有需要的青少年。医生遵守国家青少年护理指南的情况仍有很大改进空间。 (c) 2005 年青少年医学学会。版权所有。
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.