Direct Observation of Health-Habit Counseling of Adolescents

U.S. adolescents receive suboptimal preventive counseling during ambulatory care

“…In reality, some types of visits, such as visits for routine medical or physical examination, are more amenable to counseling services than others. Past studies have reported higher, though still much lower-than-expected, rates of preventive counseling during these visits than illness-related visits [8,18,24]. Our data from 1997-2000 show that no counseling services were documented for 61% of adolescent GME visits.…”

“…For example, greater incorporation of information technology will enable physicians and other health care providers to proactively plan patientcentered services rather than simply reacting to care needs brought forth by patients. It is noted in this and other studies [24] that most adolescent visits are illness-related, which may not present the best opportunity for preventive counseling. Nevertheless, some of these visits may represent "teachable moments" for symptom-driven counseling about risky behaviors, for example, HIV/STD transmission counseling during visits for prenatal examination, tobacco use/exposure counseling during visits for respiratory conditions, and skin cancer prevention counseling during visits for sebaceous symptoms/illnesses.…”

“…Studies that investigated an array of recommended counseling services are limited by their samples of adolescents with a specific type of medical insurance [9,19], residing in a specific region [18], or cared for by physicians in a specific specialty [24]. The few studies that examined national representative samples of adolescents fail to track patterns over time [17,25].…”

Does office-based counseling of adolescents and young adults improve self-reported safety habits? A randomized controlled effectiveness trial

“…Moreover, because our study only addressed safety habits, more time was prioritized for counseling on seatbelt and helmet use by study physicians than likely would be performed by clinicians in practice who were following complete preventive service guidelines. Our study was designed to reflect the time available for counseling that a practicing physician likely would have during a routine office visit, and this time is brief; a recent observational study of 119 family practice physicians revealed the average length of a well-care visit to be just 13.5 minutes [11]. Perhaps more deliberate and frequent counseling sessions even for simple interventions such as ours would enhance the intervention effect, however, this has yet to be established [19].…”

“…For example, an analysis of the preventive counseling practices of family physicians during adolescent well-care visits showed that screening for alcohol and tobacco use each occurred in less than 10% of visits and counseling on exercise, diet, or accident prevention each was delivered in less than 25% of visits [11]. Such poor physician participation is explained at least partially by the paucity of evidence establishing the benefit of counseling interventions in this age group, as well as the many topics for which they are expected to provide counseling [12,13].…”