Improving adolescent preventive services through state, managed care, and community partnerships

Klein, Jonathan D.; Sesselberg, Tracy S.; Gawronski, Beth; Handwerker, Lisa; Gesten, Foster; Schettine, Anne

doi:10.1016/s1054-139x(03)00072-7

Cited by 22 publications

(14 citation statements)

References 10 publications

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“…Studies have suggested that training clinicians about CPSs and providing screening and charting tools increase the delivery of CPSs to adolescents. 66,67 It is also possible that immunization recommendations may indirectly improve the doctor-patient relationship by increasing the number of encounters between the doctor and the adolescent, facilitating CPS delivery. Better communication between the doctor and adolescent may promote counseling and trust.…”

Section: Clinician Delivery Of Other Cpssmentioning

confidence: 99%

Adolescent Immunizations and Other Clinical Preventive Services: A Needle and a Hook?

et al. 2008

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Advances in technology have led to development of new vaccines for adolescents, but these vaccines will be added to a crowded schedule of recommended adolescent clinical preventive services. We reviewed adolescent clinical preventive health care guidelines and patterns of adolescent clinical preventive service delivery and assessed how new adolescent vaccines might affect health care visits and the delivery of other clinical preventive services. Our analysis suggests that new adolescent immunization recommendations are likely to improve adolescent health, both as a "needle" and a "hook." As a needle, the immunization will enhance an adolescent's health by preventing vaccine-preventable diseases during adolescence and adulthood. It also will likely be a hook to bring adolescents (and their parents) into the clinic for adolescent health care visits, during which other clinical preventive services can be provided. We also speculate that new adolescent immunization recommendations might increase the proportion and quality of other clinical preventive services delivered during health care visits. The factor most likely to diminish the positive influence of immunizations on delivery of other clinical preventive services is the additional visit time required for vaccine counseling and administration. Immunizations may "crowd out" delivery of other clinical preventive services during visits or reduce the quality of the clinical preventive service delivery. Complementary strategies to mitigate these effects might include prioritizing clinical preventive services with a strong evidence base for effectiveness, spreading clinical preventive services out over several visits, and withholding selected clinical preventive services during a visit if the prevention activity is effectively covered at the community level. Studies are needed to evaluate the effect of new immunizations on adolescent preventive health care visits, delivery of clinical preventive services, and health outcomes. Pediatricians have a unique opportunity to influence adolescents and their families by helping young people build a strong foundation of good health that will continue into their adult lives.American Academy of Pediatrics (AAP) 1 D ELIVERING PREVENTIVE services to US adolescents* is a public health priority. 2,3 Although most US adolescents are healthy, millions of adolescents initiate behaviors and lifestyles that can adversely affect their immediate and long-term health. 4 Potentially modifiable adolescent behaviors include failure to use seat belts, unsafe operation of motor vehicles, carrying weapons, using alcohol and other drugs, unprotected sex, inactivity, and overeating. These behaviors are directly linked to injuries and death, as well as to sexually transmitted infections (STIs), unintended *The definition of "adolescent" differs across studies and organizations; in this report, an adolescent is a person aged 11 to 18 years, unless otherwise specified.www.pediatrics.org/cgi

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Section: Clinician Delivery Of Other Cpssmentioning

confidence: 99%

Adolescent Immunizations and Other Clinical Preventive Services: A Needle and a Hook?

et al. 2008

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“…As a result, BCBSRR created a Community Physician Adolescent Health Quality Improvement Advisory Committee to identify specific needs and improve health plan performance [14]. BCBSRR is a large managed care organization (MCO) that provides insurance coverage for approximately 780,000 individuals, or 75% of the population (and Ͼ50% of the Medicaid eligible population) in Rochester, NY, and the surrounding area.…”

mentioning

confidence: 99%

“…In 2001, the University of Rochester and BCBSRR obtained support from NYSDOH to develop and evaluate a 2-year, multi-pronged, guidelinebased initiative to improve the quality of adolescent preventive care, focusing on increasing the use of screener/trigger questionnaires and provision of confidential care for adolescents. This initiative has been described elsewhere [14].…”

mentioning

confidence: 99%

Measuring Quality of Adolescent Preventive Services of Health Plan Enrollees and School-Based Health Center Users

Klein

Handwerker

Sesselberg

et al. 2007

Journal of Adolescent Health

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“…Of the original publications identified using the search techniques, eight were excluded because the study sample did not meet age criteria although it included patients less than 25 years old[32-39], six were excluded because the study did not include a clinician as an interventionist although the sample included adolescent outpatients [40][41][42][43][44][45], two were excluded because the subjects were inpatients rather than outpatients [46][47], one was excluded because the trial did not involve clinicians and adolescents in a clinical setting [48], two were excluded because the study population was too old and another publication from the same study included a sub-analysis of adolescents less than 25 years old which was included [49,50], one was excluded due to insufficient description of study design to assess computer search criteria [51], and one had comparison groups of patients but patients all received the same STD prevention intervention [52]. The search resulted in 14 publications on 14 different trials that met search criteria, and these publications were then further segmented into two groups.…”

Section: Methodsmentioning

confidence: 99%

Review of Clinical Trials Testing the Effectiveness of Clinician Intervention Approaches to Prevent Sexually Transmitted Diseases in Adolescent Outpatients

Boekeloo¹,

Griffin²

2005

CPR

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Objective-Identify approaches for improving clinician provision of sexually transmitted diseases (STDs) prevention services among outpatient adolescents.Methods-Reviewed all peer-reviewed, published clinical trials identified through computerized searches (MEDLINE, PsychINFO) evaluating STD prevention services to outpatient adolescents by clinicians.Results-Five trials were identified examining changes in clinician provision of STD prevention services. Two of these trials resulted in adolescent self-reported risk reduction but neither of these trials effectively demonstrated reductions in objectively measured STD incidence. Nine clinical trials were identified that compared clinician with non-clinician provision of STD prevention services. Four of these trials resulted in adolescent self-reported risk reduction, and one of these trials demonstrated a reduction in objectively measured STD incidence.Conclusions-Trials indicate that improvement in outpatient adolescent STD incidence is possible with non-clinicians as interventionists, and perhaps clinicians as interventionists if clinicians are supported by other educational resources. Opportunities for personalized, interactive adolescent education appears key to intervention success. The clinician role that is tested in most trials is confined to a single brief encounter with little attention to: development of clinician skills, quality of psychosexual risk assessment and tailoring to meet individual adolescent need, systemslevel resources and supports, the parental role, or the impact of incorporating prevention into an ongoing adolescent-clinician relationship.

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Improving adolescent preventive services through state, managed care, and community partnerships

Cited by 22 publications

References 10 publications

Adolescent Immunizations and Other Clinical Preventive Services: A Needle and a Hook?

Adolescent Immunizations and Other Clinical Preventive Services: A Needle and a Hook?

Measuring Quality of Adolescent Preventive Services of Health Plan Enrollees and School-Based Health Center Users

Review of Clinical Trials Testing the Effectiveness of Clinician Intervention Approaches to Prevent Sexually Transmitted Diseases in Adolescent Outpatients

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