Pediatrics
Volume 107, Issue 2, 2001, Pages 318-327

Improving adolescent preventive care in community health centers (Article)

Klein J.D.* , Allan M.J. , Elster A.B. , Stevens D. , Cox C. , Hedberg V.A. , Goodman R.A.
  • a Division of Adolescent Medicine, Strong Children's Research Center, University of Rochester School of Medicine, Rochester, NY, United States, Department of Pediatrics, University of Rochester, 601 Elmwood Ave, 690, Rochester, NY 14642, United States
  • b Division of Adolescent Medicine, Strong Children's Research Center, University of Rochester School of Medicine, Rochester, NY, United States
  • c Department of Clinical and Public Health Practice and Outcomes, American Medical Association, Chicago, IL, United States
  • d Bureau of Primary Health Care, Health Resources Services Administration, Department of Health and Human Services, Bethesda, MD, United States
  • e Department of Biostatistics, University of Rochester, School of Medicine, Rochester, NY, United States
  • f Division of Adolescent Medicine, Strong Children's Research Center, University of Rochester School of Medicine, Rochester, NY, United States
  • g Bureau of Primary Health Care, Health Resources Services Administration, Department of Health and Human Services, Bethesda, MD, United States

Abstract

Objective. To evaluate implementation of the Guidelines for Adolescent Preventive Services (GAPS) in Community and Migrant Health Centers (CMHCs). Design. Before and after comparison of health center policy, clinician and adolescent self-report, and chart reviews in 5 CMHCs. Participants. Eighty-one preintervention and 80 one-year postintervention providers and 318 preintervention and 331 postintervention 14- to 19- year-old adolescent patients being seen for well visits at 5 CMHCs. Intervention. Health center staff were trained to implement GAPS and were provided resource materials, patient questionnaires, and clinician manuals. Main Outcome Measures. Delivery of and receipt of preventive services and perceived access to care. Results. CMHC systems changes were related to stronger leadership commitment to adolescent care. Providers reported high levels of preventive services delivery before and after guideline implementation. After guideline implementation, adolescents reported increases in having discussed prevention content with providers in 19 of 31 content areas, including increased discussion of physical or sexual abuse (10% before to 22% after), sexual orientation (13% to 27%), fighting (6% to 21%), peer relations (37% to 52%), suicide (7% to 22%), eating disorders (11% to 28%), weapons (5% to 22%), depression (16% to 34%), smokeless tobacco (10% to 29%), and immunizations (19% to 48%). Adolescents were also more likely to report knowing where to get reproductive or mental health services and were more likely to have received health education materials. Implementation also increased documentation of recommended screening and counseling in 51 of 79 specific content areas assessed in chart reviews. Conclusion. Implementing GAPS increased the receipt of preventive services at these health centers. Adolescents received more comprehensive screening and counseling, more health education materials, and had greater access to care after implementation. GAPS implementation may help improve the quality of care for adolescents.

Author Keywords

Adolescents Preventive services Community health centers

Index Keywords

depression mental health service health care policy Preventive Health Services human Self Report priority journal Medical Audit Adolescent Health Services United States Community Health Centers Humans Adolescent sexual orientation male counseling female Organizational Policy sexual abuse Article Questionnaires program evaluation eating disorder adult health education health care quality Reproductive Health Guidelines health center Delivery of Health Care immunization practice guideline Data Collection Suicide health care delivery
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-0035140572&doi=10.1542%2fpeds.107.2.318&partnerID=40&md5=97a9d5ae85097f0ab4de608ce2b6e86a
DOI: 10.1542/peds.107.2.318
ISSN: 00314005
Cited by: 100
Original Language: English