Guidelines for adolescent preventive services
- Arthur Elster, MD
Arthur Elster, MD
- Clinical Associate Professor
- Feinberg School of Medicine, Northwestern University
The health status and health behaviors of adolescents have been monitored closely for many years [1-4]. Although improvement has been noted in certain indicators, compared with other age groups, adolescent health has failed to respond to the range of interventions developed for schools, communities, and the health system.
Unintentional injuries such as automobile crashes, intentional injuries such as homicide and suicide, and reproductive health issues such as unintended pregnancy and sexually transmitted infections remain the leading causes of adolescent morbidity and mortality. Alcohol and drug use contribute to many of these injuries and deaths. Obesity has become a major cause of adolescent morbidity and is a contributor to a dramatic increase in the number of youth with type 2 diabetes mellitus. Tobacco use causes harm during the teen years, and can lead to nicotine addiction that results in major morbidity and mortality later in life. The common denominator in this list is that most adolescent morbidity and mortality is related to personal behavior and, as such, is preventable.
The preventable nature of all of these conditions provides a clear mandate to pediatric healthcare providers. The challenge is to integrate preventive services into routine medical care. Practitioners can use clinic visits for routine examinations, such as preparticipation athletic evaluations and chronic disease management, to provide a range of preventive services. These clinical encounters offer an opportunity for early identification of risk behavior and disease, updating immunizations, and offering health guidance. Clinical preventive services are an adjunct to preventive interventions provided through schools and in the community.
PREVENTIVE SERVICE RECOMMENDATIONS FOR ADOLESCENTS
The purpose of preventive services is to reduce serious morbidity and premature mortality both during adolescence and in later years. Preventive services typically fall into four categories: screening, counseling to reduce risk, providing immunizations, and giving general health guidance. In addition, a recommendation for how frequently routine visits should occur usually is included. Various organizations have developed or revised guidelines that are designed to enable practitioners to identify and address specific health problems and behaviors that cause the greatest burden of suffering among adolescents:
●The United States Preventive Services Task Force (USPSTF) – Guide to Clinical Preventive Services .
- Ozer EM, Park J, Paul T, et al. America's Adolescents: Are They Healthy? 2003 Edition Revised and Updated. National Adolescent Health Information Center. Division of Adolescent Medicine, Department of Pediatrics and Institute for Health Policy Studies, University of California School of Medicine, San Francisco, 2003. www.nihcm.org/pdf/AA2003.pdf (Accessed on August 26, 2014).
- Shanklin S, Brener ND, Kann L, et al. Youth risk behavior surveillance--selected Steps communities, United States, 2007. MMWR Surveill Summ 2008; 57:1.
- Brener ND, Kann L, Garcia D, et al. Youth risk behavior surveillance--selected steps communities, 2005. MMWR Surveill Summ 2007; 56:1.
- Kann L, McManus T, Harris WA, et al. Youth Risk Behavior Surveillance - United States, 2015. MMWR Surveill Summ 2016; 65:1.
- Guide to Clinical Preventive Services, 2010-2011. Recommendations of the United States Preventive Services Task Force. www.ahrq.gov/clinic/pocketgd.htm (Accessed on May 16, 2011).
- Elster AB, Kuznets NJ. AMA Guidelines for Adolescent Preventive Services (GAPS): Recommendations and Rationale. Williams & Wilkins, Baltimore 1994. www.ama-assn.org/ama/pub/physician-resources/public-health/promoting-healthy-lifestyles/adolescent-health/guidelines-adolescent-preventive-services.page (Accessed on November 08, 2011).
- American Academy of Family Physicians. Clinical Preventive Services. www.aafp.org/online/en/home/clinical/exam.html (Accessed on November 08, 2011).
- American Academy of Family Physicians. Age charts for periodic health examinations. Kansas City 1994.
- Hagen JF, Shaw JS, Duncan PM. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd ed, American Academy of Pediatrics, Elk Grove Village, IL 2008.
- Bright Futures www.brightfutures.aap.org/web (Accessed on November 08, 2011).
- Bright Futures/American Academy of Pediatrics. Recommendations for Preventive Pediatric Health Care - Periodicity Schedule. www.aap.org/en-us/professional-resources/practice-support/Pages/PeriodicitySchedule.aspx (Accessed on December 15, 2015).
- Elster AB. Comparison of recommendations for adolescent clinical preventive services developed by national organizations. Arch Pediatr Adolesc Med 1998; 152:193.
- Richmond TK, Freed GL, Clark SJ, et al. Guidelines for adolescent well care: is there consensus? Curr Opin Pediatr 2006; 18:365.
- National Committee for Quality Assurance. Health Plan Employer Data and Information Set (HEDIS) 3.0. Washington, DC 1996.
- Rosen DS, Elster A, Hedberg V, Paperny D. Clinical preventive services for adolescents: position paper of the Society for Adolescent Medicine. J Adolesc Health 1997; 21:203.
- Olson AL, Gaffney CA, Hedberg VA, Gladstone GR. Use of inexpensive technology to enhance adolescent health screening and counseling. Arch Pediatr Adolesc Med 2009; 163:172.
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- D'Angelo LJ, Samples C, Rogers AS, et al. HIV infection and AIDS in adolescents: an update of the position of the Society for Adolescent Medicine. J Adolesc Health 2006; 38:88.
- Owens J, Adolescent Sleep Working Group, Committee on Adolescence. Insufficient sleep in adolescents and young adults: an update on causes and consequences. Pediatrics 2014; 134:e921.
- Paruthi S, Brooks LJ, D'Ambrosio C, et al. Recommended Amount of Sleep for Pediatric Populations: A Statement of the American Academy of Sleep Medicine. J Clin Sleep Med 2016.
- Adolescent Sleep Working Group, Committee on Adolescence, Council on School Health. School start times for adolescents. Pediatrics 2014; 134:642.
- Resnick MD, Bearman PS, Blum RW, et al. Protecting adolescents from harm. Findings from the National Longitudinal Study on Adolescent Health. JAMA 1997; 278:823.
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- Preventive medicine in general internal medicine residency training. Preventive Health Care Committee, Society for Research and Education in Primary Care Internal Medicine. Ann Intern Med 1985; 102:859.
- Blum RW, Beuhring T, Wunderlich M, Resnick MD. Don't ask, they won't tell: the quality of adolescent health screening in five practice settings. Am J Public Health 1996; 86:1767.
- Goodwin MA, Flocke SA, Borawski EA, et al. Direct observation of health-habit counseling of adolescents. Arch Pediatr Adolesc Med 1999; 153:367.
- Frankenfield DL, Keyl PM, Gielen A, et al. Adolescent patients--healthy or hurting? Missed opportunities to screen for suicide risk in the primary care setting. Arch Pediatr Adolesc Med 2000; 154:162.
- Guidelines for Adolescent Preventive Services: Clinical Evaluation and Management Handbook, American Medical Association, Chicago 1995.
- Schubiner H, Tzelepis A, Wright K, Podany E. The clinical utility of the Safe Times Questionnaire. J Adolesc Health 1994; 15:374.
- Schubiner H, Robin A. Screening adolescents for depression and parent-teenager conflict in an ambulatory medical setting: a preliminary investigation. Pediatrics 1990; 85:813.
- Klein JD, Allan MJ, Elster AB, et al. Improving adolescent preventive care in community health centers. Pediatrics 2001; 107:318.
- Lustig JL, Ozer EM, Adams SH, et al. Improving the delivery of adolescent clinical preventive services through skills-based training. Pediatrics 2001; 107:1100.
- Ozer EM, Adams SH, Lustig JL, et al. Increasing the screening and counseling of adolescents for risky health behaviors: a primary care intervention. Pediatrics 2005; 115:960.
- Poses RM. One size does not fit all: questions to answer before intervening to change physician behavior. Jt Comm J Qual Improv 1999; 25:486.
- Hulscher ME, Wensing M, Grol RP, et al. Interventions to improve the delivery of preventive services in primary care. Am J Public Health 1999; 89:737.
- Goodson P, Gottlieb NH, Smith MM. Put prevention into practice. Evaluation of program initiation in nine Texas clinical sites. Am J Prev Med 1999; 17:73.
- Elster AB, Levenberg P. Integrating comprehensive adolescent preventive services into routine medicine care. Rationale and approaches. Pediatr Clin North Am 1997; 44:1365.
- Dietrich AJ, Woodruff CB, Carney PA. Changing office routines to enhance preventive care. The preventive GAPS approach. Arch Fam Med 1994; 3:176.
- PREVENTIVE SERVICE RECOMMENDATIONS FOR ADOLESCENTS
- COMPREHENSIVE GUIDELINES FOR ADOLESCENTS
- Anticipatory guidance for adolescents
- Anticipatory guidance for parents
- STRATEGY FOR PROVISION OF ADOLESCENT PREVENTIVE SERVICES
- Step 1: Gather information and identify problems
- Step 2: Further assess
- Step 3: Identify and prioritize problems together
- Step 4: Solutions
- INTEGRATING PREVENTIVE SERVICES INTO ROUTINE MEDICAL CARE