Can it be done? Implementing adolescent clinical preventive services.
OBJECTIVE
To evaluate the implementation of an intervention to increase the delivery of adolescent preventive services within a large managed care organization. Target health areas were tobacco, alcohol, sexual behavior, and safety (seat belt and helmet use).


METHODS
Adolescent reports of clinician screening and counseling were obtained from adolescents who attended well visits with their primary care providers. A prepost study design was used to evaluate the preventive services intervention. The intervention had three components: (1) 89 clinicians from three outpatient pediatric clinics attended a training to increase the delivery of preventive services; (2) customized adolescent screening and provider charting forms were integrated into the clinics; and (3) the resources of a health educator were provided to the clinics.


METHODS
Following a visit, adolescents completed surveys reporting on clinician screening and counseling for each of the target risk areas. Preimplementation (three months), 104 adolescents completed surveys. Postimplementation of the training, tools, and health educator intervention, 211 adolescents completed surveys (five months). For 18 months postimplementation clinicians delivered services and 998 adolescents completed surveys.


RESULTS
Chi-square analyses of changes in screening from preimplementation to postimplementation showed that screening increased in all areas (p < .000), with an average increase in screening rates from 47 percent to 94 percent. Postimplementation counseling in all areas also increased significantly, with an average increase in counseling rates from 39 percent to 91 percent. There were slight decreases in screening from postimplementation to follow-up.


CONCLUSIONS
This study offers support for the efficacy of providing training, tools, and resources as a method for increasing preventive screening and counseling of adolescents across multiple risky health behaviors during a routine office visit.
Ozer
E M
EM
Department of Pediatrics, Division of Adolescent Medicine, School of Medicine, University of California, San Francisco, CA 94143-0503, USA.
Adams
S H
SH
Lustig
J L
JL
Millstein
S G
SG
Camfield
K
K
El-Diwany
S
S
Volpe
S
S
Irwin
C E
CE
D000293:Adolescent; D016497:Adolescent Health Services / Q000458:organization & administration* / Q000600:supply & distribution; D000428:Alcohol Drinking / Q000517:prevention & control; D002140:California; D002983:Clinical Competence; D015438:Health Behavior; D019538:Health Care Surveys; D006266:Health Education; D006279:Health Maintenance Organizations / Q000458:organization & administration* / Q000592:standards; D006284:Health Plan Implementation; D006801:Humans; D007318:Inservice Training; D011314:Preventive Health Services / Q000458:organization & administration* / Q000600:supply & distribution; D016730:Program Development; D011785:Quality Assurance, Health Care; D040242:Risk Reduction Behavior; D012309:Risk-Taking; D012449:Safety; D012725:Sexual Behavior; D000074606:Smoking Prevention