IMPLEMENTING ADOLESCENT PREVENTIVE GUIDELINES

University Of California San Francisco, San Francisco CA

Investigators

Linked publications & trials

Abstract

Overview: The majority of adolescent morbidity and mortality can be attributed to preventable risk factors. Most adolescents visit a primary care provider once a year, providing the opportunity to integrate prevention into clinical encounters. Guidelines targeting the delivery of adolescent preventive services have been developed, but are not being implemented as recommended. Provider and system-level barriers, including insufficient training and inadequate screening and charting tools, have been identified. However, research to address these barriers and increase the delivery of adolescent preventive services in primary care settings is limited. Aim: To determiner whether a systems intervention in a managed health care organization, utilizing the Precede-Proceed model as a framework for implementing provider training and customized screening and charting tools, results in higher rates of provider delivery of clinical preventive services than using usual Standard of Care. Population: Primary care providers in Pediatric clinics caring for adolescents in a large HMO will be targeted. Methods: In this experimental design, 5 clinics will be assigned randomly to two conditions: 3 into the Intervention condition and 2 into the Comparison condition. The Intervention condition is comprised of two components: training and tools. Two 4-hour training workshops will be conducted as well as a booster trainings. Providers also will receive tools which include an adolescent health screening questionnaire and a customized charting form that incorporates information from the screening questionnaire and provides reminder prompts, cues and a format for documentation of services. Comparison clinics will continue to use their usual standard of care. Provider delivery of preventive services will be assessed through provider self-reports and independent adolescent patient reports following their routine well care visits. Analyses will focus on the assessment of within-provider changes in the probabilities of screening an adolescent between the different study conditions and comparisons of these changes between the Intervention and Comparison sites.