Primary Care Research

Clinician training and charting tools can improve primary care screening and counseling of adolescents about risky behaviors

The majority of adolescent illnesses and deaths are due to preventable behaviors such as substance abuse, unsafe sexual practices, and risky vehicle use. Certain approaches by primary care clinicians can improve screening and counseling of adolescents for these and other risky behaviors, concludes a study supported primarily by the Agency for Healthcare Research and Quality (HS11095). Researchers from the University of California, San Francisco, and Kaiser Permanente of Northern California analyzed reports from adolescents about the screening and counseling they received during a well visit at an intervention clinic (two clinics) or a usual care pediatric clinic (two clinics) in the same health maintenance organization.

In the first phase of the intervention, 37 pediatric primary care providers attended a training workshop to increase screening and counseling of adolescents in six areas: tobacco, alcohol, drugs, sexual behavior, seatbelt use, and helmet use. In the second phase, intervention clinics integrated screening and charting tools, such as prompts, cues, and charting forms to document screening and counseling. In the comparison sites, 39 providers continued to provide the usual standard of care to their adolescent patients.

In the intervention sites, risky behavior screening rates increased on average from 58 to 83 percent across the six targeted areas and counseling rates increased from 52 to 78 percent. There were no significant increases in screening and counseling at the usual care clinics during the same period. The training component seemed to account for most of the increase at intervention clinics, with the screening and charting tools sustaining the effects of the training.

More details are in "Increasing the screening and counseling of adolescents for risky health behaviors: A primary care intervention," by Elizabeth M. Ozer, Ph.D., Sally H. Adams, Ph.D., Julie L. Lustig, Ph.D., and others in the April 2005 Pediatrics 115(4), pp. 960-968.

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