Original article
Increasing Delivery of Preventive Services to Adolescents and Young Adults: Does the Preventive Visit Help?

https://doi.org/10.1016/j.jadohealth.2018.03.013Get rights and content

Abstract

Purpose

Despite decades of emphasizing the delivery of adolescent preventive care visits and evidence that many preventive services reduce risk, little evidence links preventive visits to increased preventive service delivery. This study examined whether a preventive healthcare visit versus any nonpreventive healthcare visit was associated with higher rates of adolescent and young adult preventive services.

Methods

Analyzed Medical Expenditure Panel Survey data (2013–2015) to determine whether those with a preventive versus nonpreventive healthcare visit had higher rates of past-year preventive services receipt; adolescents (N = 8,474, ages 10–17) and young adults (N = 5,732, ages 18–25). Bivariable and multivariable analyses adjusting for personal/sociodemographic covariates tested for differences in preventive services rates between preventive versus nonpreventive care groups. Adolescent services were blood pressure, height and weight measured, and all three measured; and guidance given regarding healthy eating, physical activity, seatbelts and helmets, secondhand smoke, dental care, all six topics received, and time alone with provider. Young adult services were blood pressure and cholesterol checked, received influenza immunization, and all three services received.

Results

All preventive services rates were significantly higher in those attending preventive visits versus those with nonpreventive visits. Adolescent services increase ranged from 7% to 19% and young adults increase from 9% to 14% (all bivariable and multivariable analyses, p < .001). However, most rates were low overall.

Conclusions

Higher rates of preventive services associated with preventive visits support its clinical care value. However, low preventive services rates overall highlight necessary increased efforts to promote preventive care and improve the provider delivery of prevention for both age groups.

Section snippets

Study design and sampling

MEPS is an annual survey sponsored by the Agency for Healthcare Research and Quality that consists of a set of household surveys of health, insurance coverage, and healthcare utilization and expenditures of the United States civilian noninstitutionalized population. It uses an overlapping panel design in which a new cohort is recruited annually to complete face-to-face interviews at five-time periods across 2 years [22]. The present analysis utilized three MEPS data sets: the Full-Year

Demographic descriptions of adolescents and young adults

The adolescent analytic sample was 50% female, 56% white, 21% Hispanic, 13% black, 4% Asian, and 6% other. Thirty-three percent were at ≥400% FPL, 31% at 200–≤400% FPL, 20% at 100–<200% FPL, and 16% at <100% FPL (Table 1). Greater than 85% of adolescents had full-year insurance, and of those with any past-year healthcare utilization, 69% had received a preventive visit. The young adult analytic sample was 59% female, 62% white, 17% Hispanic, 12% black, 5% Asian, and 4% other. Thirty-four

Discussion

The present study found strong evidence linking receipt of a preventive visit to increased receipt of preventive services. Receipt of a preventive visit was associated with an increased likelihood of receiving preventive services: this held true for every service variable measured at highly significant levels. This study assessed a range of services; including services readily available outside the clinic setting (e.g., blood pressure). To our knowledge, this is the first study to demonstrate

Funding Sources

This study was supported by the Health Resources and Services Administration (HRSA) of the United States. Department of Health and Human Services (HHS) (under #U45MC27709, Adolescent and Young Adult Health Capacity Building Program); with supplemental support from HRSA grant #UA6MC27378.

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    Conflict of interest: The authors declare that they have no conflict of interest.

    Disclaimer: This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government.

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