Arthur Elster

Reliability in adolescent reporting of clinician counseling, health care use, and health behaviors.

Background: Accurate measures of health-care use by adolescents would be useful in managed care quality assurance, public health surveillance, and health-care research. Objective: To assess test-retest reliability and factors associated with reliability of adolescent reports of clinician counseling, preventive health services, and health behaviors. Research Design: A convenience sample of high school students (N = 253) completed identical paper-and-pencil surveys in school and 2 weeks apart. Multiple linear regression was used to evaluate the influence on response reliability of individual factors and question item characteristics. Reliability was assessed using Cohen &kgr;. Results: &kgr; values for specific questions varied widely (0.94–0.33). Median &kgr; values for behavioral, counseling, and health-service questions were 0.74, 0.63, 0.56, respectively. Lower sentence complexity, certain time frames (ever, age at first occurrence, last time), and behavioral question type were associated with greater reliability in adolescent reporting (final model R2 = 0.54). Adolescents’ age and ethnicity were not predictive of reliability, though girls were slightly more reliable reporters than boys. Overall, the prevalence of responses at times 1 and 2 were similar; 95% of responses at time 2 were within 5 percentage points of time-1 estimates (SD = 2.4). Conclusions: The reliability of adolescent reporting was strongly influenced by question characteristics such as sentence complexity and time frame; these should be carefully considered in the construction of questionnaires for adolescents. Adolescents can be an accurate source of health-care service data.

INTEGRATING COMPREHENSIVE ADOLESCENT PREVENTIVE SERVICES INTO ROUTINE MEDICINE CARE: Rationale and Approaches

Relying on therapeutic interventions to address health problems after they occur has proven costly and does not address the need to reduce the number of youth who develop these health problems. Primary care physicians have an important role to play in promoting adolescent health through a strategy of providing health guidance to adolescents and parents, screening, and promoting immunizations. Reducing the health risk behaviors of adolescents is a challenge that is best accomplished with the support of other preventive initiatives. Clinical preventive services should complement and reinforce preventive efforts in schools (i.e., comprehensive school health programs) and communities (i.e., mass media campaigns and health regulations). GAPS recommendations developed by the AMA and recommendations from other groups provide a model for organizing the content and delivery of comprehensive preventive services for adolescents. Physicians and other primary care health providers may use these recommendations to expand the quantity and quality of preventive services they offer to adolescents. Additional information about preventive services and GAPS, including a complete list of the recommendations, dates for future GAPS training, a description of the materials developed to help implement preventive services, other national efforts in adolescent preventive services, and current articles in scientific literature, can be reviewed on the AMA web site (http:/(/)www.AMA-Assn.Org/Adolhlth/Adolhlth+ ++.htm).

ADOLESCENT PREVENTIVE SERVICES

Today, there are significant risks to the health of teenagers. Drugs (tobacco, alcohol, steroids and others), sex (pregnancy, STDs, date rape), nutrition (obesity and eating disorders), and violence (abuse, fighting) are unfortunately a part of many teens lives. These risks increase throughout the teen years. Since each risk has a strong behavioral component, we hope to modify the behavior and minimize the risk. Prevention and health promotion are an important part of health care for teens. Primary care providers, such as family physicians, are in an excellent position to provide teen preventative care that is comprehensive and specific to the needs of each teen.

Making a business case for small medical practices to maintain quality while addressing racial healthcare disparities.

Various reports have documented variations in quality of care that occur among racial and ethnic populations, even after accounting for socioeconomic factors and health insurance status. Although quality improvement initiatives are often touted as the answer to healthcare disparities, researchers have questioned whether a business case exists that supports this notion. We assess various barriers and incentives for using quality improvement to address racial and ethnic healthcare disparities in small-to-medium-sized practices. We believe that although both indirect and direct cost incentives may exist, a favorable business case for small private practices cannot be made unless there are additional financial incentives. The business community can work with health plans to provide these incentives.