A New Model for Adolescent Preventive Services.

CONTEXT Preventive screening and counseling of adolescents is time-intensive and is usually done by clinicians who currently provide far fewer preventive services than guidelines suggest. OBJECTIVE Create a clinically effective, cost-efficient, replicable program to screen and counsel adolescents. DESIGN The Adolescent Preventive Services (APS) Program was designed to screen youth (aged 13-24 years) for health-compromising behaviors and emotional problems and to provide health education using interactive computer software and youthful health educators. MAIN OUTCOME MEASURES Demographics of participants, health problems identified at appointments, and length and outcome of sessions were noted in pilot evaluation and in compilation of data for the four-year KP Honolulu experience. In the pilot evaluation, APS Program visits were compared to standard clinician visits for frequency of health problems identified, guidance delivered, level of patient satisfaction, and cost. RESULTS Significantly more health problems were identified (p < .05) and more anticipatory guidance on several high-risk behaviors was given during APS Program visits than during clinician visits. After start up (at a cost of about $6700), visits each cost about $35 compared with $75 for a standard clinician visit. More patients (71%-74%) preferred an APS Program visit to a standard clinician visit. CONCLUSION The APS Program provides comprehensive screening and individualized health education for health-compromising behaviors and emotional problems in adolescents and has better outcome for lower per-visit cost than the conventional clinician-based office visits. This program model, which could easily be modified for delivery of adult preventive services, deserves expansion throughout the KP health system.