Knishkowy Barry, Schein Moshe, Kiderman Alexander, Velber Aliza, Edman Richard, Yaphe John
Department of Mother, Child and Adolescent Health, Ministry of Health, Jerusalem, Israel.
ScientificWorldJournal. 2006 Jun 7;6:619-27. doi: 10.1100/tsw.2006.116.
The AMA Guidelines for Adolescent Preventive Services (GAPS) has been the cornerstone of preventive care for teenagers since its publication in 1994. Despite this, there has been little documentation of their implementation in the family medicine literature. This article gives an overview of a family practice-based adolescent preventive health program based on GAPS recommendations, and reports on compliance, feasibility and health issues. A Community-Oriented Primary Care (COPC) program targeted all adolescent patients aged 12-18 years in two Israeli family practices. 321 teenagers were invited to participate. Every 7th and 10th grader was invited for a preventive health visit with the family physician and nurse. The visits included a medical evaluation, screening and counseling regarding health issues recommended by GAPS, and counseling regarding personal health concerns. Parents were also invited to meet with the staff. 184 (57%) of the adolescents invited for health visits attended. The overall visit time was 47 minutes, including 12 minutes for a questionnaire and 35 minutes with providers. Common biomedical problems included overweight, acne and dysmenorrhea. Health risk behaviors and psychosocial problems included cigarette or alcohol use, dieting, infrequent/never seat belt use, and feeling depressed. 78% wanted to discuss at least one personal health issue. 27% were invited for follow-up visits. Only 3% of the parents came for visits. A community-oriented approach facilitates bringing adolescents for preventive health visits. Many previously undetected health issues, particularly psychosocial and behavioral, are revealed during these visits. A concerns checklist aids in addressing personal health concerns.
自1994年发布以来，美国医学协会青少年预防服务指南（GAPS）一直是青少年预防保健的基石。尽管如此，家庭医学文献中关于其实施情况的记录却很少。本文概述了一项基于GAPS建议的以家庭医疗为基础的青少年预防健康计划，并报告了其依从性、可行性和健康问题。一项以社区为导向的初级保健（COPC）计划针对以色列两家家庭医疗诊所中所有12至18岁的青少年患者。邀请了321名青少年参与。邀请了每7年级和10年级的学生与家庭医生和护士进行一次预防健康检查。检查包括医学评估、针对GAPS建议的健康问题进行筛查和咨询，以及针对个人健康问题的咨询。还邀请了家长与工作人员会面。受邀进行健康检查的青少年中有184人（57%）参加了。每次检查的总时长为47分钟，其中包括12分钟填写问卷以及35分钟与医护人员交流。常见的生物医学问题包括超重、痤疮和痛经。健康风险行为和心理社会问题包括吸烟或饮酒、节食、很少/从不系安全带以及感到抑郁。78%的青少年希望讨论至少一个个人健康问题。27%的青少年被邀请进行随访。只有3%的家长前来就诊。以社区为导向的方法有助于促使青少年前来进行预防健康检查。在这些检查过程中发现了许多以前未被察觉的健康问题，尤其是心理社会和行为方面的问题。一份问题清单有助于解决个人健康问题。
