Paperny David M N
Perm J. 2004 Winter;8(1):74-9. doi: 10.7812/TPP/03-121.
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.
Create a clinically effective, cost-efficient, replicable program to screen and counsel adolescents.
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.
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.
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.
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.
青少年预防性筛查和咨询工作耗时较长，通常由临床医生进行，而目前这些医生提供的预防性服务远少于指南建议的数量。
创建一个临床有效、成本效益高且可复制的青少年筛查和咨询项目。
青少年预防服务（APS）项目旨在筛查13至24岁青少年的健康危害行为和情绪问题，并使用交互式计算机软件和年轻的健康教育工作者提供健康教育。
在试点评估以及整理四年期夏威夷凯泽医疗集团檀香山分部的经验数据时，记录了参与者的人口统计学信息、预约时发现的健康问题以及诊疗时间和结果。在试点评估中，将APS项目诊疗与标准临床医生诊疗在发现的健康问题频率、提供的指导、患者满意度水平和成本方面进行了比较。
与临床医生诊疗相比，APS项目诊疗发现的健康问题显著更多（p < 0.05），并且针对几种高风险行为提供了更多的预期指导。启动后（成本约为6700美元），每次诊疗费用约为35美元，而标准临床医生诊疗费用为75美元。更多患者（71%-74%）更喜欢APS项目诊疗而非标准临床医生诊疗。
APS项目为青少年的健康危害行为和情绪问题提供全面筛查和个性化健康教育，且每次诊疗成本较低，效果更好。这种项目模式可轻松修改用于提供成人预防服务，值得在凯泽医疗集团的整个医疗系统中推广。
