Harris Sion K, Aalsma Matthew C, Weitzman Elissa R, Garcia-Huidobro Diego, Wong Charlene, Hadland Scott E, Santelli John, Park M Jane, Ozer Elizabeth M
Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Department of Pediatrics, Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
J Adolesc Health. 2017 Mar;60(3):249-260. doi: 10.1016/j.jadohealth.2016.10.005. Epub 2016 Dec 20.
We reviewed research regarding system- and visit-level strategies to enhance clinical preventive service delivery and quality for adolescents and young adults. Despite professional consensus on recommended services for adolescents, a strong evidence base for services for young adults, and improved financial access to services with the Affordable Care Act's provisions, receipt of preventive services remains suboptimal. Further research that builds off successful models of linking traditional and community clinics is needed to improve access to care for all youth. To optimize the clinical encounter, promising clinician-focused strategies to improve delivery of preventive services include screening and decision support tools, particularly when integrated into electronic medical record systems and supported by training and feedback. Although results have been mixed, interventions have moved beyond increasing service delivery to demonstrating behavior change. Research on emerging technology-such as gaming platforms, mobile phone applications, and wearable devices-suggests opportunities to expand clinicians' reach; however, existing research is based on limited clinical settings and populations. Improved monitoring systems and further research are needed to examine preventive services facilitators and ensure that interventions are effective across the range of clinical settings where youth receive preventive care, across multiple populations, including young adults, and for more vulnerable populations with less access to quality care.
我们回顾了有关系统层面和就诊层面策略的研究，这些策略旨在加强为青少年及青年成年人提供临床预防服务以及提高服务质量。尽管对于青少年推荐服务存在专业共识，对于青年成年人服务有强有力的证据基础，并且《平价医疗法案》的条款改善了获得服务的经济途径，但预防性服务的接受情况仍然不尽人意。需要开展更多基于成功模式（即连接传统诊所和社区诊所）的研究，以改善所有青少年获得医疗服务的机会。为优化临床诊疗过程，一些有前景的、以临床医生为重点的改善预防性服务提供的策略包括筛查和决策支持工具，特别是当这些工具集成到电子病历系统并得到培训和反馈支持时。尽管结果参差不齐，但干预措施已从单纯增加服务提供转向证明行为改变。对新兴技术（如游戏平台、手机应用程序和可穿戴设备）的研究表明存在扩大临床医生影响力的机会；然而，现有研究基于有限的临床环境和人群。需要改进监测系统并开展进一步研究，以检查预防性服务的促进因素，并确保干预措施在青少年接受预防性护理的各类临床环境中、在包括青年成年人在内的多个人群中以及在获得优质护理机会较少的更脆弱人群中均有效。
