ADOLESCENT HEALTH: Teens Skip Out on Doctor Visits
While teenagers "today probably have more reasons to see a doctor regularly than any generation before them," many "are as out of touch with the health care system as their parents are from the music their kids listen to," the Los Angeles Times reports. Although they comprise 15% of the population, teens account for only 9% of medical visits, pointing to an "underuse of services." As the "lost souls of health care," teenagers have often "outgrown their pediatrician's ability to make them feel comfortable and meet their needs," but also are "unwelcome by practitioners who treat adults." Dr. James Perrin, director of the division of general pediatrics at Massachusetts General Hospital in Boston, acknowledged: "We've not done a great job" with treating adolescents, adding, "It's easy to do the ordinary doctoring things. But that is probably not going to meet the needs of many adolescents." One survey of HMO doctors found that only 31% of pediatricians enjoy working with adolescents, compared to 34% of internists, half of OB/GYNs and 61% of family-practice doctors. Partly because of this disconnect, few teenagers receive counseling or education during office visits. According to a study published last year in Pediatrics, only 3% of teenagers received counseling on STDs, smoking cessation and weight control. At the same time, other studies indicate that many teenagers have undiagnosed STDs or eating disorders, or have developed poor health habits that could continue into adulthood. Other teenagers avoid medical checkups altogether, as indicated by a Journal of the American Medical Association study showing that 18.7% of teenagers did not see a doctor for a medical problem in the last year. Most thought the problem would go away (63%), while 15% feared what the doctor would do or say, 14% could not pay for a visit, 11.5% worried about confidentiality, 11.7% could not get a parent or guardian to accompany them and 8.9% had difficulty making an appointment. Teens "often are unaware of their rights or are ambivalent about taking responsibility for their care," not understanding that most states' patient confidentiality laws allow them to receive birth control, prenatal care and STD treatment without their parents' knowledge or consent. And once they do get care, "experts say they don't always get the appropriate care," the Los Angeles Times reports. Recognizing the problem, the American Academy of Pediatrics last year "urged its members to be ready, willing and able to dispense contraceptives if they are going to see teenage patients."
Children Now, an Oakland, Calif.-based child advocacy organization, this week is releasing a report titled "Partners in Transition," that calls for HMOs "to do a better job of improving health care for adolescents." It describes "some ways to accomplish those improvements." Children Now President Lois Salisbury said that managed care organizations are "poised to do better by their teen patients," adding, "The managed care model, at its best, really has plenty of incentive to emphasize the preventive in ways that the classic health insurance model never had." According to one study, an HMO that provides contraceptives to sexually active teens can save between $308 and $936 in costs associated with pregnancy and treating STDs. Salisbury said, "You prevent a teen pregnancy and you have saved your plan money." At the same time, some doctors are not embracing the idea that managed care will make huge strides in adolescent health. One Santa Monica, Calif., physician, Dr. Victoria Paterno, said she will not accept HMO patients because "reimbursements fail to cover the time doctors need to spend on prevention counseling with teenagers." She said, "If you expect to have any relationship with a teenager, you have to spend time. The reality is that insurance companies don't reimburse enough" (Roan, Los Angeles Times, 4/4).