FACTORS AFFECTING PEDIATRIC RESIDENTS INTENTIONS TO SCREEN FOR HIGH-RISK BEHAVIORS

Purpose: To determine the factors associated with the intentions of pe diatric residents to: 1) screen adolescents for high risk behaviors us ing the Guidelines for Adolescent Preventive Services (GAPS) and 2) to record the results in the medical record. Methods: 64 pediatric resid ents at a university children's hospital were given seven scenarios an d were asked to rate on a five point Likert scale (1 = always, 5 = nev er) the likelihood that they would ask and document adolescent patient responses about sexual activity/birth control, alcohol/drug use, depr ession/suicidal ideation, fighting/coping with anger, and nutrition/ea ting disorders. The association of patient-related factors (e.g., gend er, presenting symptom, medical setting, known private provider, and p resence of a chronic illness) and resident-related factors (e.g. gende r, post graduate level, future plans, and a prior adolescent rotation) on intentions to screen was determined using analysis of variance for ranked data. Results: Residents indicated they were most likely to as k adolescents about sexual activity (mean Likert = 2.6, median Likert = 2, range 1-5) (P = 0.014). Residents were more likely to screen for substance use (2.8, 3, 1-5) than nutritional issues (3.5, 4, 1-5) (P l ess than or equal to 0.0001), and were least likely to ask about depre ssion (3.8, 4, 1-5) and fighting (3.9, 4, 1-5) (P less than or equal t o 0.0001). Although residents reported that they were likely to record screening results in the medical record (median Likert score = 1), th ey noted the most common reasons for not recording to be fear that par ents would see the record, lack of time, and the feeling that negative responses to screening need not be recorded. The patient-related fact ors that significantly affected residents' intentions to screen includ ed: presenting symptom, medical setting, and the presence of a chronic illness (P less than or equal to 0.05). Female gender of the patient increased only the likelihood of nutrition screening. Male residents r eported a greater intention to screen for depression (P = 0.046). Post -graduate level and a prior adolescent rotation influenced the intenti on to screen for most behaviors. Conclusions: This study found that re sidents are more likely to indicate that they would screen for sexual activity and substance use than for nutritional disorders, depression, and fighting. Several patient-related and resident-related factors in fluence the likelihood of residents to screen for various high risk be haviors. Educational efforts are needed to increase residents' screeni ng for high risk behaviors.