Preventive services in a health maintenance organization - How well do pediatricians screen and educate adolescent patients?

Objective: To determine whether pediatricians in managed care settings adhe re to national guidelines concerning the provision of clinical preventive s ervices. Design: Surveys were mailed between September 1996 and April 1997 to all pe diatricians practicing in a California group-model health maintenance organ ization. The survey asked pediatricians about their screening and education practices on 34 recommended services and the actions taken with adolescent patients who have engaged in risk behavior. Results: The response rate was 66.2% (N = 366) Pediatricians, on average, s creened 92% of their adolescent patients for immunization status and blood pressure; 85% for school performance; 60% to 80% for obesity, sexual interc ourse, cigarette use, alcohol use, drug use, and seat belt and helmet use; 30% to 47% for access to handguns, suicide, eating disorders, depression, a nd driving after drinking alcohol; fewer than 20% for use of smokeless toba cco, sexual orientation, sexual and physical abuse, and riding a bike or sw imming after drinking alcohol; and 26% to 41% for close friends' engagement in risk behavior, Pediatricians' assessment and education with adolescent patients who screened positive for risk behavior was particularly low. Fema le physicians, physicians who saw a greater proportion of older adolescents , and recent medical school graduates were more likely to provide preventiv e services. Conclusions: Pediatricians in this health maintenance organization provide preventive services to adolescent patients at rates below recommendations b ut at rates greater than physicians in other practice settings. Improvement is especially needed in the areas that contribute most to adolescent morta lity and for patients who screen positive for a risk behavior.