PEDIATRICS Vol. 104 No. 1 July 1999, pp. 35-42
Utilization of Physician Offices by Adolescents in the United States
Received Oct 19, 1998; accepted Dec 17, 1998.
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From the * Craig-Dalsimer Program in Adolescent Medicine,
Division of General Internal Medicine, Department of Medicine,
University of Pennsylvania School of Medicine, and the Section of
Adolescent Medicine, Division of General Pediatrics, Department of
Pediatrics, Children's Hospital of Philadelphia; and the
Educational Commission for Foreign Medical Graduates, Philadelphia,
Pennsylvania; and the § Division of Adolescent Medicine, Department of
Pediatrics, Children's Hospital Medical Center, Cincinnati, Ohio.
Recent guidelines for adolescent primary care call for the specification of clinical services by three adolescent age subgroups. Yet analyses of office visits have either merged adolescence into one stage or divided it at age 15 years.
Objective. To explore the utilization of physician offices in the United States by early (11-14 years), middle (15-17 years), and late (18-21 years) adolescents.
Design. Secondary analysis of the 1994 National Ambulatory Medical Care Survey, focusing on visits made by the three adolescent age groups.
Setting. Nationally representative sample of 2426 physicians in nonfederal, nonhospital offices.
Subjects. A total of 33 598 visits by patients of all ages, representing 681.5 million visits in 1994.
Main Outcome Measures. Number of visits, health insurance, providers seen, duration of visits, reasons for visits, resulting diagnoses, and counseling provided.
Results. Adolescents aged 11 to 21 years made 9.1% (61.8 million) of the total office visits and represented 15.4% of the total US population in 1994. This underrepresentation in visits held across all three adolescent age subgroups. Within the adolescent cohort, whites were overrepresented relative to their population proportion (78.5% of visits, 67.6% of population) and blacks and Hispanic adolescents were underrepresented (8.3% and 9.3% of visits, 15.5% and 13.1% of population). Middle adolescence signaled a life turning point from male to female predominance in office visits. Peak lifetime uninsurance rates occurred at middle adolescence for females (18.7%) and late adolescence for males (24.0%). Between childhood and early adolescence, public insurance decreased from 24.7% to 15.7% and uninsurance increased from 12.7% to 19.7%. Pediatricians accounted for the highest proportion of early adolescent visits (41.2%), family physicians for middle adolescent visits (35.3%), obstetrician-gynecologists for late adolescent female visits (37.3%), and family physicians for late adolescent male visits (34.8%). Mean visit duration during adolescence was 16 minutes, did not differ by age subgroup or sex, exceeded that of children (14.6 minutes), and was shorter than that of adults (19.3 minutes). Obstetrician-gynecologists spent more time with adolescents than did other physicians. Education or counseling was included in 50.4% of adolescent visits, ranging from 65.1% for obstetrician-gynecologists to 34.8% for internists. During early adolescence, the leading reasons for both male and female visits were respiratory (19.4%), dermatological (10.0%), and musculoskeletal (9.7%). A similar profile was found for middle and late adolescent males. For middle and late adolescent females, the leading reason for visits was special obstetrical-gynecological examination (12.8% and 21.1%), and the leading diagnosis resulting from visits was pregnancy (9.5% and 20.4%).
Conclusions. Adolescents underutilize physician offices and are more likely to be uninsured than any other age group. Visits are short, and counseling is not a uniform component of care. As adolescents mature, their providers, presenting problems, and resulting diagnoses change. The data from the National Ambulatory Medical Care Survey support a staged approach to adolescent preventive services, targeted to the needs of three age subgroups.
Key words: adolescents, utilization, ambulatory services, health insurance.
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