Discussion of Risky Behaviors Between Adolescents and Their Doctors 

 
 

Baseline Phase in the Examination of the Use of Pre-visit Questionnaires to Prompt Youth Violence Discussions

Authors: Alison Riese MD, Megan Ranney MD MPH, Michael Mello MD MPH

Injury Prevention Center, Department of Emergency Medicine, Rhode Island Hospital, Alpert School of Medicine at Brown University, Providence, RI

Background

  • Youth violence (YV) is a major health problem for US adolescents
  • The importance of screening for YV during primary care visits has been emphasized by the American Academy of Pediatrics, however, rates of screening are extremely low.
  • Primary care providers need tools to help support this practice
  • Electronic pre-visit questionnaires (PVQs) are viewed favorably by adolescents and can prompt disclosure of sensitive health topics
  • The feasibility, acceptability, and efficacy of an electronic PVQ in prompting YV discussions have not been studied
 

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Academic Source

Presented at: PAS ASPR Vancouver 2014

 

Objectives

  1. Determine baseline rates of pediatricians’ communication about adolescent health risk behaviors, including YV
  2. Evaluate the impact of an electronic adolescent health risk behavior PVQ on healthcare providers’ discussions about YV during primary care visits
  3. Assess the acceptability and feasibility of the electronic PVQ in a busy primary care practice
  4. Conduct an exploratory analysis of moderators of effectiveness including patient and provider characteristics
 
 Fig 1: Doctor-Patient Discussions of Health

Fig 1: Doctor-Patient Discussions of Health

 
 
 Fig 2: Among Adolescents with Violence Exposure, Frequency of Doctor-Patient Discussions (n = 21)

Fig 2: Among Adolescents with Violence Exposure, Frequency of Doctor-Patient Discussions (n = 21)

Methods

  • Study setting and participants:
    • Hasbro Children’s Hospital Primary Care Clinics, which are subdivided into 8 micro-practices
    • Adolescents ages 13-21 presenting for annual physicals
  • Phase I:
    • Two-month baseline exit surveys to obtain baseline frequencies of patient-provider discussions of health risk behaviors Surveys asked which risk behavior topics were discussed, type of counseling received; also assessed YV exposure
  • Phase II (to occur this Fall:)
    • 3-month experimental phase
    • Cluster randomized controlled trial design by micro-practice
    • Will randomize to experimental vs control electronic PVQ
    • Experimental version includes YV 5 questions derived from 2011 YRBS
    • Exit surveys to determine patient-provider discussion of health risk behaviors
  • At close of Phase II, healthcare providers will complete brief assessments of acceptability & feasibility of the PVQ

 

Preliminary Results 

 
 
Table 1. Demographics of Baseline Participants Participants (n=50)
Mean Age 50
Sex
    Male

26 (52%)
Race/Ethnicity
    White
    Black
    Hispanic
    Asian
    Other

7 (14%)
17 (34%)
23 (46%)
6 (23%)
1 (2%)
Visit Characteristics
    Had seen doctor previously
    Talked with doctor alone

31 (62%)
43 (86%)
Violence Exposure
    Report of violence exposure
    Physical fight in past 12 months
    Threatened with weapon
    Carried weapon

21 (42%)
12 (24%)
1 (2%)
1 (2%)
Risk Behaviour Topics
    Was bullied sometimes/often

  12 (24%)
 
 
 Fig 3: Adolescent-Rated Helpfulness of Health Risk Behaviour Discussions

Fig 3: Adolescent-Rated Helpfulness of Health Risk Behaviour Discussions

Conclusions

  • Fighting/violence is topic least discussed during primary care visits, similar to prior literature
  • Majority of adolescents who did discuss fighting/violence rated conversation very helpful—a greater percentage than other health risk behavior discussions
  • Next steps: Introduce pre-visit questionnaire with YV questions and evaluate effect on doctor-patient discussions

Acknowledgements

Special thanks to Janette Baird, PhD,  Patrick Vivier, MD PhD, Tina Cheng, MD MPH

 

 
 
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Injury Prevention Center, Department of Emergency Medicine, Rhode Island Hospital, Alpert School of Medicine at Brown University, Providence, RI 

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