Primary care providers' responsiveness to health-risk behaviors reported by adolescent patients

OBJECTIVE: To assess clinicians' responsiveness to health-risk behaviors reported by adolescent patients during a comprehensive clinical preventive services visit. DESIGN: Nonprobability sample of adolescent patients scheduled for a routine physical examination. SETTING: Seven clinical sites in the Chicago, Ill, area. PARTICIPANTS: Fifteen primary care providers and 95 adolescent patients between 11 and 18 years of age. INTERVENTION: Providers delivered comprehensive clinical preventive services to adolescent patients using the Guidelines for Adolescent Preventive Services model. This model includes screening, guidance, a physical examination, and immunizations. Prior to the visit, adolescent patients completed a screening questionnaire that included a 52-item health-risk behavior profile. Responses on the screening questionnaire were discussed during the visit. MAIN OUTCOME MEASURES: Each provider's responsiveness to reported health-risk behaviors was determined by comparing the adolescent patient's responses on the screening questionnaire with those reported during a debriefing interview with the adolescent about whether specific subjects were discussed. Responsiveness to highly sensitive behaviors was determined by comparing the screening questionnaire and the medical record. RESULTS: On average, each adolescent patient reported 10 risk behaviors, of which 7 were discussed. The severity of the reported risk behavior, the number of reported biological health concerns, and the adolescent patient's sex were significant predictors of the provider's responsiveness. The number of reported health-risk behaviors, visit duration, provider's professional role and sex, whether the adolescent was a new patient, and the adolescent patient's age were unrelated to responsiveness. CONCLUSIONS: Providers addressed most health-risk behaviors reported during a single visit, but responsiveness declined when 3 or more biological health concerns or relatively severe problems were reported. Steps can be taken to increase providers' responsiveness.