National health care visit patterns of adolescents - Implications for delivery of new adolescent vaccines

Objective: To prepare for new adolescent vaccinations by examining current use of adolescent outpatient health care visits throughout the United States. Design: Cross- sectional analysis of visits. Setting: Outpatient hospital- and office- based practices in the United States included in the 1994- 2003 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. Participants: Adolescents ages 11 to 21 years ( n= 63 529) with outpatient visits. Main Outcome Measures: Type of physician seen for overall and preventive visits, visit trends over time, demographics of adolescents seen by pediatricians vs family physicians, and visit type during which a vaccine was provided. Results: Late- adolescence females ( 18- 21 years old) had the most overall visits, 36% of which were to obstetriciangynecologists. Pediatricians were seen at most outpatient visits for adolescents 14 years or younger, with fewer visits for those older than 14 years. Family practitioners were seen at one quarter of all outpatient visits. Only 9% of all adolescent visits were for preventive care. Early adolescents ( 11- 14 years old) had 3 times more preventive visits than late adolescents ( P < .001). Pediatricians were more likely to see adolescents who were younger, male, black, and urban and were more likely to be seen for preventive visits compared with family physicians ( P < .001 for all). Altogether, 80%, 70%, and 64% of visits that included measles- mumps- rubella, hepatitis B, and diphtheriatetanus vaccinations, respectively, were for preventive care. Conclusions: On the basis of current utilization patterns, adolescent vaccinations should be delivered during early or middle adolescence. If vaccines are to be provided to older adolescent females, involvement of obstetrician- gynecologists in vaccine delivery is critical.