This report presents findings from Periodic Survey #42 on pediatricians’ current practices and attitudes regarding adolescent care, as well as barriers to providing that care. The survey was initiated by the Section on Adolescent Health. These finding will be used to help develop the content of educational programs in adolescent health care and assist in efforts to encourage residency programs to increase the amount of time in adolescent health care training, as well as encourage insurers to improve coverage for adolescent health care. The survey was conducted from November 1998 to February 1999; after five mailings a total of 943 completed questionnaires were received for a response rate of 58.1%. These analyses are based on responses from the 704 pediatricians who provide health supervision to patients age 12 or older (this represents 96.4% of pediatricians who provide health supervision).

 Providing Health Care to Adolescents 

• Two-thirds of pediatricians with patients over age 11 (66.9%) are satisfied with the number of adolescent patients in their practice, and 29.7% would like to see more adolescent patients. Pediatricians estimate an average of 20.7% of their patients is over age 11. 
• A majority of pediatricians say they discuss substance abuse, fitness and nutrition, school issues, sexual activity and pregnancy/STD prevention with almost all of their adolescent patients:

  Percent of pediatricians who discuss:

• Tobacco use (77.9%)
• Drug/alcohol use (77.5%)
• School Issues (73.3%)
• Sexual activity/pregnancy prevention (72.7%)
• Exercise/physical fitness (59.2%)
• Nutrition/eating disorders (58.7%)
• STDs (56.6%) 

• Overall, pediatricians are fairly confident in their ability to assess and manage common medical problems of adolescents. On a scale where 1=very confident and 5=not at all confident, the mean score for confidence in assessing and managing medical problems is 1.5 and 1.4, respectively. However, pediatricians are slightly less confident in their ability to diagnose and manage gynecological problems (mean score: 2.8 and 2.9, respectively) and psychosocial problems (2.5 and 2.8) of adolescents.  

Barriers to Providing Health Care to Adolescents 

• A large proportion of pediatricians named the following as barriers to providing adolescent health care in their practice:
  
  
• Lack of training in gynecological and pregnancy care (56.9% of pediatricians reporting)
• Infrequent follow-up/poor attendance (51.0%)  
• Lack of adequate reimbursement for the time it takes to provide care for adolescents (46.1%)
• Lack of interest in providing gynecological/pregnancy care (41.8%)
• Difficulty identifying where to refer adolescents for psychosocial problems (39.9%)
• Lack of training in adolescent health problems (39.5%) 

According to a majority of pediatricians, the following are not perceived as barriers to adolescent health care in their practice: difficulties identifying where to refer adolescents for subspecialty (medical) care (68.4%), the inability to take on additional patients (66.6%), high medical liability costs (64.5%), a lack of interest in adolescent health issues (60.2%), and difficulties communicating with adolescents (55.6%). 

For all of the listed potential barriers, many pediatricians (20%-30%) are unsure as to whether these factors act as barriers to providing adolescent care in their practice.

• Overall, pediatricians report more frequent barriers to providing adolescent health care in managed care plans than in traditional (fee-for-service) indemnity plans.
  
  
• 48.8% of pediatricians say they almost always receive inadequate reimbursement for seeing adolescents in managed care plans compared to 29.8% who say reimbursement from indemnity plans is almost always inadequate.
• 34.3% of pediatricians say they almost always have difficulty referring adolescents in managed care for a psychosocial problem; 18.9% say this is almost always a problem in indemnity plans.
• Problems scheduling adequate time for adolescent visits are said to be a barrier more frequently in managed care than in indemnity plans: 30.1% and 21.4% of pediatricians reporting, respectively.
  
  
• Pediatricians identified the following as very effective in reducing potential barriers to providing adolescent health care:
  
  
• Availability of clearly defined state statutes on confidentiality, consent and other legal issues (61.4%)
• Statements regarding confidentiality, consent and ethics of adolescent care by state medical boards, malpractice insurers, the AAP, etc. (57.2%)
• Information on local resources for referral for adolescents’ medical or psychosocial problems (54.4%)
• Training in the area of confidentiality, informed consent and ethical decision-making at continuing medical education sessions (52.6%)
• Brochures and other printed material on adolescent health topics for patient education (50.7%)
• Training on how to communicate effectively with adolescents (50.4%)
• Information on appropriate ICD-9 and CPT codes for adolescent-specific care (49.9%)  

Interest in Further Education in Adolescent Health

More than one-third of pediatricians (36.3%) are very interested in receiving further education in the area of adolescent health, and 53.7% are somewhat interested. These pediatricians identified AAP self-instructional material (56.2%), local 2-day training courses (54.5%) and handbooks, guidelines or other written materials (51.5%) as preferred ways to receive education in adolescent health.