Study Compares Adolescent Annual Well Visits Before and After the ACA

Since the implementation of the Affordable Care Act (ACA), annual well visits among adolescents improved with visits increasing the most among Hispanic adolescents, according to a new study published in JAMA Pediatrics.

The study compared the number of annual well visits and preventive services that adolescents received before and after the enactment of the ACA, which allows patients to receive preventive services recommended by the American Academy of Pediatrics and the US Preventive Services Task Force without a copay.

Annual well visits give adolescents professional guidance regarding nutrition, substance use, and mental health with the intention of preventing the consequences of unhealthy behaviors. Topics including sexually transmitted diseases, obesity, and depression can be uncomfortable for an adolescent patient to discuss when in the same room as a parent or guardian, making it necessary for clinicians to spend time alone with their patient, the authors explained.

The study looked at the difference in wellness visits between 2007 and 2009 (pre-ACA) and 2012 and 2014 (post-ACA). Researchers used a population of 25,695 adolescents who represent the demographics of the United States to see if there was a significant increase in the amount of wellness visits. An increase in individual time spent with the physician was also recognized. The amount of clinician guidance in the following 6 topics was also recorded: healthy eating, physical activity, seatbelt use, helmet use, second-hand smoke, and dental visits.

The results showed that well visit rates increased within the population from 41% in 2007-2009 to 48% in 2012-2014. When broken down demographically, annual visits increased the most among minority and low-income groups. Black adolescent well visits increased about 10% and Hispanic adolescent well visits increased 20%. Anticipatory guidance given to adolescent patients increased the most in healthy eating and physical activity and slightly decreased in helmet use. However, time alone with clinicians only increased by 1%.

Although adolescent well-visit rates increased, less than half of the adolescent population received annual preventive care. Adolescents need more time alone with physicians in order to receive adequate information on sexual health and substance use, the authors noted.

“Building on these improvements, efforts are needed to address family perceptions of the value of the well visit for this age group and to increase system capacity to provide preventive services in a confidential setting,” concluded the authors. “These are highly challenging efforts given that systems are currently addressing complex changes in the financing and delivery of health care.”