Adolescents were more likely to receive contraception and sexually transmitted infection (STI) screening if they were enrolled in a patient-centered medical home (PCMH), according to a new study.
The research, which also included young adults, found patients who benefitted most tended to be older, insured, foreign-born and non-students.
“These findings support the need to expand this model of care to benefit more low-income adolescents and young adults as a strategy to reduce health inequities,” authors said in the study “Effect of Patient-Centered Medical Home on Preventive Services for Adolescents and Young Adults” (Garcia-Huidobro D, et al. Pediatrics. May 16, 2016, http://dx.doi.org/10.1542/peds.2015-3813).
In the PCMH model of care, primary care pediatricians partner with specialists and families to provide continuous, comprehensive care.
To study its impact, the team analyzed data on 21,704 patients ages 10-24 years receiving care at clinics at the Hennepin County Medical Center in Minnesota. Approximately 3% were enrolled in a PCMH, and those patients were more likely to be Latino and have public health insurance.
Unadjusted rates show PCMH enrollees were more likely than non-PCMH patients to receive multiple preventive services, including prescriptions for contraception, screening for STIs, and vaccinations for meningococcal disease, human papillomavirus and influenza. The findings held true in most categories in the ratios adjusted for demographic differences.
Compared to non-enrollee counterparts,
- female enrollees were more likely to receive meningococcal vaccination;
- adolescent enrollees (ages 10-18) were more likely to receive contraception and STI screening but less likely to receive preventive visits or influenza vaccination;
- Latino enrollees were more likely to receive preventive visits but less likely to have flu shots;
- foreign-born enrollees were more likely to receive preventive visits, vaccinations, contraception and STI screening;
- insured patients were more likely to receive preventive visits, vaccinations, STI screening and contraception; and
- uninsured patients were more likely to receive meningococcal vaccination and contraception.
The authors noted several limitations to their study, including different lengths of time patients were exposed to services and the possibility of receiving services outside the clinics in the study. They also did not look at how welcoming the clinics were to adolescents.
As only about 3% of those in the study received PCMH services, they stressed the need to increase enrollment.
“Local, State and Federal policies need to fund the implementation of coordinated team-based service, especially at locations that serve low-income, minority, and uninsured patients, who are least likely to receive preventive and therapeutic care,” they said.