The health needs of young adults as they transition from adolescence to adulthood have received increased attention in recent years. Young or emerging adulthood focuses on the years from approximately 18 to the mids, recognizing these ages as distinct from the preceding adolescent years as well as the young adult years that follow. Because these health problems are largely preventable, primary care visits can present a key opportunity for improving the health of Adult preventive care adults through preventive screening and intervention, with evidence supporting the efficacy of clinical preventive services.
Screening rates were especially low in the areas critical to young adult morbidity and mortality, such as injury prevention, mental health, sexually transmitted infections, and obesity, ranging from a low of 2. There are no specific clinical preventive guidelines for young adults. Furthermore, although the USPSTF guidelines comprise evidence-based recommendations across Adult preventive care specific health areas, recommendations are not consolidated into comprehensive preventive services.
A broad consensus has emerged for comprehensive clinical guidelines for adolescent preventive services, beginning with the American Medical Association's Guidelines for Adolescent Preventive Services GAPS: Recommendations and Rationale 12 and the first version of Bright Futures: The third edition of Bright Futures 14 includes recommendations for preventive care up to age 21 years and could serve as a useful starting point for comprehensive recommendations for young adults.
However, it is focused on pediatric care, when Adult preventive care 1. In recent years, state and local public and private Adult preventive care have focused on expanding young adults' health insurance.
Although the ACA provides an unprecedented opportunity to expand health coverage to young adults, the anticipated influx of this population will also increase demands on the health care system and the need to provide preventive services.
The ACA includes several provisions to improve access to preventive services, including requiring health plans to cover preventive services recommended by the USPSTF, 8 vaccinations recommended by the Advisory Committee for Immunization Practices, 17 the comprehensive services outlined in Bright Futures14 and additional preventive screening services for women to be developed under the auspices of the Health Resources and Services Administration.
The largely preventable health problems, low provision of preventive services, and potential to increase services given the ACA's insurance and preventive care provisions indicate a pressing need for Adult preventive care for young adult preventive health care.
To identify relevant preventive care guidelines for the young adult age group, an online search was conducted for established comprehensive preventive services guidelines for adolescents and adults created by national organizations, federal agencies, health professional associations, and medical societies. We searched the Web sites of federal agencies and professional organizations that focus on health areas linked to the care of young adults or directly provide health care to adolescents and adults.
We also conducted general Internet searches using multiple combinations of the terms preventive services guidelinesclinical preventive servicesyoung adultadolescentfamily practicegeneral practiceand guidelinesalso Adult preventive care guidelines developed by private health plans and state policy organizations.
We then cross-checked the Agency for Healthcare Research and Quality's guidelines database to verify that we had captured all guidelines. Searches were conducted primarily by one author J. As a next step in reviewing and comparing guidelines, we examined adolescent and adult preventive service guidelines developed by the USPSTF, 8 the standard for evidence-based preventive service Adult preventive care in the United States.
The recommendations of the USPSTF are determined after a rigorous review of evidence by an independent panel of experts in primary care and prevention. We found no specific guidelines for young adults regardless of the definition Adult preventive care the age range Adult preventive care, years, years, or years. Because such guidelines do not exist, for the purpose of presenting our results, we selected the upper age of 26 years in response to the ACA's health insurance benefit requirement.
In addition to the USPSTF, we identified consensus guidelines issued by 4 organizations that intersected with the age range of 18 to 26 years. Two of these professional organizations created their own guidelines that included recommendations for the care of youth whose ages fall within a subset of the young adult age group.
Guidelines for Health Supervision of Infants, Children, and Adolescentsa professional consensus document created jointly by the Health Resources and Services Administration's Maternal and Child Health Bureau and the Adult preventive care Academy of Pediatrics, 22 provides recommendations for the care of adolescents up to age 21 years.
The American Congress of Obstetricians and Gynecologists ACOG created guidelines for female adolescents and adults between the ages of 19 and 39 years. Table 1 reviews guidelines for adolescent and young adult preventive care and recommendations for screening, as well as recommended components of the physical examination.
Under adultwe included all adult recommendations that could be Adult preventive care to individuals between the ages of 18 and 26 years, excluding guidelines that do not apply to this age group eg, prostate cancer examination for older men.
Task Force grades of A or B are recommended as priority preventive services areas by USPSTF, a grade of C is lower priority, and services with a D grade are discouraged unless there are unusual additional considerations. A grade of I indicates that the evidence is insufficient to recommend for or against routinely providing the service. The most comprehensive set of guidelines that Adult preventive care with the age group of 18 to 26 years is the Bright Futures recommendations for adolescents between the ages of 11 and 21 years.
Bright Futures recommendations were incorporated into the ACA for this age group. Many of the recommendations included in the Bright Futures guidelines for adolescents are supported Adult preventive care sufficient evidence to be recommended by the USPSTF for individuals older than 18, such as screening and counseling for tobacco and alcohol use. These include obtaining further detail on components of the physical examination; performing a risk assessment to determine the need to screen for vision and hearing problems, anemia, and tuberculosis; screening sexually active females for pregnancy; and inquiring about birth control methods for both males and females.
To identify which of Adult preventive care recommendations apply to young adults aged 18 to 26 years, we examined recommendations for female youth up to age 21 adolescent and for women, aged 19 to ACOG has updated the cervical cancer screening recommendation to begin screening at 21 years. ACOG does not address vision screening or state that sexually active females should be screened for pregnancy under specific conditions; both of these areas are recommended by Bright Futures.
Table Adult preventive care presents a broad comparison of the evidence-based recommendations of the USPSTF and the guidelines issued by the 4 major professional organizations whose members provide primary care to adolescents and adults.
Although none of these guidelines targets young adults yearswe developed a young adult category that includes all recommendations that intersect with that age range.
For example, if a relevant recommendation is for individuals 18 years or older ie, extending beyond 26 yearswe included it in the young adult category. As reported in Table 2the major professional medical organizations whose members deliver primary care to young adults Adult preventive care relatively consistent in the preventive services that they recommend.
Recent studies 911 revealing the low number of preventive services delivered to young adults have highlighted the lack of uniformly endorsed preventive health guidelines and called for the development of young adult guidelines to ensure appropriate care for this at-risk age group.
Our examination of professional guidelines Adult preventive care that, when the ages of 18 to 26 years are carved out of established guidelines across specialty groups, there is a broad number of recommendations that can inform the care of young adults. The good news is that the medical specialties that deliver care to young adults are fairly consistent in the preventive services that they recommend.
There is no need to reinvent the wheel when targeting preventive services for young adults; in fact, the recommendations that we reviewed not only extend the preventive services guidelines for adolescents but document even more evidence of efficacy when applied to the care of young adults.
These guidelines cover screening for many of the major risks for morbidity and mortality among young adults, including alcohol Adult preventive care related to high rates of injuries, depression related to suicide, sexually transmitted infections, and nutrition, exercise, and body Adult preventive care index screening related to high rates of obesity.
The lessons learned during the past 15 years in developing and implementing adolescent clinical preventive guidelines can inform the young adult guideline process, and we suggest several steps to enhance the likelihood that the delivery of preventive services to this population will be increased.
First, we recommend the establishment of young adult preventive health care guidelines that reflect the current evidence-based recommendations that overlap with this age group. We suggest prioritizing the guidelines to include those that are evidence based, assuring clinicians that the time spent delivering preventive services might result in positive behavioral or health outcomes and making it more likely that the services can be delivered within the time constraints of an office visit.
One barrier to the delivery of care in accordance with adolescent preventive guidelines has been Adult preventive care large number of recommendations, with only a small portion based on sufficient evidence of effectiveness. Second, the difficulty in delivering preventive services within busy clinical practices with competing demands and Adult preventive care visits have been well documented.
Primary care interventions that have increased the delivery of preventive services to adolescents have demonstrated the effectiveness of clinician training to increase self-efficacy and skills and the importance of integrating clinical decision-making supports, such as screening and charting tools, that are targeted, easy to use, and fully integrated into the clinic system.
Models from different professional groups are Adult preventive care to integrate preventive services in a manner that is most relevant to that specialty group, practice, or setting, as well as to the young adult group. For example, young adults receive care not only through primary care practice settings but also through institutions such as college health services and the military. Furthermore, the use of interactive computerized technology has great potential for integration into young adult health care across settings.
Third, gaps exist in the evidence for screening and counseling young adults in critical risk areas, such as drug use and helmet and seat belt use. We suggest prioritizing research in areas without sufficient evidence. Given the relatively small amount of research focused on preventive interventions, as well as the difficulty in assessing behavioral and health outcomes, further clarification of the efficacy of these services is necessary.
Adult preventive care
A limitation of our review is that because we relied on guidelines that were developed by scientific review panels, professional consensus, and other task forces, it is possible that we overlooked recommendations that might apply to young adults that were not included within these guidelines.
However, because we reviewed a broad number of specialties, we assume that we have included guidelines that would apply Adult preventive care the majority of young adults during a visit for clinical preventive services health checkup and physical or annual examination. Young adulthood represents a critical point Adult preventive care the life cycle during which individuals are beginning to assume responsibility for their care, develop a relationship with their primary care clinician, and learn to navigate Adult preventive care health care system.
Guidelines on young adult health care that outline a core set of preventive services will better enable clinicians and young adults to take full advantage of the primary care opportunity. Study concept and design: Ozer, Urquhart, Brindis, Park, and Irwin.
Analysis and interpretation of data: Drafting of the manuscript: Ozer, Urquhart, and Brindis. Critical revision of the manuscript for important intellectual content: Administrative, technical, and material support: Urquhart, Brindis, and Irwin.
Ozer, Brindis, and Irwin. Arch Pediatr Adolesc Med. Ozer, PhD ; John T.
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Urquhart, BA ; Claire D. Brindis, DrPH ; et al M. Review and comparison of guidelines. American Congress of Obstetricians and Gynecologists. Back to top Article Information. The health status of young adults in the United States.
A behavioral scientist looks at the science of adolescent brain development. Trends in adolescent and young adult Adult preventive care in the United States. Leading causes of death, fatal and nonfatal injury reports. Accessed November 5, Centers for Disease Control and Prevention Web site. Accessed November 18, Changes in ambulatory health care use during the transition to young adulthood. Ambulatory care among young adults in the United States.
American Medical Association; American Academy of Pediatrics; Young people's health care: Accessed November 15, Realizing health reform's potential: Issue Brief Commonw Fund. Promoting prevention through the Adult preventive care Care Act. N Engl J Med.
Young adults are worse off than adolescents. A midcourse review of the Healthy People American Academy of Pediatrics. It is hard to overstate how important regular preventive care and health screenings are for maintaining a patient's physical wellbeing.
At Primary Care of Wesley.