Increasing and improving the teen well visit: lessons from 27 Alabama practices

by Cason Benton, MD, FAAP

Alabama pediatricians know that the teen well visit supports the “healthy cognitive, physical, sexual, and psychological development [adolescents need] to successfully enter adulthood” (AAP Policy Statement, December 2019). We also know that many¹--if not most--teens do not attend the well visit. 

What can we do at the practice level to increase teen well visits? 

Twenty-seven practices tackled that question during the 2019 Alabama Child Health Improvement Alliance #StayWell learning collaborative and shared their reflections to improve care. 

Know your data: Step one is to have reliable data of who is due for a visit. #StayWell practices used various methods to track teen visits, such as scheduling systems, electronic medical records, or payer reports. Selecting a process your office can sustain is key. 

Establish reminder/recall process: Practices tested different ways to contact the families. Some found that text reminders boosted visits, while others discovered personal phone calls led to more completed visits. Practices learned to test which approach works best for them. 

Encourage teen-centered care: Practices had a number of recommendations including the following:

• Look at your office through a teen’s eyes (or better yet, have teens assess the office!) What do youth see when they walk through the door? Is the decor for younger children? Do the staff talk with the teens or only with the parents? The Adolescent Health Initiative’s (AHI)² Youth-Led Health Center Assessment Tool captures teen input. AHI’s 15-minute staff “Spark” trainings start office conversations to have a more youth-friendly office.

• Incentivize visits. One practice held a live-stream raffle for an Apple Watch for those who completed the well visit over the summer. Another practice promoted monthly gift card drawings for both the teen and caregiver.

• Develop a transition plan. #StayWell participants standardized the office process to transition a preteen with little understanding of healthcare into a 19-year-old able to navigate health needs independently.

• Develop a confidentiality plan. Providing confidential care results in better health outcomes. Collaborative peer-to-peer learning was particularly valued as practices tested how to partner with parents while still allowing teens to have confidentiality when needed.2 Posting the clinic standard throughout the office helps communicate confidentiality clearly.

Implementing these teen-friendly activities led to the following improvements over the nine-month collaborative: the well visit rate increased by 10 percent; practices with a transition plan increased from 4 percent to 72 percent. Teen well visits increased by 9,000 from 2018 to the 2019 collaborative year. The #StayWell practices demonstrate that increasing teen well care is possible in Alabama when we establish reminder/recall systems and a teen-friendly office.

For more information on the #StayWell collaborative and resources to help you get started in your own practice, visit https://achia.org/resources/past-projects-resources.

¹Medicaid.gov Accessed January 27, 2021 https://www.medicaid.gov/state-overviews/scorecard/adolescent-well-care-visits/index.html

²Adolescent Health Initiative. Accessed January 27, 2021 https://www.umhs-adolescenthealth.org/improving-care/spark-trainings/

This article first appeared in the First Quarter 2021 Edition of the Alabama Pediatrician Newsletter.