Purpose: To determine the factors associated with the intentions of pediatric residents to: 1) screen adolescents for high risk behaviors using the Guidelines for Adolescent Preventive Services (GAPS) and 2) to record the results in the medical record.
Methods: 64 pediatric residents at a university children's hospital were given seven scenarios and were asked to rate on a five point Likert scale (1 = always, 5 = never) the likelihood that they would ask and document adolescent patient responses about sexual activity/birth control, alcohol/drug use, depression/suicidal ideation, fighting/coping with anger, and nutrition/eating disorders. The association of patient-related factors (e.g., gender, presenting symptom, medical setting, known private provider, and presence of a chronic illness) and resident-related factors (e.g. gender, post graduate level, future plans, and a prior adolescent rotation) on intentions to screen was determined using analysis of variance for ranked data.
Results: Residents indicated they were most likely to ask adolescents about sexual activity (mean Likert = 2.6, median Likert = 2, range 1-5) (P=0.014). Residents were more likely to screen for substance use (2.8, 3, 1-5) than nutritional issues (3.5, 4, 1-5) (P < or = 0.0001), and were least likely to ask about depression (3.8, 4, 1-5) and fighting (3.9, 4, 1-5) (P < or = 0.0001). Although residents reported that they were likely to record screening results in the medical record (median Likert score = 1), they noted the most common reasons for not recording to be fear that parents would see the record, lack of time, and the feeling that negative responses to screening need not be recorded. The patient-related factors that significantly affected residents' intentions to screen included: presenting symptom, medical setting, and the presence of a chronic illness (P < or = 0.05). Female gender of the patient increased only the likelihood of nutrition screening. Male residents reported a greater intention to screen for depression (P = 0.046). Post-graduate level and a prior adolescent rotation influenced the intention to screen for most behaviors.
Conclusions: This study found that residents are more likely to indicate that they would screen for sexual activity and substance use than for nutritional disorders, depression, and fighting. Several patient-related and resident-related factors influence the likelihood of residents to screen for various high risk behaviors. Educational efforts are needed to increase residents' screening for high risk behaviors.