Encouraging adolescent health with group visits

Since mid-September I've seen at least two to three adolescents per week for pre-participation sports physicals. I often think that if it weren't for these required visits, these patients would probably never see a doctor until their mid-40s, when they are overweight with type 2 diabetes and hypertension.

Whenever I see an adolescent in the office, I never miss an opportunity to have a conversation about promoting general good health — it would be negligent not to.

Adolescence is a time of rapid growth and development, and a period of an equally rapid increase in temptations for poor health choices. It is also the time when autonomy in decision-making determines which habits will become sustainable and which will not.

Many adolescents think their parents' opinions are unreasonable, valuing the insight of their peers as omnipotent. I'm not sure exactly where health-care providers fit in, but the teens I see seem to be receptive when I bring up topics that they are too embarrassed or afraid to ask about. They have questions, and they want answers. They are curious, and for the most part are open to listening to what I have to say.

The importance of wearing seat belts, making healthy food choices, avoiding drugs and alcohol and situations in which they would be tempted to use these substances, are just a few of the topics I discuss with adolescents.

Others include promoting abstinence as the best way to avoid pregnancy and STDs and answering questions about contraceptives. I also talk with teens about technology and urge them to limit the time they spend in front of computer and television. I screen them for anxiety and depression, and make sure they have my name and phone number, so they can call me at the clinic if any health questions arise.

Recently, I've begun thinking about implementing group health care visits for adolescents similar to those organized for patients with uncontrolled diabetes, who have enormous learning curves to overcome. These encounters generally consist of five or six patients discussing health concerns as a group and provide an arena for support and understanding.

Group health care visits could improve adolescent health by encouraging commitment to a prevention-based lifestyle and could help shift U.S. health care away from a system based on treating diseases, to one that aims at stopping them before they begin.

For preventive medicine to be successful, it must be initiated before a disease develops. Beginning with adolescents who present in primary care clinics for pre-participation sports physical and expanding to more groups in the future, group health care visits provide the perfect opportunity for health care providers to initiate discussion before the onset of increasingly prevalent diseases, including obesity and diabetes.

Leigh Montejo, MSN, FNP-BC, provides health care to underserved populations at the Metropolitan Community Health Service's Agape Clinic in Washington, North Carolina.

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