Adolescent Primary Care Utilization
Overall, 16-20% of adolescent girls lack access to primary care and are more likely to report no regular source of health care as compared to children (McKee & Fletcher, 2006; Schoen, Davis, & Scott Collins, 1997; Burns & Leininger, 2012). Minority adolescent females, particularly Asian adolescents, are less likely to have a usual source of care as are women born outside the mainland U.S., those with lower maternal education, and those who are not sexually active (McKee & Fletcher, 2006; Schoen et al., 1997). Of females with access to primary care, the primary care setting also differed by race: Black and Hispanic females disproportionately access hospital outpatient clinics as their source of primary care, while white females disproportionately access non-hospital based physicians’ offices for their primary care (Hoover, Tao, Berman, & Kent, 2010). Younger girls tend to see pediatricians for their primary care, but by 17-18 years of age, women are significantly more likely to see an OB/GYN (Hoover et al., 2010). Privately insured and Medicaid covered adolescent females alike are likely to go multiple years without a preventive care visit, but do access primary care for problem focused visits more than once per year (Nordin, Solberg, & Parker, 2010; Dempsey & Freed, 2010). Even when girls access primary care, their needs are not met; although two thirds of adolescent girls surveyed said that doctors should discuss sensitive issues such as pregnancy prevention, less than a quarter reported discussing these types of topics (Schoen et al., 1997). Adolescents and young adults more frequently access the emergency department (ED) in place of a primary care provider (PCP) for non-urgent health care needs as compared to children and older adults (Uscher-Pines, Pines, Kellermann, Gillen, & Mehrotra, 2013; Ziv, Boulet, & Slap, 1998). Nationally, African Americans, females, and 18-21 year-olds account for a disproportionately high amount of ED usage compared to their proportion of the total population (Ziv et al., 1998). Adolescents who use the ED as their usual source of care were more likely to report missed care and fewer regular preventive health visits (Wilson & Klein, 2000). Higher risk groups of adolescents such as those reporting high risk behaviors and clinical history significant for depression and sexual abuse were are all more likely to use the ED as their usual source of care (Wilson & Klein, 2000). Non-urgent patients express a variety of reasons for accessing emergency services including: urgent need to seek medical attention, referral by PCP, and shorter wait times (Weiss, D’Angelo, & Rucker, 2014). A substantial portion of women presenting to the PED feel it is an acceptable place to receive contraception or related information, with the majority of women preferring a location such as the PED over their physician’s office (Todd, Plantinga, & Lichenstein, 2005). Women who would prefer to receive contraception or related information in a setting other than their physician’s office are significantly more likely to be uninsured and lack a PCP (Todd et al., 2005).