1. Improving Adolescent &
Young Adult Clinical Practice:
Reviewing Guidelines & Evidence Base
Charles E. Irwin, Jr., MD
Project Director, AYAH-NRC
May 10, 2017

2. Adolescent Clinical Preventive Services: 20 years of consensus & growing evidence base
Growing evidence for:
Effectiveness of services in positive health outcomes
Health system interventions to increase clinicians’ delivery of services
Guidelines in Bright Futures endorsed by major health professional groups
Comprehensive Guidelines, through age 21 years
4th edition released in February 2017! (more on that shortly…)

3. Preventive Services for Adolescents: Major Guidelines
Bright Futures up to 21 years (more on this shortly!)
US Preventive Services Task Force ≥ 18 years
Advisory Committee on Immunization Practices, Centers for Disease Control and Prevention (“CDC-ACIP”)

4. US Preventive Services Task Force (USPSTF)*
“Gold Standard” for evidence-based preventive service guidelines in US
Recommendations - < 18 and ≥ 18 (adult)
Rigorous review of existing evidence
Rating:
A or B – priority preventive services;
C- lower priority;
D discouraged
I – insufficient evidence for recommendation *

5. Preventive Service Guidelines for Young Adults

6. Preventive Guidelines for Young Adults
No guidelines specifically for Young Adults:
Bright Futures: 18-to 21 years
USPSTF ≥ 18 years
ACOG, AAFP, ACP – Adult guidelines that overlap with young adult age-group
CDC-ACIP

7. Summary of Young Adult Guidelines
Guidelines can be “carved out” :
A 2012 review of existing preventive services guidelines identified recommendations that intersect with the young adult age group
When ages 18 to 26 years are “carved out” of existing guidelines, several recommendations can inform young adult care
Many of these recommendations are evidence- based, warranting a USPSTF grade of A or B
Ozer et al. 2012

8. USPSTF Preventive Services Recommended for Adolescents & Young Adults (with A or B recommendations)

9. Five Key Guideline Areas for Screening
Substance Use
Reproductive Health
Mental Health
Nutrition and Exercise
Safety and Violence
I’m thinking the next step is to consolidate a little? It seems like this section has two sets of similar, but not totally overlapping slides: An overview slide followed by several pages of comparing what different guidelines say to do about different topics.

10. USPSTF: Substance Use Guidelines
Adolescent Ages 11-18
Young Adult Ages 18-26
Alcohol
No recommendation √
Tobacco
(education and brief counseling)
(screening & cessation help)

11. USPSTF: Reproductive Health Guidelines
Age Groups
Adolescent Ages 11-18
Young Adult Ages 18-26
STI screening counseling
√ if risk factors
Chlamydia (Female)
Chlamydia (Male) No
recommendation
Gonorrhea/ Syphilis

12. USPSTF: Reproductive Health Guidelines
Age Groups
Adolescent Ages 11-18
Young Adult Ages 18-26
HIV screening √
<15: if risk factors
15-19: everyone
√ (everyone)
Cervical Cancer Screening No
recommendation
18-21: No recommendation
>21: everyone

13. Mental Health Guidelines
Adolescent Ages 11-18
Young Adult Ages 18-26
Depression Screening √*
Ages 12-18
*When there are adequate systems in place to ensure accurate diagnosis, effective treatment and follow-up

14. USPSTF: Nutrition and Exercise Guidelines
Age Groups
Adolescent Ages 11-18
Young Adult Ages 18-26
Obesity/BMI √*
Lipid disorder I √
[≥20 with increased risk for coronary artery disease]*
Cholesterol
No recommendation
√ if risk factors
Healthy Diet
Hypertension/ Blood Pressure
* topic update in progress

15. USPSTF: Safety and Violence Guidelines
Adolescent Ages 11-18
Young Adult Ages 18-26
Family/Partner Violence √*
* topic update in progress

16. Preventive Services & the Affordable Care Act (our current legal framework)
Access to Preventive Services
Provided by plans without cost-sharing to members
Requirements established by:
US preventive Services Task Force “A” and “B” recommendations
Bright Futures Guidelines for Children and Adolescents
CDC-ACIP Immunization Recommendations
HRSA-supported IOM recommendations for women’s health

17. Emerging evidence
Promising research in several additional areas suggests that preventative screening may result in adolescent behavior change.
helmet use,
alcohol and illicit drug use,
healthy diet,
suicide risk,
chlamydia in boys, and
and physical activity
New research also suggests that limiting prescriptions of narcotics reduces opioid addiction

18. Featured Resources: Clinician “Cheat SHEETS” for AYAs
Summary of Recommended Guidelines for Clinical Preventive Services for Adolescents up to age 18, one-page clinical tool, with supplement
Summary of Recommended Guidelines for Clinical Preventive Services for Young Adults ages 18-26, one-page clinical tool, with supplement

20. Featured Resources: Fact Sheet
Evidence-based Clinical Preventive Services for Adolescents and Young Adults:
A one-page fact sheet about the evidence base in clinical preventive services, with emphasis on USPSTF recommendations .