Ambulatory Care Among Young Adults in the United States
- Robert J. Fortuna, MD, MPH;
- Brett W. Robbins, MD; and
- Jill S. Halterman, MD, MPH
- From the Center for Primary Care and Strong Children's Research Center, University of Rochester School of Medicine and Dentistry, Rochester, New York.
Abstract
Background: Young adults are the most likely age group to be uninsured and have the highest prevalence of substance abuse, motor vehicle accidents, and sexually transmitted diseases, yet little is known about their use of ambulatory care.
Objective: To characterize ambulatory care of young adults.
Design: Cross-sectional data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey.
Setting: Community and hospital-based clinics.
Patients: Nonpregnant young adults age 20 to 29 years.
Measurements: Ambulatory care utilization, types of visits, and preventive care.
Results: Insured young adults had more visits (2.16 [95% CI, 2.14 to 2.19] annual visits per capita) than those without insurance (0.59 [CI, 0.54 to 0.67] annual visits per capita). Young men utilized ambulatory medical care less than adolescents age 15 to 19 years or older adults age 30 to 39 years (1.10, 1.65, and 1.73 annual visits per capita, respectively) and had lower rates of utilization than young women (1.10 vs. 2.31 annual visits per capita). Young black and Hispanic men had considerably fewer annual visits per capita (0.75 and 0.65, respectively) than did young white men (1.21). Young men had nearly one half the preventive care visits compared with male adolescents or older men (0.11, 0.24, and 0.19 annual visits per capita, respectively) and less than one quarter the visits compared with young women (0.11 vs. 0.48 annual visits per capita). Only 30.6% of visits by young adults included any preventive counseling, and few encounters included counseling directed toward injury prevention (2.4%), mental health (4.1%), or sexually transmitted diseases (2.7%).
Limitation: School-based clinics were not included, and counseling may be underreported.
Conclusion: Young adults use less ambulatory medical care relative to other groups and infrequently receive preventive care directed at the greatest threats to their health. Efforts to ensure appropriate preventive care are needed.
Primary Funding Source: None.
Article and Author Information
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Acknowledgment: The authors thank the Center for Primary Care at the University of Rochester School of Medicine and Dentistry for support of this project.
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Reproducible Research Statement: Study protocol and statistical code: Available from Dr. Fortuna (e-mail, Robert_Fortuna{at}urmc.rochester.edu). Data set: Available through the National Center for Health Statistics (www.cdc.gov/nchs/about/major/ahcd/ahcd1.htm).
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Potential Financial Conflicts of Interest: None disclosed.
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Requests for Single Reprints: Robert J. Fortuna, MD, MPH, University of Rochester School of Medicine and Dentistry, 913 Culver Road, Rochester, NY, 14609; e-mail, Robert_Fortuna{at}urmc.rochester.edu.
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Current Author Addresses: Drs. Fortuna and Robbins: University of Rochester School of Medicine and Dentistry, Culver Medical Group, 913 Culver Road, Rochester, NY, 14609.
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Dr. Halterman: University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY, 14642.
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Author Contributions: Conception and design: R.J. Fortuna, B.W. Robbins, J.S. Halterman.
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Analysis and interpretation of the data: R.J. Fortuna, B.W. Robbins, J.S. Halterman.
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Drafting of the article: R.J. Fortuna.
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Critical revision of the article for important intellectual content: R.J. Fortuna, B.W. Robbins, J.S. Halterman.
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Final approval of the article: R.J. Fortuna, B.W. Robbins, J.S. Halterman.
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Provision of study materials or patients: R.J. Fortuna.
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Statistical expertise: R.J. Fortuna.
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Collection and assembly of data: R.J. Fortuna.
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