Patterns of Primary Care Physician Visits for US Adolescents in 2014: Implications for Vaccination

OBJECTIVE: Because most adolescent vaccinations are delivered in primary care, opportunities to vaccinate depend on the presence of visits and types of visits. We evaluated: 1) national visit patterns (having an annual preventive visit with a physician, provider type seen, visit types) for adolescents across the United States, and 2) the type of physician visits at which vaccines are administered for this age group. METHODS: We performed a secondary data set analysis of the 2014 Medical Expenditure Panel Survey. Data are collected through interviews of caregivers of a nationally representative sample of the noninstitutionalized US population. We used descriptive analyses to examine use of health care according to age and gender, and visit types at which vaccines were given according to age. RESULTS: During a 12-month period, almost half of participants had no primary care physician (PCP) visits, and one-third had a preventive visit to a PCP. An additional 19% had only nonpreventive care visits to a PCP. Uninsured participants had the highest rate of no care, and the lowest rate of preventive care. Most preventive care visits by adolescents 11 to 17 years of age were to pediatricians, and most visits among those 18 to 21 years of age were to family/general practitioners. Overall, 67% of non check-up PCP visits were for acute care, 10% were for follow-up, and 7% for immunization only. Nationally, 61%, 26%, and 12% of vaccines were given at preventive, immunization-only, and acute/follow-up visits, respectively. CONCLUSIONS: Fewer than half of adolescents receive preventive care, and many have no PCP visits. This reinforces the need to offer outreach to adolescents to improve rates of preventive visits, and to take advantage of all primary care visits for vaccinations. Because pediatricians and family practice/general practice physicians vaccinate most adolescents, these providers should remain the target audience for vaccine education and quality improvement activities.