Guidelines for Adolescent Preventive Services: the GAPS in practice

Arch Pediatr Adolesc Med. 2003 May;157(5):426-32. doi: 10.1001/archpedi.157.5.426.


Design: Pre- and post-Guidelines for Adolescent Preventive Services (GAPS) comparison of outcomes gathered via chart audit.

Setting: A rural hospital-based general pediatric clinic.

Participants: Adolescents who underwent annual examinations between April 1, 1998, and March 31, 2001. A random sample of 441 medical records was reviewed.

Intervention: Training in the GAPS model and use of the questionnaire began in April 1998.

Main outcome measures: Detection of, discussion of, and referrals for GAPS-related risk behavior.

Results: The medical records of 162 younger adolescents (aged 11-15 years) and 279 older adolescents (aged 16-19 years) were audited. Detection of risk behaviors increased from 19% at baseline to 95% with the initial GAPS and 87% with the periodic GAPS. The most prevalent risk factor was having a rifle or gun in the home (younger adolescents, 47% and older adolescents, 39%). The mean number of risk behaviors and health concerns documented was higher in the initial GAPS (4.8 and 1.3, respectively) than in the periodic GAPS (3.8 and 0.7) (P =.01 and.006). The GAPS questionnaires detected lower levels of risk behavior compared with a local Youth Risk Behavior Survey. Controlling for sex, age, and clinician, discussion of psychosocial topics increased during the study period; however, there was considerable variation among clinicians regarding the topics addressed. The GAPS-related referral rate did not change significantly.

Conclusion: The GAPS model increases clinicians' detection and discussion of risk behaviors.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adolescent Behavior*
  • Adolescent Health Services / organization & administration
  • Adolescent Health Services / statistics & numerical data*
  • Adult
  • Child
  • Humans
  • Medical Records
  • New York
  • Practice Guidelines as Topic
  • Preventive Health Services / organization & administration
  • Preventive Health Services / statistics & numerical data*
  • Risk-Taking
  • Rural Population*
  • Surveys and Questionnaires