KEYWORDS:
Hepatitis B vaccine, GAPS, adolescents

BACKGROUND:
The dramatic improvements in delivering vaccinations to young children have not carried over to adolescent immunization. Consequently, debate continues as to the best vehicle for delivering the full complement of adolescent vaccinations. School-based health advocates argue it is more cost-effective to use school-based health services, while providers argue that a visit for adolescent immunization offers one of the few opportunities to provide clinical preventive services like GAPS (Guidelines for Adolescent Preventive Services).

OBJECTIVE(S):
To determine the likelihood of an eligible adolescent to receive a Hep B shot; to determine if there is any relationship between vaccination opportunities and the provision of GAPS-like activities.

METHOD(S):
As part of the UCSD PIP project, serial chart audits of clinical encounters were performed for children 11-14 years of age in 10 community-based practices between July 1999 and June 2001.

RESULT(S):
Of 963 children in this audit, 448 were eligible to receive a Hep B vaccination. Of those only 121 actually received a Hep B vaccination. GAPS-like activities were documented in 39.7% of those receiving shots and 14.1% in those who did not. An important factor associated with not delivering an eligible Hep B shot was the lack of documentation for ANY prior Hep B vaccinations (124/214, 57.9%).

CONCLUSIONS(S):
Recommended health services to adolescents continue to be delivered at sub-optimal levels. However, the lack of opportunity may be less important than availability of prior health history and other factors that contribute to less-than-optimal care.

LEARNING OBJECTIVES:
Understand the link between delivery of adolescent health care and GAPS-like activities.