The elusive patient: Getting twentysomethings into the health care system

Young adults share many health risks with adolescents but have less access to care.

By Victoria Stagg Elliott, AMNews staff. May 14, 2007.

A few years ago, Gail Martin, MD, a Kaiser Permanente family physician in Oakland, Calif., noticed that when her young adult patients graduated from pediatrics, they didn't seem to know where to go. This observation inspired her to set up a clinic for 18- to 24-year-olds.

"These young adults weren't getting what they needed," Dr. Martin said. "We developed a mission and an approach to take care of these patients and address what may be going on in their lives."

Emphasis was placed on the biggest causes of mortality and morbidity for this age group. Also, efforts were made to reduce the need for return visits, because it became clear that these patients are less likely to be able to make it to a doctor's office because of work and school schedules.

The results have been positive. According to surveys, the clinic increased patient satisfaction. In addition, screenings such as for cervical cancer and sexually transmitted infections went up. The facility, which has a dozen physicians on staff, is expanding to 16. And the HMO plans to establish similar clinics at other locations.

Obviously, Dr. Martin is not alone in trying to reach this demographic. Many physicians and health policy experts now recognize that the risks of adolescence do not stop at age 18. Instead, they actually get worse -- a circumstance amplified by the fact that young adults have few resources for support. A July 2006 National Institute for Health Care Management report termed young adult health care a "national imperative," and efforts to improve adolescent health are increasingly being expanded to include this population.