Rebate for an Adolescent Health Assessment Trial (RAd Health Trial)

INTERVENTION: GPs will be encouraged to undertake annual health assessments with adolescents aged 14‐24 years. They will receive one rebate payment for each adolescent health assessment conducted per patient per year. It will be an annual rebate because the RACGP and the RACP recommend annual checks for young people. The rebate amount will be based on the MBS rebate for assessments such as the 45‐49 and 75+ year checks. There is no minimum requirement for this health check; however, all GPs will be supplied with a comprehensive template for health assessment. The rebate claimed will be commensurate with time taken to undertake the assessment i.e. <30 mins (MBS item # 701) $59.35; 30‐<45 minutes (MBS # 703) $137.90; 45‐<60 mins (MBS # 705) $190.30 or 60 mins+ (MBS #707) $268.80. This rebate will be administered by University of Melbourne and will mimic the process of Medicare whereby funds are transferred electronically to the clinic on a weekly basis. CONDITION: Diet and Nutrition ‐ Obesity Diet and Nutrition ‐ Other diet and nutrition disorders Mental Health ‐ Anxiety Mental Health ‐ Depression mental health conditions;sexually transmissible infections;substance use / abuse;unintended pregnancy;weight issues;nutritional issues;physical inactivity; ; mental health conditions ; sexually transmissible infections ; substance use / abuse ; unintended pregnancy ; weight issues ; nutritional issues ; physical inactivity Public Health ‐ Health promotion/education Reproductive Health and Childbirth ‐ Contraception PRIMARY OUTCOME: The rate of health conditions detected and recorded in the patient medical record. This includes sexually transmissible infections (such as Chlamydia) and blood borne viruses (such as Hepatitis B or HIV), pregnancies (planned or unplanned, obesity and mental health conditions. [This will be assessed at the initial visit when the health check is conducted and at the conclusion of the trial after a 2 year intervention period, allowing for two health checks in two years.] The rate of risk behaviours detected and recorded in the patient medical record. ; This includes alcohol and drug use, smoking, sexuality, sexual activity and risk of sexually transmissible infections, weight, nutrition & physical activity, immunisation update and mental health / emotional distress.[This will be assessed at the initial visit when the health check is conducted and at the conclusion of the trial after a 2 year intervention period, allowing for two health checks in two years.] ; ; This includes STI test undertaken, contraception and vaccine prescription, mental health care or care management plan initiated, anti‐smoking medications prescribed, counselling provided or referrals. [This will be assessed at the conclusion of the trial after an up to 2 year intervention period.] INCLUSION CRITERIA: 1) Clinics: a general practice will be eligible if they have (i) at least 600 consultations each year with 14‐24 year‐olds; (ii) use Medical Director or Best Practice for their electronic medical records software, as these are compatible with our data extraction tool GRHANITE.™ 2) 14‐24 year‐olds: will be eligible for participating in the cohort study if they are aged 14 to 24 years, are attending the clinic for their own health during the trial and are able to give informed consent to participate. SECONDARY OUTCOME: An economic evaluation will compare the costs and outcomes of the RAd Health intervention with the costs and outcomes of the control group. Data from RAd Health trial will be used to estimate costs and efficacy in terms of risk behaviours and health conditions detected and quality of life. [This will be assessed at the conclusion of the trial.] Process outcome: ii) Duration of consultation for each consultation during the trial[After initial visit using the data extraction tool, and up to 2 years after initial visit if the patient attends again in that time period. ] Process outcome: Acceptability of the intervention among clinic staff and patients.[During the process evaluation interviews (taken 6 months and 18 months after enrolment, the acceptability of the intervention will be assessed with the process evaluation interviews. About 20 GPs, 20 nurses / practice managers and 20 young people will be interviewed and purposively sampled to ensure representation by age, gender and geographical location. Recruitment numbers will be dependent on reaching saturation of themes. ; ] Process outcome: Continuity of care (the proportion of 14 to 24 year‐olds who attend the clinic 2+ times during the trial[Measured at conclusion of the trial; measured at baseline, 6 months after the initial visit and at the conclusion of the trial. ] Quality of life will be assessed using age appropriate, validated instruments (CHU‐9D for school‐aged children and AQOL‐6D adolescent version for young people aged 18‐24). [This will be assessed at time of recruitment and again at 12 months] Safety of the intervention[During the process evaluation interviews (taken 6 months and 18 months after enrolment, the safety and fidelity of the intervention will be undertaken. This will include the impact of undertaking the health assessment on the resources / capacity of the GP practice, as well as any harms and acceptability identified by the participants, About 20 GPs, 20 nurses / practice managers and 20 young people will be interviewed and purposively sampled to ensure representation by age, gender and geographical location. Recruitment numbers will be dependent on reaching saturation of themes. ] The rate of patient management activities conducted and recorded in the patient medical record.