Ah, the teen years.

Many parents know them as a time when their kids don’t seem to listen. Maybe they talk back. Dress funny.

Not surprisingly, it’s also hard to get young people to see a doctor, especially if they feel healthy. It’s a problem not only in Central Oregon, but across the state and the country.

Among the nearly 11,000 eligible adolescents in Central Oregon who rely on the Oregon Health Plan, Oregon’s version of Medicaid, about 1,600 — roughly 15 percent — had been to the doctor for their annual well-care visit as of September.

“We have this barrier around culturally bringing your adolescent in, who seems to be perfectly healthy, annually for a check-up the way you would for your baby or your toddler or yourself,” said Kate Wells, director of community health development for PacificSource Community Solutions, the company that manages care for the local OHP population. “So it’s kind of a gap.”

The state provides financial incentives to communities that meet a number of health goals among their OHP populations, and getting a certain proportion of adolescents ages 12 to 21 in for their annual exams is one of those.

In Central Oregon, the goal is to screen 31.4 percent of eligible adolescents by the end of 2014. With Central Oregon half way there in September, Wells said it’s unclear whether the region will meet the goal.

Wells pointed out that the number of people who are determined to be eligible for the screenings — the 11,000 figure — tends to go down after the end of the year because state officials realize that not all of them were enrolled in the program for the entire year. That will likely boost the 15 percent figure, she said. Last year, 29.3 percent of eligible adolescents in Central Oregon who rely on OHP got the screenings, the fourth-highest rate compared with other parts of the state.

Nationally, about half of adolescents ages 12 to 21 are getting the annual exams, according to a February report by the U.S. Centers for Medicare and Medicaid Services. Oregon has set a statewide goal of getting 57.6 percent of adolescents on OHP in for their annual checks in 2014, which would require a significant increase from 2013, in which 29.2 percent received the checks statewide.

The emphasis on getting teens to see doctors has only come about in recent years. In Oregon, it began in 2012 when the state included adolescent well-care visits as one of the 17 measures used to gauge the success of reaching OHP patients in communities.

The medical community has been slow to recognize the importance of checking adolescents for serious issues that tend to crop up during those pivotal developmental years, said Ellie Milan, a pediatric nurse practitioner for Mosaic Medical, a provider that sees 31 percent of the adolescents in Central Oregon who rely on OHP and are eligible for the screenings.

During their teen years, kids are faced with a number of choices whose decisions can have negative consequences, such as smoking, riding in cars with people who have been drinking and having a poor diet, Milan said.

“What we’re really trying to address is preventative care for these high-morbidity and high-mortality issues that go along with adolescence — that being injury, substance abuse, high-risk behaviors, STDs,” she said. “It’s really about prevention at this age so we’re not getting adults in the office with issues that really could have been prevented at an adolescent visit.”

About six months ago, Mosaic began screening all of its adolescent patients for depression or suicidal thoughts, Milan said. Deschutes County also has high rates of chlamydia, a sexually transmitted infection, which can be asymptomatic in both males and females, so screening teens annually for chlamydia and gonorrhea and talking to them about safe sex is important, too, she said.

“That’s one of the most important things I touch on with these teenagers,” Milan said.

The state of Oregon has a strict set of guidelines around what an adolescent well-care visit must include. In addition to the standard physical exam, it’s an assessment of the patient’s medical and family medical history, their emotional and mental well-being, their academic performance, their diet and exercise and a time for the provider to educate them on topics such as their reproductive health, the dangers of alcohol and tobacco and injury prevention.

At Mosaic, all of that happens in a 20-minute visit, Milan said, adding that sometimes that means the doctor has to prioritize and skip some things if others seem more important. For example, Milan said there have been times when she didn’t spend time talking about diet when she could tell the patient was actively suicidal or was having multiple sexual partners.

Providers in Central Oregon have gotten creative to try to reach all of the adolescents who need the screenings, even sneaking them into visits for sprained ankles or pink eye, Milan said.

Mosaic providers, who sponsor and staff the school-based health clinic at Ensworth Elementary in Bend, routinely perform sports physicals on any students who need them. If those students happen to be Mosaic patients, they’ll make the sports physicals double as their annual well-care visit, Milan said. Combining the two visits does not increase the amount of time it takes to perform the exam, as sports physicals should already include questions about a patient’s health history and family health history, she said.

“You essentially can just sign off on the paperwork as long as you’ve done the exam and identified any reason why they couldn’t participate in sports, which you should be doing regardless,” Milan said.

Wells said she thinks combining the sports physicals and well-care visits holds promise, and she’s hoping more providers will start using the sports physicals as an opportunity to perform the well-care visits.

“We have to think about where we can reach them,” she said.

— Reporter: 541-383-0304,

tbannow@bendbulletin.com