Rapid Responses to:

CLINICAL REVIEW: Ann McPherson Adolescents in primary care BMJ 2005; 330: 465-467 [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

Health Facilitators for adolescents with complex needs.

Woody Caan   (26 February 2005)

Adolescents and primary health care

Jacob Urkin, Mohammed Morad and Joav Merrick   (27 February 2005)

Health Facilitators for adolescents with complex needs. 26 February 2005
Woody Caan, Professor of public health APU, Chelmsford, Essex CM1 1SQ. Send response to journal: Re: Health Facilitators for adolescents with complex needs.	McPherson's excellent review captures the common interactions between general practitioners (GPs) and adolescent patients. She identifies a need for "staff with special skills or training in working with young people" [1]. For the minority of young patients with complex problems or with fluctuating long-term needs for care, appropriate primary care skills and training may be crucial for their survival. These skills are in short supply, for example in a study of GP interactions with vulnerable adolescents whose problems included a pattern of self-harm, only 2 / 76 consultations noted any psychological problems and for these two no interventions were undertaken [2]. Young patients with complex disabilities required a lot of teamwork to plan their long term care, but even those professionals in frequent contact with such cases felt they needed additional training and support for care planning [3]. At that time we suggested an innovative co- ordinating role for "community supernurses". This role for adolescents was almost identical to the new Department of Health role for Community Matrons [4] to co-ordinate person-centred care for patients aged over 65. With Neighbourhood Renewal funding to improve access to primary health care, we have begun evaluating the nursing role of Health Facilitator [5]. Our preliminary findings show great promise for this primary care role in relation to secondary school pupils with complex disabilities (and their families). As well as undertaking direct work with adolescents, a key feature of this new role has proved to be training: to build primary care team skills and capacity. 1 McPherson A. Adolescents in primary care. BMJ 2005; 330: 465-467. 2 Clarke T, Watts C, Caan W, Sherr L. Primary care governance: the costs and benefits of greater access to records. http://bmj.bmjjournals.com/cgi/eletters/321/7261/608#9670 (8 September 2000). 3 Caan W, Streng I, Moxon R, Machin A. A joint health and social services initiative for children with disabilities. British Journal of Community Nursing 2000; 5: 87-90. 4 Department of Health. Supporting People with Long Term Conditions. An NHS and Social Care Model to support local innovation and integration. London: DH, 2005. 5 Caan W. PCTs - strike up the band for health facilitators. Health Service Journal 2003; 3 April: 23. Competing interests: Past chair of the School Health Research Group
Adolescents and primary health care 27 February 2005
Jacob Urkin, Chairman and community pediatrician Pediatric Primary Care Unit, Ben Gurion University, Box 653, 84105 Beer-Sheva, Israel, Mohammed Morad and Joav Merrick Send response to journal: Re: Adolescents and primary health care	EDITOR---First of all we would like to congratulate BMJ and Russell Viner for the initiative to publish papers on the ABCs of adolescence, but also comment on the recent paper by Ann McPherson (1) on primary care for adolescents and add some ideas to the list of suggestions. Even though adolescents do visit their general practitioner (GP), it is usually due to acute and specific health needs. Some do not come at all for extended periods of time. Therefore a proactive act by the GP could be to invite all adolescents for routine check-up, which could achieve the following objectives: no need for an excuse for coming for a visit, an opportunity for the adolescent to get acquainted with the clinic and staff in a relaxed atmosphere without the pressure of an acute need, an opportunity to perform health supervision and education that is not necessarily provided elsewhere. Before the encounter the adolescent is asked to mark a checklist of issues that concerns her/him. Some adolescents find it easier to check the relevant items than to initiate a talk about them. The physician can use the list as a tool that facilitates in-depth discussion. As most adolescents attend school, strengthening the ties with local schools can also help bring adolescents to the clinic. "Adopting" a school in the neighborhood is a way to influence adolescent health by involvement in health education at school. It helps the school teachers to know the local health providers and thus communicate with them or direct adolescents to the clinic, when needed. A physician talk to parents and adolescents at school is another way to open the doors of the clinic to those youngsters, who hesitate to seek help. This is also an opportunity to advertise the variety of ways to communicate with the practice, including email access. Adolescent medicine is a subspecialty of pediatrics that involve commitment, knowledge and skills. Many primary physicians find it difficult to keep up with the bulk of information on adolescent medicine. Many feel uncomfortable with issues, such as pediatric gynecology or psychiatry. One of the ways to help the clinic and the patients would be to assign one of the physicians as the one who have special interest in adolescent medicine. This physician can focus on updates in adolescent medicine, run the young persons clinic, and build the affiliations with external consultants for these special patients. She or he can provide immediate consultants within the practice and lead the other staff members, who serve adolescents. Learning more about the teenagers' community, where the practice is located, is another way of understanding the needs of adolescents in the neighborhood. Leading a community-based research on local health issues is another way of involvement in adolescent medicine that the practice and the adolescents could benefit from. AFFILIATION Jacob Urkin, MD, MPH, is a primary pediatrician and also director of the Pediatric Primary Care Unit, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel. E-mail: jacobur@clalit.org.il Mohammed Morad, MD, is a family physician, the medical director of a large area clinic in the city of Beer-Sheva, Israel. E-mail: morad62@barak-online.net Joav Merrick, MD, DMSc is professor of child health and human development, director of the National Institute of Child Health and Human Development and the medical director of the Division for Mental Retardation, Ministry of Social Affairs, Jerusalem, Israel. E-mail: jmerrick@internet-zahav.net. Website: www.nichd-israel.com REFERENCES 1. McPherson A. Adolescents in primary care. BMJ 2005;330:465-7. Competing interests: None declared