Adolescents in primary care
BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.330.7489.465 (Published 24 February 2005) Cite this as: BMJ 2005;330:465
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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
Competing interests: No competing interests
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
Competing interests: No competing interests