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Adolescent health in 2012: The view from Primary Care. Dr Jane H Roberts Clinical Senior Lecturer and GP, Chair RCGP Adolescent Health Group. Background. Historically the data set is patchy RCGP AHG welcomes the beacons of light shone by the Key Data

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adolescent health in 2012 the view from primary care

Adolescent health in 2012: The view from Primary Care

Dr Jane H Roberts

Clinical Senior Lecturer and GP, Chair RCGP

Adolescent Health Group

background
Background
  • Historically the data set is patchy
  • RCGP AHG welcomes the beacons of light shone by the Key Data
  • ‘Virtually no studies carried out since 2000’; ‘a scandal’ (Coleman,2011)
  • Early work: Jacobson et al (1994): consultations shorter by approx 2m-used by GPs as ‘catch up’ time as YP not demanding
  • Followed by studies looking at how YP and GPs view each other (Churchill et al, 2000 Jacobson et al, 2001)
  • Landmark paper ‘Tackling Teenage Turmoil’ (2002 )
  • Specifically looking at consultations involving MH concerns: Martinez et al (2006)-’the elephant in the room’
  • Biddle et al (2006): GPs perceived as unskilled in MH, focused on ‘the physical’, keen to prescribe
exploring unease in the consultation
Exploring unease in the consultation
  • Embarrassment
  • Concerns about confidentiality
  • The Triadic consult (75% accompanied by parent/s; Martinez et al, 2006)
  • Feeling hurried-insufficient time
  • Worries and fears not a legitimate problem for PC
  • GPs not interested or knowledgeable in YP
  • Previous negative experiences of consulting
adolescence agency and primary care
Adolescence , agency and primary care
  • An absence of qualitative research to explore GPs’ perspectives on consulting with YP
  • a dominant popular narrative that YP have agency in their own lives and can affect change
  • Barnardo’s study Nov 2011

49% polled: “YP are ‘violent, angry, abusive’ “

No consideration of YP’s own experiences or ‘why’

Such narratives influence PHC workers

confidentiality
Confidentiality
  • Ethical considerations in a legal framework
  • Relationship based care
  • Dynamic
  • Safeguarding vs promoting engagement
  • GPs lack confidence: YP want a lead

Toolkit available from Oct 2011.

DH funded.

Available on RCGP website:CIRC

policy implications
Policy Implications
  • Knowledge from Teen Demonstration Sites 2006-08

YP at the centre, MDT working, leadership, planning and regular review.

Plurality: Targeted & Universal services

Creativity to reach the most marginalized: inverse care law remains with us

  • ‘You're welcome’ built on this knowledge : quality criteria to make PC youth –friendly
  • Required a commitment, training ,resources.
  • Funding ended May 2011. Remain as a self check list
real life illustrations
Real life illustrations
  • Main stream services made more accessible or ‘specialist services’?
  • Birthday checks? [ Chris Donovan, 1990s]-variable uptake
  • Teen drop-in clinics-often Nurse led. Usually highly motivated, mixed response from clinical teams

[RCT Walker et al, BMJ, 2002: 1516 14-15 yr olds; ‘change in behaviour slight but encouraging’, 97% would recommend to friend; ‘cheap’]

Develop from word of mouth. Marketing expensive, time consuming. Over lap with school nurses role.

PCT training provided-youth workers. Communication skills.

case examples washington ne
Case examples:Washington NE
  • Group practice wanting to improve services for YP
  • Ran focus groups summer 2011

YP wanted better access to mainstream services, not ‘youth clinic’

Unsure of what was available/what PCC could cover

Role of PSHE in school?

case example south london
Case Example: South London
  • The Well Centre, Streatham
  • Rate of attendance of 12-19 yrs old half of 0-14
  • 1 in 5 obese; 1 in 10 MHP
  • Clinicians from Herne Hill, Redthread (youth work),
  • Regional Innovation Fund
  • Attached to a local youth centre, drop-in
  • Formal evaluation
health inequalities primary care and young people
Health inequalities, primary care and young people
  • GPs see YP in the context of their wider life, families + local communities
  • Greater knowledge of the social determinants of ill-health
  • See disadvantaged YP fall pregnant at young ages and the effects of generational inequalities
  • Poverty is the greatest contributor to poor health
  • If we are serious about improving the health of YP then we need to address disadvantage at a structural level
concluding thoughts
Concluding thoughts
  • We have to do better regarding promoting youth friendly primary care
  • YP are the only group who have not seen significant health improvements in last 20 yrs (Viner & Barker, 2005)

Needs a multi-layered approach:

Education and training for practitioners,

Structural barriers-organization; payment,

Research –under resourced & under -prioritized

Commitment at Government level

Need to be more creative: working with schools, youth services

references
References

http://www.ayph.org.uk/publications/53_BriefingPaper2.

Biddle, L et al. (2006). Young adults' perceptions of GPs as a help source for mental distress: a qualitative study. Br J Gen Pract, 56(533), 924-931.

Churchill RD, et al(2000).Do the attitudes and beliefs of young teengers towards general practice influence actual consultation behaviour? The British Journal of General Practice 50,953-57

Jacobson L, et al (1994) Is the Potential of Teenage Consultations Being Missed? : A study of consultation times in primary care.  Family Practice ; 11: 296-299.

Jacobson L, et al (2002). Tackling teenage turmoil: primary care recognition and management of mental health during adolescence. Family Practice 19,No.4 401-409.

Martinez, R et al. (2006). Factors that influence the detection of psychological problems in adolescents attending general practices. Br J Gen Pract, 56(529), 594-599.