Aims of today 1. To recognise the barriers adolescents may face in accessing primary care services 2. To highlight areas of clinical concern in adolescent health 3. To consider issues and challenges around consultations with young people 4. To discuss how GP practices can be made more teenage friendly
Young people in our society There are 6 million aged in UK
Why is adolescent health important? Death rates in year olds now exceed those in 1-4 year olds. Main causes Accidents Violence Suicide 25% of young people have seen their GP in the last 3 months, but there is evidence that some young people find it difficult to access health services appropriately.
Young people’s point of view
Your teenage experience Think about when you were a teenager (or a teenager you know well). What health concerns did you/they have? What contacts did you/they have with health professionals? What did the health contacts feel like? What made/ may make these contacts more difficult than for adults?
Barriers for teenagers in accessing primary care Concern about confidentiality Embarrassed about symptoms Lack of information about services Appointment system Geography/ transport
Young people’s health agendas Sexual health – c/c, pregnancy (TOP/parenthood), STDs, sexual orientation Mental health – self esteem, exam stress, adolescent adjustment, home and school relationships Appearance – skin, body image, size Minor illness – not minor to them, not familiar with it Chronic illness – may express resentment by non compliance
The GP’s point of view
Your medical experience Think about consultations with teenage patients In any context – not just GP What were the issues? How did the consultations differ from adult or child consultations?
Issues in the consultation Communication/rapport Confidentiality Consent Access 3 way consultations Presenting problem vs hidden agenda vs health promotion
In the consultation Relate directly to young children so they’re used to it by the time they’re teenagers Extra explanation time for common problems (flu, cystitis) Be very patient centred esp with non compliant teenagers with chronic diseases Health promo sensitive to young people’s agendas Don’t make assumptions Get their mobile phone number
A scheme for assessing troubled teenagers (HEADSS) Home – can you talk to your parents? Education – ask about actual school performance Activities – what do you like doing? Do you have friends you can trust? Drugs (incl smoking and alcohol) – explain why you want to know Sex – ask permission to ask the questions Suicide risk – if consultation makes you feel you should ask
Contrasting agendas Young people Sexual health – c/c, pregnancy (TOP/parenthood), STDs, sexual orientation Mental health – self esteem, exam stress, adolescent adjustment, home and school relationships Appearance – skin, body image, size Minor illness – not minor to them, not familiar with it Chronic illness – may express resentment by non compliance Health professionals Lifestyle issues – smoking, alcohol, drugs, diet, exercise Sexual health – c/c, STDs, pregnancy Mental health – suicide prevention, behaviour in school
Consultations with young people 1 Evie 2. Ruth
Organising primary care for young people
Improving access What can a practice do to provide a service which teenagers will use? Resources: RCGP “Getting it right for teenagers in your practice” 2002
In the practice Confidentiality made clear Staff trained to be welcoming Accessibility – advance appts don’t work well for young people Health promotion sensitive to young people’s concerns
Useful resources For teenagers: For teenagers: For parents: (Choose “Advice”,“teenagers”)