Carmen Jarrett

How professional identity shapes youth healthcare

PURPOSE The primary care sector is experiencing considerable change. How change and uncertainty are accommodated by the professional identity of medicine has not been examined. The purpose of this paper is to address the youth healthcare as an exemplar as this field is often a source of uncertainty for general practitioners (GPs). DESIGN/METHODOLOGY/APPROACH Using heterogeneity sampling, 22 GPs participated in focus groups to explore perceptions of youth healthcare, factors that help and hinder it, and training needs. Analysis of the research material was guided by a theoretical model on professional identity. FINDINGS GPs described tensions that challenged their professional identity - the challenges of working with young people and their complex issues, the extent to which youth healthcare sits within the purview of general practice, and the scope of training required. These tensions appeared to destabilise professional identity. Some participants had customised their identity by enriching understandings of and approach to general practice. Participants also reported work customisation as a way of managing the complex demands of the general practice role. Deepened insight appeared to bolster perceived capacity to support a complex patient cohort. Research limitations/implications - Participants are not representative of the primary care sector - furthermore, the methodology limits the generalisability of the findings. PRACTICAL IMPLICATIONS To bolster youth health, mere clinician training is insufficient. Youth health requires explicit support from governments and training providers to be incorporated into the healthcare landscape. ORIGINALITY/VALUE This study extends current research on professional identity by examining youth healthcare within the changing context of primary care.

The promise of primary health reform for youth health.

As in other nations, the Australian primary care sector represents the first port of call for most young people aged 12 to 24 years seeking health care. Australian young people are more likely to consult general practitioners (GPs) for support and counsel than other clinicians. This is especially the case for sensitive matters, like mental health issues. Seventy to ninety per cent of young people access primary care at least once a year, primarily for respiratory or dermatological concerns. GPs are therefore well-placed to promote youth health. As part of the primary care sector, GPs are responsible for promoting and reinforcing prevention, early intervention and connected care. In some Western nations, like the UK and Australia, they serve as the conduit to secondary and tertiary care, and thus moderate patient-flow within the health system. Furthermore, the developmental phase of young people provides an opportune period for prevention and early intervention. Attending to youth health represents a sound investment. This is recognised by a number of governments that endeavour to facilitate youth access to general practice. For instance, the Department of Health in the UK has released criteria to promote youth access to health care, which include the availability of appointment times that are accessible to young people, confidentiality, and staff training in youth health. Similarly, the Australian federal government entitles young people to hold their own Medicare card from the age of 15 years and thus access primary care services independently. Despite government support for primary care and young people’s seeming acceptance of GPs, youth access to primary care remains limited. Recent research on GP activity throughout Australia suggests that patients aged 15 to 24 years account for approximately 8.6 percent of all encounters – yet young people represent 13.6 percent of the Australian population. At a state level, NSW data suggest that youth access to GPs is largely in decline, particularly among young males. Although this research indicates that over two-thirds of NSW young people access a GP within a given 12-month period, this means that one-third do not, representing close to 300 000 young people. Furthermore, research would suggest that these young people may be less likely to seek help in the future. Even when young people access primary care services, research suggests some receive suboptimal care. A national study of general practice in Australia revealed that GPs do not embrace opportunities to target problematic lifestyle choices with patients, including alcohol and tobacco use. This reflects international research findings. For instance, in a North American study involving approximately four-hundred young people aged 15 to 25 years, 76% screened positive for at least one major health-related social problem – yet only 3% reported comprehensive screening by any clinician within the last 12 months, and 33% had not been screened at all. These examples might partly explain why young people have been described as a ‘forgotten group caught between bureaucratic barriers and professional spheres of influence’. Limited youth access to timely and appropriate health care can have personal, social and economic implications. At the personal level, many Australian young people experience chronic health and/or mental health issues. At a social level, chronic health and/or mental health issues can exacerbate the oft-cited burden of care among family members; these issues can also limit educational opportunities and employment prospects. At an economic level, lack of well-being is likely to require more services, more hospitalisation, more treatment, more medication, and continued access to clinicians and other practitioners. Furthermore, lack of well-being foreshadows reduced employability and perhaps increased reliance on government benefits. Given there are almost 3 million young people in Australia, ‘adolescent health [represents] an opportunity not to be missed’. To harness this opportunity and enhance youth health, innovative, systemic change is required. This includes (but is not limited to) changing the types of primary care services delivered to young people, how they are delivered and how these services are supported. In this epoch of health reform, there is arguably no better time for such change. Like many other nations, Australia is witnessing ‘the single biggest health reform in a quarter of a century’, the essence of which is health care that is ‘funded nationally . . . and run locally’. Given mounting evidence on what works in youth health care, current health reforms represent a window of opportunity to promote youth health. This article reveals how recent policy developments and growing research on evidence-based youth health care provide a strong platform on which to promote youth health. This is achieved through a narrative review of recent Australian health Correspondence: Professor David Bennett, Youth Health and Wellbeing, NSW Kids and Families, LMB 961, North Sydney, NSW 2059, Australia. Fax: +61 02 9424 5888; email: David.bennett@health.nsw.gov.au

Enhancing Youth Health in Primary Care: Lessons Learned From General Practitioners

Primary care represents a fundamental component of the health system, particularly for young people. However, youth access to primary care is less than ideal. To optimize clinician capacity to promote youth health, an interactive training module was developed and tailored to the needs of general practitioners. As part of an exploratory study, 11 participants were interviewed to determine the perceived capacity of the module to promote youth-friendly primary care. Findings suggest the module can enhance clinician skills, knowledge, and confidence to promote youth health; however, it has a limited ability to inform how organizational capacity might be bolstered—this includes the development of interagency networks. In this epoch of primary care reform, these findings are important for two key reasons. First, they reveal the need to bolster clinicians’ perceived ability to use youth healthcare skills; second, they highlight the complementary importance of organizational support to ensure and sustain youth-friendly practices. The article concludes with a discussion of key implications for policymakers, practitioners, and researchers.

Exploring young people's dignity: A qualitative approach

Human dignity as an important consideration in health care has been primarily investigated from an adult perspective. This paper explores young peoples perceptions of dignity and how it impacts on their health‐care experience.

In Their Own Words: Engaging Young People in a Youth Research Advisory Group: Letters to the Editor

intra-operatively. It may be associated with Trisomy 21, coronary heart disease, malrotation, polysplenia or further small bowel atresia. Rarely, perforation may occur before intervention. Most of the current reports detail successful outcome. We feel that our patient being premature with limited resources did not respond successfully. Multiple DA is a neonatal challenge. Having knowledge of this uncommon entity prepares the surgeon to handle the challenges posed by it.