Young people and their GP: a register-based study of 1717 Norwegian GPs

Use of general practitioner services among youth and young adults in Norway from 2006 to 2021

OBJECTIVE

To describe the frequency and content of contacts with general practitioners (GPs) among youth and young adults by sex, age and time, emphasizing mental health, sexual health and respiratory tract infections.

DESIGN

Registry-based population-wide cohort study.

SETTING

General practice in Norway 2006-2021.

SUBJECTS

Norwegian residents aged 13-25 within the study period.

MAIN OUTCOME MEASURES

Contacts with GPs and out-of-hours services, including type of contact, specific procedures and diagnoses.

RESULTS

Average number of GP consultations increased over the study period for all age groups. Conversation therapy and time-consuming consultations increased over time, while chlamydia testing and contraceptive guidance decreased among young women. Consultations with mental health diagnoses increased substantially over the study period for all age groups. Use of GP and out-of-hours services increased with age, with a peak at the end of upper secondary school. Youth more often met their own regular GP when consulting for mental health diagnoses than for respiratory tract infections.

CONCLUSION

This study confirmed the continuing trend of increasing use of general practice services among youth, with an increase in conversation therapy and consultations with mental health diagnoses. Procedures related to sexual health became less common. Youth usually meet their regular GP for consultations, in particular those whose diagnosis indicates the highest need of continuity.

Adolescents and young adults' concerns under stress, the COVID-19 pandemic: a Portuguese cross-sectional study

Background

Adolescents and young adults are a critical target regarding reducing healthrisk behaviors' adoption, particularly in a stressful context such as the COVID-19 pandemic. Surveying their perceptions and behavioral changes may lead to a revised health promotion approach.

Objectives

This study aims to describe adolescents' and young adults' early reactions to a stressful event, the COVID-19 pandemic, characterizing their social determinants and preferences, such as sources of information, experienced symptoms, habits, and main concerns regarding themselves, their relatives, and the community. We intended to explore the association of their concerns and significant determinants such as age, gender, education, source of information, feelings of fear, prospecting the implications of communication, and individual and social determinants in managing stressful events.

Methods

We conducted a cross-sectional, population-based, self-report survey of 3,898 individuals aged between 16 and 24  years from Portugal.

Results

The main concerns about COVID-19 were the possibility of transmitting to someone and permanent social changes. Our findings present significant differences according to gender, education, age, and expressing fear.

Conclusion

The pandemic deteriorated baseline community inequalities. Young people appreciate official information and are available to contribute to society's safety. However, valuing official information is associated with deeper expressed concerns. Therefore, official information should include strategies to reach young people, promote healthier choices, and avoid distress and disinformation.

Young People Awareness of Sexually Transmitted Diseases and Contraception: A Portuguese Population-Based Cross-Sectional Study

Adolescents and young adults are an important target concerning reducing health-risk behavior adoption, including sexual health. Studying their knowledge concerning sexuality and their main counsellors, can be an important step in targeting an updated health promotion approach. This study characterized adolescents and young adults' knowledge and attitudes about sexually transmitted diseases (STDs), and contraception, prospecting for their main trusted counseling sources. We conducted a cross-sectional, population-based, self-report survey of 746 individuals aged between 14 and 24 years from Paredes, Portugal. The questionnaire included many dimensions, as demographic characteristics, youth behavior, currently sexually active status, main counselors concerning health topics, awareness, and knowledge about STDs and contraception. Mean age of the participants was 18.3 years, 50.5% of them had started their sexual activity. Males present themselves as more sexually active, starting earlier, and have more sexual partners than females. Participants reported an adequate knowledge perception about STDs and contraception methods, however we found different patterns on specific STDs and contraceptive methods, according to gender, age, and sexually active status. Our results help design specific interventions to reach youth, community, and healthcare providers, pointing out the value of bringing people to the center of health policies.

Functional somatic symptoms in youths in general practice: A cross-sectional study on prevalence, clinical management and perceived burden

OBJECTIVE

Functional somatic symptoms (FSS) may progress into a functional disorder if poorly managed, which may have serious implications. This cross-sectional study describes the management of youths compared to adults in general practice and estimates the prevalence of FSS in youths in this setting by comparing consultation-related aspects between youths with FSS and 1) youths with a specific diagnosis and 2) adults with FSS.

METHODS

We used data from a Danish survey (2008-2009), including 3295 face-to-face consultations between GPs and patients aged 15-64 years. Patients were divided into youths (15-24 years) and adults (25-64 years) and then into subgroups according to the GPs' classifications: 1) specific diagnosis, 2) resolving symptom and 3) FSS. Logistic regression analysis was used for all comparisons, and estimates were adjusted for gender, concomitant chronic disorder and GP cluster.

RESULTS

The GPs more frequently ensured continuity of care in adults (AOR:0.75, 95%CI:0.61-0.92, p < 0.01) and perceived youths as less time consuming (AOR:0.58, 95%CI: 0.43-0.77, p < 0.01) and less burdensome (AOR:0.60; 95%CI: 0.45-0.81, p < 0.01) compared to adults. FSS prevalence was 4.4% in youths and 9.0% in adults. However, GPs perceived youths with FSS as more burdensome (AOR:7.77, 95%CI:2.93-20.04, p < 0.01) and more time consuming (AOR:3.98, 95%CI:1.42-11.12, p < 0.01) than youths with a specific diagnosis. No significant differences were found between youths and adults with FSS, respectively, in regards to perceived burden and consultation time.

CONCLUSION

The results indicate age-related variations in the prevalence and clinical management of FSS in general practice. The GPs perceived both youths and adults with FSS time consuming, which underlines a need for supportive management strategies.

[Doctor-patient relationship: teenagers prefer "tu" to "vous"]

The quality of the relationship is important for the medical care of adolescents. The choice of the pronoun of address, "tu" or "vous", could be a determining factor in this relationship. A study of 220 adolescents showed that they preferred to be addressed as "tu". They waited for the doctor to offer it to them.

Adolescents consulting general practitioners for psychological problems-a nationwide, register-based study in Norway

BACKGROUND

Psychological problems are increasing among adolescents, but little is known about the role of GPs in this area.

OBJECTIVES

This study aims to investigate the frequency of GP consultations with a psychological diagnosis in adolescence and predictors for such help seeking.

METHODS

Nationwide longitudinal register-based study investigating GP consultations among adolescents aged 13-17 years (N = 123 516) in Norway. First, all GP consultations within the study population were identified from the national GP claims register for 2006-11. Second, adolescents with a first-time consultation with a psychological diagnosis at age 15-16 years were identified, and prior GP consultations, prior somatic diagnoses, parental education and GP and GP-practice characteristics were assessed as possible predictors for seeking help.

RESULTS

From age 13 to 17 years, 15.3% of girls and 13.0% of boys had ≥1 GP consultation with a psychological diagnosis. In total, 6.8% of girls and 4.8% of boys consulted a GP for the first time with a psychological problem at age 15-16 years. For both sexes, number of prior GP consultations and a prior diagnosis of headache and abdominal pain predicted consulting with an internalizing problem (depression, anxiety and stress). A prior headache diagnosis predicted consulting for behavioural problems. Psychological diagnoses were more often found among adolescents with lower parental education. There were only minor associations with GP characteristics.

CONCLUSIONS

Norwegian adolescents often consult a GP and one in seven had a GP-diagnosed psychological problem at age 13-17. Policies to improve mental health care for adolescents should include strengthening of GP services.

Screening for adolescent suicidality in primary care: the bullying-insomnia-tobacco-stress test. A population-based pilot study

AIM

Adolescents at risk for suicide often see their general practitioner solely for somatic or administrative reasons. A simple screening test given during a conversation would be of substantial help to send a signal and tackle the problem. We propose to update a screening test previously validated in France - the TSTS-Cafard - because of significant changes in the lives of adolescents with the growth of the cyber world since 2000.

METHODS

The design and setting was a cross-sectional study involving 912 15-year-old adolescents in 90 French schools. They completed a questionnaire that included the TSTS-Cafard and risk factors extracted from the Health Behaviour in School-Aged Children survey. To improve the test, we selected questions drawn from the recent literature. Answers were analysed according to 'suicidality' = at least one suicide attempt in life or suicidal ideation often over the past 12 months.

RESULTS

Suicidality rates were 9.6% for boys and 23.1% for girls. Although the TSTS-Cafard test was generally effective, one question was no longer discriminating. A new test, entitled 'BITS', included only four questions on bullying, insomnia, tobacco and stress, with three levels of response and scores ranging from 0 to 8. Improvement was achieved without loss of performance. Using a cut-off score of 3, we achieved 78% accuracy (area under the curve), 75% sensitivity and 70% specificity.

CONCLUSION

The BITS test could allow the question of suicide risk to be addressed during a routine check-up in primary care but the results need to be validated with 13 to 18-year olds.

Even if they are not aware of it, general practitioners improve well-being in their adolescent patients

Background: Most adolescents consult their general practitioner (GP) for common reasons, somatic or administrative but many of them have hidden feelings of distress.

Objectives: To assess the immediate impact of ‘ordinary’ consultations on feelings of distress among adolescents and to compare adolescents experiencing difficulties (D) to those with no difficulties (N). To analyse how accurately GPs assess the impact of their consultation on adolescents’ feelings.

Methods: GPs were randomly selected from two non-contiguous French administrative areas between April and June 2006. Fifty-three GPs gave two questionnaires to the first 10 to 15 adolescents aged 12 to 20 seen in consultation. One questionnaire was issued before the consultation and the other one afterwards. Adolescents had to position themselves about different aspects of well-being and say where they would seek help if they had problems. A GP questionnaire assessed how well they estimated their impact on the adolescent’s feeling of well-being.

Results: Six hundred and sixty-five adolescents were assessed. They reported feeling better about their health, being able to talk, having someone to talk to or to confide in and on feeling understood. The D group (n = 147) felt significantly better compared to the N group (n = 518). GPs tended to underestimate this improvement, especially regarding adolescents in the D group feeling better about their health.

Conclusions: Consulting a GP generates increased well-being among adolescents, especially for those experiencing difficulties. GPs tend to underestimate the positive impact they may have. Further studies are needed to explore if this benefit is permanent over time.

How can the general practitioner support adolescent children of ill or substance-abusing parents? A qualitative study among adolescents

OBJECTIVES

To explore significant experiences of adolescents as next of kin that the general practitioner (GP) should identify and recognize.

DESIGN

Qualitative study with focus-group interviews.

SUBJECTS AND SETTING

Three focus-group interviews were conducted with a total of 15 Norwegian adolescents each with an ill or substance-abusing parent. The participants were recruited from existing support groups.

RESULTS

The adolescents' days were dominated by unpredictability in their family situation and their own exhausting efforts to keep up an ordinary youth life. Mostly, they consulted GPs for somatic complaints. In encounters with the GP, they wanted to be met both as a unique person and as a member of a family with burdens. Their expectations from the GP were partly negatively formed by their experiences. Some had experienced that both their own and their parent's health problems were not addressed properly. Others reported that the GP did not act when he or she should have been concerned about their adverse life situation. The GP may contribute to better long-term psychosocial outcomes by ensuring that the adolescents receive information about the parent's illness and have someone to talk to about their feelings and experiences. In addition, the GP may help by supporting their participation in relieving activities.

CONCLUSION

Burdened adolescents seek a GP most often for somatic complaints. The GP has a potential to support them by taking the initiative to talk about their life situation, and by recognizing their special efforts. Key points Little is known about how a general practitioner can support adolescents with ill or substance-abusing parents. Adolescents experience unpredictability in life and strive to find balance between their own needs and the restrictions caused by parental illness. In encounters with adolescents having ill parents, the GP should take the initiative to talk about their family situation. The GP may help them by recognizing their experiences and struggles, give information, offer talks and support coping strategies.

Developing and sustaining adolescent-friendly health services: A multiple case study from Ecuador and Peru

Adolescent-Friendly Health Services (AFHSs) are those that are accessible, acceptable, equitable, appropriate and effective for different youth sub-populations. This study investigated the process through which four clinics in two countries - Peru and Ecuador - introduced, developed and sustained AFHSs. A multiple case study design was chosen, and data from each clinic were collected through document review, observations and informant interviews. National level data were also collected. Data were analysed following thematic analysis. The findings showed that the process of introducing, developing and sustaining AFHSs was long term, and required a creative team effort and collaboration between donors, public institutions and health providers. The motivation and external support was crucial to initiating and sustaining the implementation of AFHSs. Health facilities' transformation into AFHSs was linked to the broader organisation of country health systems, and the evolution of national adolescent health policies. In Peru, the centralised approach to AFHSs introduction facilitated the dissemination of a comprehensive national model to health facilities, but dependency on national directives made it more difficult to systemise them when ideological and organisational changes occurred. In Ecuador, a less centralised approach to introducing AFHSs made for easier integration of the AFHSs model.

Encouraging adolescents to contact their GP: a community-based trial

Background

Adolescents, especially males, often fail to see their GP.

Aim

To determine whether an informative letter could enhance the accessibility and utilisation of healthcare facilities and services.

Design and setting

A community-based trial in one town in Oslo, using a retrospective control group.

Method

GPs in one town in Oslo sent a personal, informative letter at the beginning of 2008 and 2009 to individuals in their practice population who were turning 16 years of age that year. The pooled data for the same year for each surgery were collected. Retrospective data from 1990 and 1991 served as controls for the intervention groups of data collected in 2006 and 2007 respectively. An International Classification of Primary Care-2 diagnosis was given for each contact.

Results

The proportion of adolescents in contact with a GP increased from 59% in the control group to 69% in the intervention group (P<0.001). For the males, the increase was from 54% to 72% (P<0.001). This reduced sex differences in healthcare seeking. For diagnoses mentioned in the informative letter the incidence rose from 38% in the control group to 55% in the intervention group (P<0.001). For the females, there was a non-significant increase in the proportion in contact with the GP, from 63% to 66% in control and intervention groups, respectively. The most frequent contact reasons were respiratory disorders, followed by general and unspecified complaints, skin disorders, musculoskeletal disorders, and psychological disorders. This pattern did not change because of the intervention.

Conclusion

An information letter about health problems and health rights (such as the protection of the adolescent’s privacy) seems to enhance the accessibility and utilisation of GPs, as measured by contact rate, particularly for males.

Enhanced Performance of Community Health Service Centers during Medical Reforms in Pudong New District of Shanghai, China: A Longitudinal Survey

BACKGROUND

The performance of community health service centers (CHSCs) has not been well monitored and analysed since China's latest community health reforms in 2009. The aim of the current investigation was to evaluate the performing trends of the CHSCs and to analyze the main factors that could affect the performance in Pudong new district of Shanghai, China.

METHODS

A regional performance assessment indicator system was applied to the evaluation of Pudong CHSCs' performance from 2011 to 2013. All of the data were sorted out by a panel, and analyzed using descriptive statistics and a generalized estimating equation model.

RESULTS

We found that the overall performance increased annually, with a growing number of CHSCs achieving high scores. Significant differences were observed in institutional management, public health services, basic medical services and comprehensive satisfaction during the period of three years. However, we found no differences in the service scores of Chinese traditional medicine (CTM). The investigation also demonstrated that the key factors affecting performance were the location, information system level, family GP program and medical association program rather than the size of the center. However, the medical association participation appeared to have a significant negative effect on performance.

CONCLUSIONS

It can be concluded from the three-year investigation that the overall performance was improved, but that it could have been further enhanced, especially in institutional management and basic medical service; therefore, it is imperative that CHSCs undertake approaches such as optimizing the resource allocation and utilization, reinforcing the establishment of the information system level, extending the family GP program to more local communities, and promoting the medical association initiative.

Exploration of health status, healthcare utilization, and health service expectations among Taiwanese adolescents

There have been few reports about adolescent experiences with and expectations of health service utilization in an Asian societal setting. The aim of this study is to analyze the use of healthcare services in relation to health status and explore adolescents' preferences for youth-friendly service among Taiwanese high school students. A cross-sectional questionnaire-based survey was conducted on Taiwanese adolescents aged 12–18 years in 2010.We invited participants to rate their health status, report their previous healthcare service use, and rank their health service preferences.We used logistic regression analysis to investigate the association between self-rated health status and healthcare utilization and used nonparametric analysis to compare health service preferences among sociodemographic subgroups. A total of 4,907 students (97.2 % response rate) returned valid questionnaires for analysis. Poor health status and chronic illness were most salient factors independently associated with frequent healthcare service use. Only 40 % of respondents reported having a regular doctor, and pediatrics (57.7 %) was the most commonly identified professional source of medical care. A great majority (86.2 %) of respondents made clinical visits with parents. For characteristics of youth-friendly clinician, the top-ranked items included competency and patience, while having helpful and friendly personnel was highlighted for clinical setting.

CONCLUSION

Family participation is critical in healthcare for adolescents in Asian cultures. Health service use is significantly influenced by health status and chronic illness in the general health insurance system. Understanding these background influences on expectations for healthcare may help to create youth-friendly health services that are more culturally appropriate.

Primary healthcare providers' views on improving sexual and reproductive healthcare for adolescents in Bolivia, Ecuador, and Nicaragua

Objectives

To elicit the views of primary healthcare providers from Bolivia, Ecuador, and Nicaragua on how adolescent sexual and reproductive health (ASRH) care in their communities can be improved.

Methods

Overall, 126 healthcare providers (46 from Bolivia, 39 from Ecuador, and 41 from Nicaragua) took part in this qualitative study. During a series of moderated discussions, they provided written opinions about the accessibility and appropriateness of ASRH services and suggestions for its improvement. The data were analyzed by employing a content analysis methodology.

Results

Study participants emphasized managerial issues such as the prioritization of adolescents as a patient group and increased healthcare providers’ awareness about adolescent-friendly approaches. They noted that such an approach needs to be extended beyond primary healthcare centers. Schools, parents, and the community in general should be encouraged to integrate issues related to ASRH in the everyday life of adolescents and become ‘gate-openers’ to ASRH services. To ensure the success of such measures, action at the policy level would be required. For example, decision-makers could call for developing clinical guidelines for this population group and coordinate multisectoral efforts.

Conclusions

To improve ASRH services within primary healthcare institutions in three Latin American countries, primary healthcare providers call for focusing on improving the youth-friendliness of health settings. To facilitate this, they suggested engaging with key stakeholders, such as parents, schools, and decision-makers at the policy level.

The potential cost-effectiveness of general practitioner delivered brief intervention for alcohol misuse: evidence from rural Australia

OBJECTIVE

This paper aims to model General Practitioner (GP) delivered screening and brief intervention (BI), and to identify the costs per additional risky drinker who reduces alcohol consumption to low-risk levels, relative to current practice.

METHOD

A decision model and nine different scenarios were developed to assess outcomes and costs of GP-delivered screening and BI on the potential number of risky drinkers who reduce their alcohol consumption to low-risk levels in 10 rural communities in New South Wales, Australia.

FINDINGS

Based on evidence from current practice, approximately 19% of all risky drinkers visiting GPs annually would reduce alcohol consumption to low-risk levels, of which 0.7% would do so because of GP-delivered screening and BI. If rates of screening and BI are increased to 100%, 36% of these risky drinkers would reduce their drinking to low risk-levels. Alternatively, increments of 10% and 20% in GP-delivered screening and BI would reduce the proportion of risky drinkers by 2.1% and 4.2% respectively. The most cost-effective outcome per additional risky drinker reducing their drinking relative to current practice would be if all of these risky drinkers are screened alone with an ICER of AUD$197.

CONCLUSION

These findings indicate that increments in rates of screening and BI delivered by GPs can result in cost-effective reductions per additional risky drinkers reducing their drinking to low-risk levels, relative to current practice. They also imply that achieving substantial reductions in the prevalence of risky drinking in a community will require strategies other than opportunistic screening and BIs by GPs.

Trust, autonomy and relationships: the help-seeking preferences of young people in secondary level schools in London (UK)

Help-seeking among young people is complicated, often determined vicariously by the ability of adults, family or professionals, to recognize, and respond to, their difficulties. We know very little about the complex concerns of teenage young people and how they impact on help-seeking preferences. We aimed to ascertain the help-seeking preferences for a range of mental health problems among adolescents attending schools in an inner-city area of London. In particular we sought to examine the relationship between such adolescents and their family doctor. Using a mixed methods approach we explored help-seeking attitudes of young people. Emotional and mental health problems are not seen by young people as the domain of General practitioners. Moreover, there is a worrying lack of confidence and trust placed in family doctor and other professionals by young people. Young people do not tend easily to trust adults to help them with emotional difficulties.