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Kotsis K, Mitropoulou A, Tzotzi A, Marchionatti LE, Hoffmann MS, Schafer JL, Casella CB, Simioni A, Papanikolaou K, Basta M, Serdari A, Koumoula A, Salum GA. Experience of Service Questionnaire (ESQ) in children and adolescents: factor structure, reliability, validity, item parameters and interpretability of the parent version for practical use in Greece. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.07.05.24309986. [PMID: 39006435 PMCID: PMC11245072 DOI: 10.1101/2024.07.05.24309986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
Background Health systems need tools to assess patient's experience of service, but existing tools lack reliability and validity assessment. Our aim is to investigate the factor structure, reliability, validity, item parameters and interpretability of the parent version of the Experience of Service Questionnaire (ESQ) for practical use in Greece. Methods A total of 265 caregivers that were using mental health services in Greece participated in this study as part of the Nationwide cross-sectional survey from the Child and Adolescent Mental Health Initiative (CAMHI). Confirmatory Factor Analysis was used to test factor structure. Reliability of all models were measured with omega coefficients. Tobit regression analysis was used to test for convergent and discriminant validity with specifically designed questions. Item parameters were assessed via Item Response Theory. Interpretability was assessed by means of IRT-based scores. Results We found that ESQ is best represented and scored as a unidimensional construct, given potential subscales would not have enough reliability apart from a general factor. Convergent and discriminant validity was demonstrated, as caregivers who perceived that their child benefited from the received mental health care had 6.50 higher summed scores (SMD=1.14, p<0.001); while those who believed that their child needed additional help had 5.08 lower summed scores on the ESQ (SMD=-0.89, p<0.001). Average z-scores provided five meaningful categories of services, in terms of user satisfaction, compared to the national average. Conclusions Our study presents evidence for the reliability and validity of the ESQ and provides recommendations for its practical use in Greece. ESQ can be used to measure experience of service and might help drive improvements in service delivery in the Greek mental health sector.
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Affiliation(s)
- Konstantinos Kotsis
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, Greece
- Department of Psychiatry, Community CAMHS, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Andromachi Mitropoulou
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, Greece
- Department of Psychiatry, Community CAMHS, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Alexandra Tzotzi
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, Greece
- Department of Psychiatry, Community CAMHS, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Lauro Estivalete Marchionatti
- Child Mind Institute, New York, United States of America
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Mauricio Scopel Hoffmann
- Department of Neuropsychiatry, Universidade Federal de Santa Maria, Santa Maria, Brazil (UFSM)
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Julia Luiza Schafer
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, Greece
- Child Mind Institute, New York, United States of America
| | - Caio B. Casella
- Child Mind Institute, New York, United States of America
- Department of Psychiatry, Universidade do Estado de São Paulo (USP), São Paulo, Brazil
| | - André Simioni
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, Greece
- Child Mind Institute, New York, United States of America
| | - Katerina Papanikolaou
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, Greece
- Department of Child and Adolescent Psychiatry, Agia Sophia Children’s Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Basta
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, Greece
- Department of Psychiatry, University of Crete, Heraklion, Greece
| | - Aspasia Serdari
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, Greece
- Department of Child and Adolescent Psychiatry, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Anastasia Koumoula
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, Greece
| | - Giovanni Abrahão Salum
- Child and Adolescent Mental Health Initiative (CAMHI), Stavros Niarchos Foundation & Child Mind Institute, Greece
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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Thomsen EL, Boisen KA, Andersen A, Jørgensen SE, Teilmann G, Michelsen SI. Low Level of Well-being in Young People With Physical-Mental Multimorbidity: A Population-Based Study. J Adolesc Health 2023; 73:707-714. [PMID: 37389522 DOI: 10.1016/j.jadohealth.2023.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 03/16/2023] [Accepted: 05/10/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE We aimed to examine whether wellbeing, health behavior, and youth life among young people (YP) with co-occurrence of physical-mental conditions, that is, multimorbidity differ from YP with exclusively physical or mental conditions. METHODS The population included 3,671 YP reported as having a physical or/and mental condition from a Danish nationwide school-based survey (aged 14-26 years). Wellbeing was measured by the five-item World Health Organization Well-Being Index and life satisfaction by the Cantril Ladder. YP's health behavior and youth life were evaluated in seven domains: home, education, activities/friends, drugs, sleep, sexuality, and self-harm/suicidal thoughts, in accordance with the Home, Education and employment, Eating, Activities, Drugs, Sexuality, Suicide and depression, and Safety acronym. We performed descriptive statistics and multilevel logistic regression analysis. RESULTS A total of 52% of YP with physical-mental multimorbidity reported a low level of wellbeing, compared to 27% of YP with physical conditions and 44% with mental conditions. YP with multimorbidity had significantly higher odds of reporting poor life satisfaction, compared to YP with exclusively physical or mental conditions. YP with multimorbidity had significantly higher odds for psychosocial challenges and health risk behavior, compared to YP with physical conditions, along with increased odds for loneliness (23.3%), self-harm (63.1%), and suicidal thoughts (54.2%), compared to YP with mental conditions. DISCUSSION YP with physical-mental multimorbidity had higher odds for challenges and low wellbeing and life satisfaction. This is an especially vulnerable group and systematic screening for multimorbidity and psychosocial wellbeing is needed in all healthcare settings.
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Affiliation(s)
- Ena Lindhart Thomsen
- Center of Adolescent Medicine, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Denmark, Copenhagen, Denmark.
| | - Kirsten Arntz Boisen
- Center of Adolescent Medicine, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Denmark
| | - Anette Andersen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Denmark
| | | | - Grete Teilmann
- Department for Children and Adolescents, Nordsjaellands Hospital, Hilleroed, Denmark
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Breuner CC, Alderman EM, Jewell JA. The Hospitalized Adolescent. Pediatrics 2023; 151:190499. [PMID: 36995186 DOI: 10.1542/peds.2022-060646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
This policy statement is the first published statement in the United States on this topic and the authors aim to provide pediatricians with evidence-based information on the unique aspects required to care for hospitalized adolescents. Included in this policy statement is a description of the possible effects hospitalization may have on the developmental and emotional progress of adolescence, the role of the hospital setting, the importance of confidentiality, and issues related to legal/ethical matters and bias and institutional and systemic racism that may occur during hospitalization.
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Affiliation(s)
- Cora C Breuner
- Division of Adolescent Medicine, Departments of Pediatrics and Orthopedics and Sports Medicine, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | - Elizabeth M Alderman
- Division of Adolescent Medicine, Department of Pediatrics, Albert Einstein College of Medicine and The Children's Hospital at Montefiore, Bronx, New York
| | - Jennifer A Jewell
- The Barbara Bush Children's Hospital at Maine Medical Center, MaineHealth, Portland, Maine
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Eg M, Jensen CS. The challenges of maintaining patient confidentiality in pediatric settings. J Pediatr Nurs 2023; 69:18-23. [PMID: 36599177 DOI: 10.1016/j.pedn.2022.12.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/15/2022] [Accepted: 12/18/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE The study investigated challenges encountered by healthcare professionals in complying with the duty of confidentiality in a pediatric department. DESIGN AND METHODS In this qualitative study, we conducted two focus group interviews with healthcare professionals from two pediatric departments in Denmark using the methodology described by Kvale and Brinkmann. RESULTS We identified three challenges related to maintaining confidentiality. 1) Time pressure and physical surroundings in the clinical setting. 2) Communication challenges (where and with whom). 3) Navigation in the clinical setting to uphold privacy. In general, nurses and physicians struggle to maintain patient confidentiality in a setting where sensitive information is shared quickly. CONCLUSION Pediatric nurses and physicians experience challenges related to patient confidentiality that impact their clinical practice. These challenges relate to privacy and dignity and communicating with children and their parents. PRACTICE IMPLICATIONS Building design or renovation of pediatric departments should underpin confidentiality and privacy issues. Our study makes an important and novel contribution to existing knowledge regarding healthcare professionals' experiences in maintaining patient privacy and confidentiality.
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Affiliation(s)
- Marianne Eg
- Department of Paediatrics and Adolescent Medicine, Viborg Regional Hospital, Denmark.
| | - Claus Sixtus Jensen
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Denmark; Research Center for Emergency Medicine, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
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Ryberg AM, Nielsen PB, Graarup KS, Ingeman K, Thellefsen MR, Jensen CS. Danish translation and cultural adaptation of the 'What do you think of hospital' patient reported experience measure for children and adolescents in outpatient settings. J Pediatr Nurs 2023; 68:e36-e42. [PMID: 36372698 DOI: 10.1016/j.pedn.2022.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 09/28/2022] [Accepted: 10/30/2022] [Indexed: 11/12/2022]
Abstract
PURPOSE The aim of this study was to translate the patient reported experience measure (PREM) questionnaire"What do you think of the hospital? Help us to get better!" into Danish used in outpatient clinics and to explore its face and content validity. DESIGN AND METHODS The translation process followed WHO recommendations and included forward translation, expert panel evaluation, back translation, pre-testing and cognitive interviews with 23 children and adolescents. RESULTS Children and adolescents were positive to using PREM as a way to express their experiences. The layout of the questionnaire was important as use of colours was more appealing and the topics of the questionnaire were better visualised. The concepts in the original questionnaire related to distinguishing between different rooms for examination and conversation are not used in a Danish context. Otherwise, only minor translation adjustments were needed to match the Danish target group. CONCLUSION Children and adolescents found that the Danish version of the PREM questionnaire tool was easy to read and understand, and the layout emphasised that they are the target group. After pre-testing among 23 children and adolescents, the questionnaire is now ready for pilottest in a larger group. PRACTICE IMPLICATIONS The present study provides a tool to generate knowledge and evaluate the experiences of children and adolescents in an outpatient clinic. Using the questionnaire, healthcare staff may monitor the quality of the experiences of children and adolescents and collect data for research purposes. Likewise, it will be possible to compare hospitals and organizations nationally.
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Affiliation(s)
- Anne Marie Ryberg
- Master in Clinical Nursing, Project nurse, RN, Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, N, Denmark.
| | - Pia Bonde Nielsen
- Staff Development Nurse, Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, N, Denmark.
| | - Karen Sønderby Graarup
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, N, Denmark.
| | - Katrine Ingeman
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Psychiatry, The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus, Denmark.
| | - Mette Ramskov Thellefsen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Blegdamsvej 9, 2100 København, Denmark.
| | - Claus Sixtus Jensen
- Clinical Nurse Specialist and Postdoctoral researcher, Department of Paediatrics and Adolescent Medicine, Aarhus University, Hospital, Aarhus, Denmark; Research Centre for Emergency Medicine, Emergency Department, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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Walker N, Medlow S, Georges A, Steinbeck K, Ivers R, Perry L, Skinner SR, Kang M, Cullen P. Emergency Department Initiated Mental Health Interventions for Young People: A Systematic Review. Pediatr Emerg Care 2022; 38:342-350. [PMID: 34620805 DOI: 10.1097/pec.0000000000002551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Young people (10-24 years old) with mental health concerns are increasingly presenting to hospital emergency departments (EDs). The purpose of this review was to identify the core components and outcomes of mental health interventions for young people that are initiated in the ED, such that they are delivered in the ED and/or by ED health workers. METHODS Six electronic databases were systematically searched. Primary peer-reviewed qualitative or quantitative studies describing an ED-initiated mental health intervention for young people published between 2009 and 2020 were included. RESULTS Nine studies met the inclusion criteria. The included studies demonstrated that compared with traditional ED care, ED-initiated mental health interventions lead to improved efficiency of care and decreased length of stay, and a core component of this care was its delivery by allied health practitioners with mental health expertise. The studies were limited by focusing on service efficiencies rather than patient outcomes. Further limitations were the exclusion of young people with complex mental health needs and/or comorbidities and not measuring long-term positive mental health outcomes, including representations and whether young people were connected with community health services. CONCLUSIONS This systematic review demonstrated that ED-initiated mental health interventions result in improved service outcomes, but further innovation and robust evaluation are required. Future research should determine whether these interventions lead to better clinical outcomes for young people and staff to inform the development of best practice recommendations for ED-initiated mental health care for young people presenting to the ED.
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Affiliation(s)
| | | | | | | | | | - Lin Perry
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Ultimo
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Davidson SK, Sanci L, de Nicolás Izquierdo C, Watson CJ, Baltag V, Sawyer SM. Best Practice During Teleconsultations With Adolescents: A Scoping Review. J Adolesc Health 2022; 70:714-728. [PMID: 35082052 DOI: 10.1016/j.jadohealth.2021.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/31/2021] [Accepted: 11/05/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Teleconsultations are increasingly used to deliver health care, yet guidance on how to maximize health outcomes and ensure the quality and rights-based principles of adolescent health care during teleconsultations is lacking. This scoping review synthesized the literature on teleconsultations with adolescents, with the objective of informing a practical guidance for healthcare professionals. METHODS Eight databases were searched to identify articles published between 2010 and 2020 in English, French, or Spanish that provided evidence or guidance on synchronous teleconsultations with 10- to 19-year-olds. Web sites in six high-income countries and six low- to middle-income countries were also searched and a Google search was conducted. Data were analyzed using narrative synthesis. RESULTS Of 59 total references, 51 were from high-income countries. References included primary research (n = 21), reviews (n = 13), clinical guidance (n = 9), case reports (n = 9), commentaries (n = 6), and a website (n = 1). Just under half (46%) were descriptive, qualitative, or expert opinion. The main focus was mental health and behavioral disorders. DISCUSSION Good evidence on the complexities of conducting teleconsultations with adolescents is lacking. Questions remain regarding the scope and acuity of health issues for which teleconsultations are appropriate, their role in overcoming or contributing to inequalities, and the practicalities of conducting consultations.
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Affiliation(s)
- Sandra K Davidson
- Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lena Sanci
- Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Cathy J Watson
- Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Valentina Baltag
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing (MCA), World Health Organization (WHO), Geneva, Switzerland
| | - Susan M Sawyer
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Centre for Adolescent Health, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
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Jensen CS, Eg M. Confidentiality breaches in hospital: the experiences of young people and parents. Nurs Child Young People 2022; 34:22-27. [PMID: 35253412 DOI: 10.7748/ncyp.2022.e1389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Healthcare professionals, including nurses, have a vital role in protecting patient confidentiality. However, evidence shows that breaches of confidentiality are common in hospitals for various reasons, including the ward design and issues related to healthcare staff's professionalism. The situation can be complicated further in paediatric care because of the age range of patients and their associated needs and rights about information sharing, confidentiality and consent. AIM To explore the views and experiences of young people admitted to hospital, and their parents and related caregivers, about the effects of confidentiality breaches. METHOD A descriptive questionnaire-based survey was conducted in 2018 in two regional hospitals in Denmark over two weeks. A total of 214 surveys were completed by parents and related caregivers (n=173) and by young people (n=41). FINDINGS Many parents and young people reported that they had overheard healthcare professionals discussing care, including information about named patients, test results, personal disclosures and various comments or opinions. In many cases these breaches of confidentiality affected patients' overall experience of hospital and led some to withhold important information. CONCLUSION This study demonstrates the challenges of preserving confidentiality in children's wards. Situations in which confidentiality breaches were reported appear to have been affected by the physical environment, such as ward design, as well as staff behaviour and attitudes. Therefore, nurses and other healthcare professionals need to enhance their understanding of issues related to confidentiality and pay attention to how and where information about patients is shared.
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Affiliation(s)
| | - Marianne Eg
- Paediatrics and Adolescents, Viborg Regional Hospital, Viborg, Denmark
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Satisfaction with in-patient child and adolescent psychiatric treatment: development and psychometric properties of the BEST questionnaires for adolescents and for parents. Child Adolesc Psychiatry Ment Health 2021; 15:46. [PMID: 34481525 PMCID: PMC8418705 DOI: 10.1186/s13034-021-00395-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/12/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Interest in the assessment of patient satisfaction with in-patient psychiatric treatment has steadily increased and several measurement tools are available for the quantification of patients' experience. However, they are often uni-dimensional or focus mainly on therapeutic relationship and environment, and neglect other important issues such as information about treatment and participation. The BEST questionnaires were developed as comprehensive instruments that include items on all of the mentioned topics. The present study evaluates the psychometric properties of the BEST in a version for adolescents and for parents. Furthermore, the dimensionality of the satisfaction ratings is analyzed. METHOD Descriptive statistics were applied to data of 1582 adolescents (mean age = 15.0 years, SD = 1.65; 62.4% female) and 1998 parents/guardians assessed in seven in-patient units across Germany. The factorial structure of the BEST questionnaires was determined by exploratory and confirmatory factor analyses, including a bifactor model. RESULTS The psychometric quality of the scales was strong. Correlations with another assessment instrument of patient satisfaction were good to high, indicating good convergent validity. Exploratory factor analyses revealed three factors in adolescents that were labelled as: Therapeutic relationship, environment, and general satisfaction and treatment success. For parents, the same three factors could be distinguished. Confirmatory bifactor models suggested that the vast majority of variance was accounted for by the general factor; the three specific factors provided some additional information. Agreement between the subscales of adolescents and their parents was only moderate. Parents were usually more satisfied. CONCLUSIONS The BEST questionnaires can be considered as reliable and valid instruments to not only assess the "classical" aspects of patient satisfaction, but to also assess newer fundamental topics such as children's rights and treatment participation. For scientific usage, the total score seems superior because of the high explained variance by the general factor, but the subscale scores provide further information. The use of single items seems advantageous for quality management purposes.
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Kosola S, Culnane E, Loftus H, Tornivuori A, Kallio M, Telfer M, Miettinen PJ, Kolho KL, Aalto K, Raivio T, Sawyer S. Bridge study protocol: an international, observational cohort study on the transition of healthcare for adolescents with chronic conditions. BMJ Open 2021; 11:e048340. [PMID: 34155079 PMCID: PMC8217914 DOI: 10.1136/bmjopen-2020-048340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 05/18/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION More than 10% of adolescents live with a chronic disease or disability that requires regular medical follow-up as they mature into adulthood. During the first 2 years after adolescents with chronic conditions are transferred to adult hospitals, non-adherence rates approach 70% and emergency visits and hospitalisation rates significantly increase. The purpose of the Bridge study is to prospectively examine associations of transition readiness and care experiences with transition success: young patients' health, health-related quality of life (HRQoL) and adherence to medical appointments as well as costs of care. In addition, we will track patients' growing independence and educational and employment pathways during the transition process. METHODS AND ANALYSIS Bridge is an international, prospective, observational cohort study. Study participants are adolescents with a chronic health condition or disability and their parents/guardians who attended the New Children's Hospital in Helsinki, Finland, or the Royal Children's Hospital (RCH) in Melbourne, Australia. Baseline assessment took place approximately 6 months prior to the transfer of care and follow-up data will be collected 1 year and 2 years after the transfer of care. Data will be collected from patients' hospital records and from questionnaires completed by the patient and their parent/guardian at each time point. The primary outcomes of this study are adherence to medical appointments, clinical health status and HRQoL and costs of care. Secondary outcome measures are educational and employment outcomes. ETHICS AND DISSEMINATION The Ethics Committee for Women's and Children's Health and Psychiatry at the Helsinki University Hospital (HUS/1547/2017) and the RCH Human Research Ethics Committee (38035) have approved the Bridge study protocol. Results will be published in international peer-reviewed journals and summaries will be provided to the funders of the study as well as patients and their parents/guardians. TRIAL REGISTRATION NUMBER NCT04631965.
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Affiliation(s)
- Silja Kosola
- Pediatric Research Center, New Children's Hospital, Helsinki, Finland
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Evelyn Culnane
- Transition Support Service, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Hayley Loftus
- Transition Support Service, Royal Children's Hospital, Parkville, Victoria, Australia
- Health Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | | | - Mira Kallio
- Pediatric Research Center, New Children's Hospital, Helsinki, Finland
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Clinical Research, University of Helsinki, Helsinki, Finland
| | - Michelle Telfer
- Department of Adolescent Medicine, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Päivi J Miettinen
- Pediatric Research Center, New Children's Hospital, Helsinki, Finland
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Kaija-Leena Kolho
- Pediatric Research Center, New Children's Hospital, Helsinki, Finland
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Faculty of Medicine and Medical Technology, Tampere University, Tampere, Finland
| | - Kristiina Aalto
- Pediatric Research Center, New Children's Hospital, Helsinki, Finland
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Taneli Raivio
- Pediatric Research Center, New Children's Hospital, Helsinki, Finland
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Stem Cells and Metabolism Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Susan Sawyer
- Health Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Adolescent Medicine, Royal Children's Hospital, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- Centre for Adolescent Health, Murdoch Children's Research Institute and the Royal Children's Hospital, Parkville, Victoria, Australia
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Quinlan-Davidson M, Roberts KJ, Devakumar D, Sawyer SM, Cortez R, Kiss L. Evaluating quality in adolescent mental health services: a systematic review. BMJ Open 2021; 11:e044929. [PMID: 33972340 PMCID: PMC8112446 DOI: 10.1136/bmjopen-2020-044929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 03/22/2021] [Accepted: 04/15/2021] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES To evaluate the quality of adolescent mental health service provision globally, according to the WHO Global Standards of adolescent mental health literacy, appropriate package of services and provider competencies. DESIGN AND DATA SOURCES Systematic review of 5 databases, and screening of eligible articles, from 1 January 2008 to 31 December 2020. STUDY ELIGIBILITY CRITERIA We focused on quantitative and mixed-method studies that evaluated adolescent mental health literacy, appropriate package of services and provider competencies in mental health services, and that targeted depression, anxiety and post-traumatic stress disorder among adolescents (10-19 years). This included adolescents exposed to interventions or strategies within mental health services. STUDY APPRAISAL AND SYNTHESIS METHODS Study quality was assessed using the National Institutes for Health Study Quality Assessment Tools. Data were extracted and grouped based on WHO quality Standards. RESULTS Of the 20 104 studies identified, 20 articles were included. The majority of studies came from high-income countries, with one from a low-income country. Most of the studies did not conceptualise quality. Results found that an online decision aid was evaluated to increase adolescent mental health literacy. Studies that targeted an appropriate package of services evaluated the quality of engagement between the therapist and adolescent, patient-centred communication, mental health service use, linkages to mental health services, health facility culture and intensive community treatment. Provider competencies focused on studies that evaluated confidence in managing and referring adolescents, collaboration between health facility levels, evidence-based practices and technology use. CONCLUSIONS AND IMPLICATIONS There is limited evidence on quality measures in adolescent mental health services (as conforms to the WHO Global Standards), pointing to a global evidence gap for adolescent mental health services. There are several challenges to overcome, including a need to develop consensus on quality and methods to measure quality in mental health settings. PROSPERO REGISTRATION NUMBER CRD42020161318.
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Affiliation(s)
| | | | - Delan Devakumar
- Institute for Global Health, University College London, London, UK
| | - Susan M Sawyer
- Centre for Adolescent Health, Royal Children's Hospital; Murdoch Children's Research Institute; and Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Rafael Cortez
- Health, Nutrition and Population, The World Bank, Washington, District of Columbia, USA
| | - Ligia Kiss
- Institute for Global Health, University College London, London, UK
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Raymundo G, Smith-Merry J, McNab J. Experiences of health service literacy and access amongst Australian young adults from migrant backgrounds. Health Promot J Austr 2020; 32 Suppl 1:69-79. [PMID: 32808333 DOI: 10.1002/hpja.408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/11/2020] [Accepted: 08/14/2020] [Indexed: 11/09/2022] Open
Abstract
ISSUE ADDRESSED We currently know very little about the attitudes of young adult Australians from migrant backgrounds towards health service utilisation. This qualitative study aimed to explore their experiences of accessing health services and identify barriers and facilitators to health service utilisation. METHODS Semi-structured interviews were conducted with young people aged between 18-24 and living in Greater Western Sydney. Interview questions focused on facilitators and barriers to health service access. NVivo 11 was used to facilitate thematic analysis of the interviews. RESULTS Twenty-five young adults between 18-24 years from migrant backgrounds participated. Twenty semi-structured individual interviews and one group interview with five participants were conducted. Analysis identified themes relating to health literacy, cultural factors and quality of care and showed the importance of families, the education system and service outreach in facilitating access. CONCLUSIONS Findings indicate that more effective delivery of health services information in education, positive engagement between service-providers and service-users, and age-appropriate, culturally considerate health promotion strategies are needed to overcome barriers to health services accessibility. SO WHAT?: The results show the importance of families and communities, the education system and health service outreach in facilitating health service access for young people from migrant backgrounds. The paper highlights the need for more effective health promotion strategies targeting this group, their families and communities. To increase access, health promotion practitioners need to actively reach out to families and young people from migrant backgrounds through education and community-relevant forums.
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Affiliation(s)
- Gianina Raymundo
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Lidcombe, NSW, Australia
| | - Jennifer Smith-Merry
- Centre for Disability Research and Policy and Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Lidcombe, NSW, Australia
| | - Justin McNab
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Lidcombe, NSW, Australia
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Thomsen EL, Hertz PG, Blix C, Boisen KA. A national guideline for youth-friendly health services developed by chronically ill young people and health care professionals - a Delphi study. Int J Adolesc Med Health 2020; 34:487-498. [PMID: 32877363 DOI: 10.1515/ijamh-2020-0185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 08/02/2020] [Indexed: 11/15/2022]
Abstract
Objectives Significant variation in cultural and socio-economic factors across different countries means that modification of existing guidelines for youth-friendly health services are needed. Furthermore, including the views and perspectives of young people in developing health services add significant value. The aim of this study was to develop a national guideline for youth-friendly health services using the Delphi method. Methods We invited young people with chronic conditions, managers of paediatric, psychiatric and relevant adult departments and health care professionals with experience and interest in adolescent medicine to participate. The initial list of elements was constructed based on international guidelines and systematic reviews. The study consisted of three electronic questionnaire rounds assessing relevance, importance and whether the elements were essential/very important, respectively. We used 70% agreement as cut-off. Results More than 70% of participants agreed that only one element was essential: 'Young people should be actively involved in decisions about their treatment and encouraged and supported to ask questions about their illness and treatment'. Additionally, 18 elements reached more than 70% agreement, when the 'essential' was combined with the 'very important' category. We grouped these 19 elements into five themes: 1) staff competences and workflow, 2) developmentally appropriate communication, 3) focus on youth life, including mental health 4) youth participation and shared decisions, and 5) autonomy and transitional care. Conclusion This guideline for a youth-friendly health care system may serve as inspiration for concrete changes, both locally and internationally, as it was developed together by young people, staff, and management.
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Affiliation(s)
- Ena Lindhart Thomsen
- Department of Pediatric and Adolescent Medicine, Center of Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Pernille Grarup Hertz
- Department of Pediatric and Adolescent Medicine, Center of Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Charlotte Blix
- Department of Pediatric and Adolescent Medicine, Center of Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kirsten A Boisen
- Department of Pediatric and Adolescent Medicine, Center of Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Improving Tracking of Postdischarge Results of Sexually Transmitted Infection Screening Tests in Hospitalized Adolescents and Young Adults: A Quality Improvement Initiative. Sex Transm Dis 2020; 46:354-356. [PMID: 30985637 DOI: 10.1097/olq.0000000000000973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hospitalizations offer chlamydia and gonorrhea screening opportunities for youth who may not seek preventive care. Tracking of screening test results still pending after hospital discharge is an important component of clinical care. This process can be improved by protocol use and enhanced by effective, automated electronic health record tools.
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Iversen HH, Bjertnaes O, Helland Y, Skrivarhaug T. The Adolescent Patient Experiences of Diabetes Care Questionnaire (APEQ-DC): Reliability and Validity in a Study Based on Data from the Norwegian Childhood Diabetes Registry. PATIENT-RELATED OUTCOME MEASURES 2019; 10:405-416. [PMID: 31920415 PMCID: PMC6938190 DOI: 10.2147/prom.s232166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/13/2019] [Indexed: 12/31/2022]
Abstract
Purpose Patient-reported experiences are a key source of information on quality in health care. Most patient experience surveys only include adults’ assessments including parent or proxy surveys in child health care settings. The aim of this study was to determine the psychometric properties of the Adolescent Patient Experiences of Diabetes Care Questionnaire, a new instrument developed to measure adolescent experiences of paediatric diabetes care at hospital outpatient departments in Norway. Patients and Methods The questionnaire was developed based on a literature review, qualitative interviews with adolescents, expert-group consultations, pretesting of the questionnaire and a pilot study. The pilot study involved adolescents aged 12–17 years with type 1 diabetes, sampled from the four largest paediatric outpatient departments in Norway. We assessed the levels of missing data, ceiling effects, factor structure, internal consistency, item discriminant validity and construct validity. Results The pilot study included responses from 335 (54%) patients. Low proportions of missing or “not applicable” responses were found for 17 of the 19 items, and 14 of these 19 items were below the ceiling-effect criterion. Five indicators were identified: consultation, information on food and physical activity/exercise, nurse contact, doctor contact and outcome. All except one indicator met the criterion of 0.7 for Cronbach’s alpha. Each of the single items had a stronger correlation with its hypothesized indicator than with any of the other indicators. The construct validity of the instrument was supported by 38 out of 45 significant associations. Conclusion The content validity of the instrument was secured by a rigorous development process. Psychometric testing produced good evidence for data quality, internal consistency and construct validity. Further research is needed to assess the usefulness of the Adolescent Patient Experiences of Diabetes Care Questionnaire as a basis for quality indicators.
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Affiliation(s)
- Hilde Hestad Iversen
- Division of Health Services, Norwegian Institute of Public Health, Oslo N-0403, Norway
| | - Oyvind Bjertnaes
- Division of Health Services, Norwegian Institute of Public Health, Oslo N-0403, Norway
| | - Ylva Helland
- Division of Health Services, Norwegian Institute of Public Health, Oslo N-0403, Norway
| | - Torild Skrivarhaug
- Division of Paediatric and Adolescent Medicine, The Norwegian Childhood Diabetes Registry, Oslo University Hospital, Oslo N-0424, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo N-0318, Norway
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Iversen HH, Bjertnaes O, Skrivarhaug T. Associations between adolescent experiences, parent experiences and HbA1c: results following two surveys based on the Norwegian Childhood Diabetes Registry (NCDR). BMJ Open 2019; 9:e032201. [PMID: 31678954 PMCID: PMC6830699 DOI: 10.1136/bmjopen-2019-032201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE The aim of the current study was to determine the association between the experiences of adolescents and their parents with paediatric diabetes care at hospital outpatient departments and the association between these experiences and the Hemoglobin A1c (HbA1c) levels of adolescents. DESIGN Cross-sectional survey. SETTING Paediatric diabetes care at hospital outpatient departments in Norway. PARTICIPANTS Parents of all outpatients registered in the Norwegian Childhood Diabetes Registry and patients in the same registry aged 12-17 years. INTERVENTION 1399 parents participated in a national pilot survey and 335 patients aged 12-17 years from the four largest paediatric outpatient departments in Norway responded in another pilot study. 181 paired parental and patient questionnaires were analysed. MAIN OUTCOME MEASURES The correlations between single items, indicator scores and overall scores were explored, as was that between indicator scores and HbA1c levels. RESULTS There was a moderate but significant correlation between the responses of the patients and parents. For 40 of the 42 associations the correlations were significant, ranging from 0.16 to 0.42. A weak but significant negative correlation was found between the indicator scores of parents and the HbA1c levels of the adolescents. The strongest correlations were between HbA1c level and nurse contact and organisation, both with a correlation coefficient of 0.21 (p<0.01). There was no significant correlation between HbA1c level and patient indicator scores. CONCLUSIONS These results highlight the need to obtain information from both parents and adolescents, and indicate that the views of adolescents are not always mirrored by their parents. Three of the seven parent experience indicators were significantly related to the HbA1c levels of adolescents, but replication in future research with larger sample sizes is warranted.
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Affiliation(s)
| | - Oyvind Bjertnaes
- Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Torild Skrivarhaug
- Division of Paediatric and Adolescent Medicine, The Norwegian Childhood Diabetes Registry, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Jordan A, Joseph-Williams N, Edwards A, Holland-Hart D, Wood F. "I'd Like to Have More of a Say Because It's My Body": Adolescents' Perceptions Around Barriers and Facilitators to Shared Decision-Making. J Adolesc Health 2019; 65:633-642. [PMID: 31395512 DOI: 10.1016/j.jadohealth.2019.05.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/15/2019] [Accepted: 05/24/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE Adolescents living with long-term conditions (LTCs) often feel as though they are left out of discussions and decisions with healthcare professionals, which can give them the impression that their views are not important. Research around decision-making during clinical encounters often fails to represent adolescents' perspectives. This study explores adolescents' perceptions and experiences, focusing on identifying the perceived barriers to, and facilitators for, their involvement in shared decision-making (SDM). METHODS Nineteen adolescents (aged 13-19 years) with LTCs were recruited from endocrinology, rheumatology, neurology, and nephrology clinics. Participatory qualitative interviews were conducted using life grids and pie charts, and transcripts were analyzed thematically. RESULTS Four overarching themes and nine sub-themes were identified which describe barriers and facilitators around SDM. Adolescents need to feel, as though their involvement is supported by parents and healthcare professionals, that their contribution to the decision-making process is important and will yield a positive outcome. Adolescents often feel it is their right to be involved in decisions that affect them but also feel as though the adults' contributions to the decisions are considered more valuable. Adolescents need to feel capable of being involved, in terms of being able to understand and process information about the available options and ask appropriate questions. CONCLUSIONS This work highlights a number of ways SDM can be facilitated between healthcare practitioners and adolescents with LTCs. Identifying the needs of adolescents with LTCs is necessary for optimizing the SDM process and to support them during healthcare consultations.
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Affiliation(s)
- Amber Jordan
- Cardiff University, Heath Park Campus, Heath Park, Cardiff, United Kingdom.
| | | | - Adrian Edwards
- Cardiff University, Heath Park Campus, Heath Park, Cardiff, United Kingdom
| | | | - Fiona Wood
- Cardiff University, Heath Park Campus, Heath Park, Cardiff, United Kingdom
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Rapley T, Farre A, Parr JR, Wood VJ, Reape D, Dovey-Pearce G, McDonagh J. Can we normalise developmentally appropriate health care for young people in UK hospital settings? An ethnographic study. BMJ Open 2019; 9:e029107. [PMID: 31501109 PMCID: PMC6738748 DOI: 10.1136/bmjopen-2019-029107] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE The WHO has argued that adolescent-responsive health systems are required. Developmentally appropriate healthcare (DAH) for young people is one approach that could underpin this move. The aim of this study was to explore the potential for DAH to become normalised, to become a routine, taken-for-granted, element of clinical practice. DESIGN Qualitative ethnographic study. Analyses were based on procedures from first-generation grounded theory and theoretically informed by normalisation process theory. SETTING Two tertiary and one secondary care hospital in England. PARTICIPANTS 192 participants, health professionals (n=121) and managers (n=71) were recruited between June 2013 and January 2015. Approximately 1600 hours of non-participant observations in clinics, wards and meeting rooms were conducted, alongside 65 formal qualitative interviews. RESULTS We observed diverse values and commitments towards the care of young people and provision of DAH, including a distributed network of young person-orientated practitioners. Informal networks of trust existed, where specific people, teams or wards were understood to have the right skill-mix, or mindset, or access to resources, to work effectively with young people. As young people move through an organisation, the preference is to direct them to other young person-orientated practitioners, so inequities in skills and experience can be self-sustaining. At two sites, initiatives around adolescent and young adult training remained mostly within these informal networks of trust. At another, through support by wider management, we observed a programme that sought to make the young people's healthcare visible across the organisation, and to get people to reappraise values and commitment. CONCLUSION To move towards normalisation of DAH within an organisation, we cannot solely rely on informal networks and cultures of young person-orientated training, practice and mutual referral and support. Organisation-wide strategies and training are needed, to enable better integration and consistency of health services for all young people.
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Affiliation(s)
- Tim Rapley
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Albert Farre
- School of Nursing and Health Sciences, University of Dundee, Dundee, UK
| | - Jeremy R Parr
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - Victoria J Wood
- Department of Applied Health Research, University College London, London, UK
| | - Debbie Reape
- Child Health Department, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Gail Dovey-Pearce
- Child Health Department, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Janet McDonagh
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
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19
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Colver A, Rapley T, Parr JR, McConachie H, Dovey-Pearce G, Couteur AL, McDonagh JE, Bennett C, Hislop J, Maniatopoulos G, Mann KD, Merrick H, Pearce MS, Reape D, Vale L. Facilitating the transition of young people with long-term conditions through health services from childhood to adulthood: the Transition research programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2019. [DOI: 10.3310/pgfar07040] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background
As young people with long-term conditions move from childhood to adulthood, their health may deteriorate and their social participation may reduce. ‘Transition’ is the ‘process’ that addresses the medical, psychosocial and educational needs of young people during this time. ‘Transfer’ is the ‘event’ when medical care moves from children’s to adults’ services. In a typical NHS Trust serving a population of 270,000, approximately 100 young people with long-term conditions requiring secondary care reach the age of 16 years each year. As transition extends over about 7 years, the number in transition at any time is approximately 700.
Objectives
Purpose – to promote the health and well-being of young people with long-term conditions by generating evidence to enable NHS commissioners and providers to facilitate successful health-care transition. Objectives – (1) to work with young people to determine what is important in their transitional health care, (2) to identify the effective and efficient features of transitional health care and (3) to determine how transitional health care should be commissioned and provided.
Design, settings and participants
Three work packages addressed each objective. Objective 1. (i) A young people’s advisory group met monthly throughout the programme. (ii) It explored the usefulness of patient-held health information. (iii) A ‘Q-sort’ study examined how young people approached transitional health care. Objective 2. (i) We followed, for 3 years, 374 young people with type 1 diabetes mellitus (150 from five sites in England), autism spectrum disorder (118 from four sites in England) or cerebral palsy (106 from 18 sites in England and Northern Ireland). We assessed whether or not nine proposed beneficial features (PBFs) of transitional health care predicted better outcomes. (ii) We interviewed a subset of 13 young people about their transition. (iii) We undertook a discrete choice experiment and examined the efficiency of illustrative models of transition. Objective 3. (i) We interviewed staff and observed meetings in three trusts to identify the facilitators of and barriers to introducing developmentally appropriate health care (DAH). We developed a toolkit to assist the introduction of DAH. (ii) We undertook a literature review, interviews and site visits to identify the facilitators of and barriers to commissioning transitional health care. (iii) We synthesised learning on ‘what’ and ‘how’ to commission, drawing on meetings with commissioners.
Main outcome measures
Participation in life situations, mental well-being, satisfaction with services and condition-specific outcomes.
Strengths
This was a longitudinal study with a large sample; the conditions chosen were representative; non-participation and attrition appeared unlikely to introduce bias; the research on commissioning was novel; and a young person’s group was involved.
Limitations
There is uncertainty about whether or not the regions and trusts in the longitudinal study were representative; however, we recruited from 27 trusts widely spread over England and Northern Ireland, which varied greatly in the number and variety of the PBFs they offered. The quality of delivery of each PBF was not assessed. Owing to the nature of the data, only exploratory rather than strict economic modelling was undertaken.
Results and conclusions
(1) Commissioners and providers regarded transition as the responsibility of children’s services. This is inappropriate, given that transition extends to approximately the age of 24 years. Our findings indicate an important role for commissioners of adults’ services to commission transitional health care, in addition to commissioners of children’s services with whom responsibility for transitional health care currently lies. (2) DAH is a crucial aspect of transitional health care. Our findings indicate the importance of health services being commissioned to ensure that providers deliver DAH across all health-care services, and that this will be facilitated by commitment from senior provider and commissioner leaders. (3) Good practice led by enthusiasts rarely generalised to other specialties or to adults’ services. This indicates the importance of NHS Trusts adopting a trust-wide approach to implementation of transitional health care. (4) Adults’ and children’s services were often not joined up. This indicates the importance of adults’ clinicians, children’s clinicians and general practitioners planning transition procedures together. (5) Young people adopted one of four broad interaction styles during transition: ‘laid back’, ‘anxious’, ‘wanting autonomy’ or ‘socially oriented’. Identifying a young person’s style would help personalise communication with them. (6) Three PBFs of transitional health care were significantly associated with better outcomes: ‘parental involvement, suiting parent and young person’, ‘promotion of a young person’s confidence in managing their health’ and ‘meeting the adult team before transfer’. (7) Maximal service uptake would be achieved by services encouraging appropriate parental involvement with young people to make decisions about their care. A service involving ‘appropriate parental involvement’ and ‘promotion of confidence in managing one’s health’ may offer good value for money.
Future work
How might the programme’s findings be implemented by commissioners and health-care providers? What are the most effective ways for primary health care to assist transition and support young people after transfer?
Study registration
This study is registered as UKCRN 12201, UKCRN 12980, UKCRN 12731 and UKCRN 15160.
Funding
The National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Allan Colver
- Child Health Department, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Tim Rapley
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Jeremy R Parr
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
- Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Complex Neurodevelopmental Disorders Service, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Helen McConachie
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Gail Dovey-Pearce
- Child Health Department, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Ann Le Couteur
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
- Complex Neurodevelopmental Disorders Service, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Janet E McDonagh
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Jennifer Hislop
- Health Economics Group, Newcastle University, Newcastle upon Tyne, UK
| | | | - Kay D Mann
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Hannah Merrick
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Mark S Pearce
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Debbie Reape
- Child Health Department, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Luke Vale
- Health Economics Group, Newcastle University, Newcastle upon Tyne, UK
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Michaud PA, Weber MW, Namazova-Baranova L, Ambresin AE. Improving the quality of care delivered to adolescents in Europe: a time to invest. Arch Dis Child 2019; 104:214-216. [PMID: 29599165 DOI: 10.1136/archdischild-2017-314429] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 03/07/2018] [Accepted: 03/10/2018] [Indexed: 11/03/2022]
Affiliation(s)
- Pierre-André Michaud
- Adolescent Medicine and Health, Lausanne University Hospital, Lausanne, Switzerland
| | - Martin W Weber
- Child and Adolescent Health, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Leyla Namazova-Baranova
- Department of Pediatrics, Scientific Centre of Children's Health, Russian State Medical University, Moscow, Russia
| | - Anne-Emmanuelle Ambresin
- Interdisciplinary Division for Adolescent Health, Lausanne University Hospital, Lausanne, Switzerland
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Ngeno B, Waruru A, Inwani I, Nganga L, Wangari EN, Katana A, Gichangi A, Mwangi A, Mukui I, Rutherford GW. Disclosure and Clinical Outcomes Among Young Adolescents Living With HIV in Kenya. J Adolesc Health 2019; 64:242-249. [PMID: 30482659 PMCID: PMC6375672 DOI: 10.1016/j.jadohealth.2018.08.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 07/31/2018] [Accepted: 08/16/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Informing adolescents of their own HIV infection is critical as the number of adolescents living with HIV increases. We assessed the association between HIV disclosure and retention in care and mortality among adolescents aged 10-14 years in Kenya's national program. METHODS We abstracted routinely collected patient-level data for adolescents enrolled into HIV care in 50 health facilities from November 1, 2004, through March 31, 2010. We defined disclosure as any documentation that the adolescent had been fully or partially made aware of his or her HIV status. We compared weighted proportions for categorical variables using χ2 and weighted logistic regression to identify predictors of HIV disclosure; we estimated the probability of LTFU using Kaplan-Meier methods and dying using Cox regression-based test for equality of survival curves. RESULTS Of the 710 adolescents aged 10-14 years analyzed; 51.3% had severe immunosuppression, 60.3% were in WHO stage 3 or 4, and 36.6% were aware of their HIV status. Adolescents with HIV-infected parents, histories of opportunistic infections (OIs), and enrolled in support groups were more likely to be disclosed to. At 36 months, disclosure was associated with lower mortality [1.5% (95% CI .6%-4.1%) versus 5.4% (95% CI 3.6.6%-8.0%, p < .001)] and lower LTFU [6.2% (95% CI 3.0%-12.6%) versus 33.9% (95% CI 27.3%-41.1%) p < .001]. CONCLUSIONS Only one third of HIV-infected Kenyan adolescents in treatment programs had been told they were infected, and knowing their HIV status was associated with reduced LTFU and mortality. The disclosure process should be systematically encouraged and organized for HIV-infected adolescents.
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Affiliation(s)
- Bernadette Ngeno
- Division of Global HIV & TB, US Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Anthony Waruru
- Division of Global HIV & TB, US Centers for Disease Control and Prevention, CDC-Kenya, Nairobi, Kenya
| | | | - Lucy Nganga
- Division of Global HIV & TB, US Centers for Disease Control and Prevention, CDC-Kenya, Nairobi, Kenya
| | - Evelyn Ngugi Wangari
- Division of Global HIV & TB, US Centers for Disease Control and Prevention, CDC-Kenya, Nairobi, Kenya
| | - Abraham Katana
- Division of Global HIV & TB, US Centers for Disease Control and Prevention, CDC-Kenya, Nairobi, Kenya
| | - Anthony Gichangi
- Division of Global HIV & TB, US Centers for Disease Control and Prevention, CDC-Kenya, Nairobi, Kenya
| | - Ann Mwangi
- National AIDS and STI Control Programme, Ministry of Health, Annex Kenyatta National Hospital Grounds, Nairobi, Kenya
| | - Irene Mukui
- National AIDS and STI Control Programme, Ministry of Health, Annex Kenyatta National Hospital Grounds, Nairobi, Kenya
| | - George W. Rutherford
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco California
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An exploratory survey on the state of training in adolescent medicine and health in 36 European countries. Eur J Pediatr 2019; 178:1559-1565. [PMID: 31463767 PMCID: PMC6733827 DOI: 10.1007/s00431-019-03445-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/18/2019] [Accepted: 08/06/2019] [Indexed: 11/11/2022]
Abstract
The development of adolescent health and medicine as a medical discipline lags behind in Europe compared with other regions of the world. This study aims to evaluate the structure and content of adolescent medicine and health training curricula for medical students, paediatricians, and other primary care physicians in the European region. A questionnaire survey was sent by e-mail to experts in the field from 36 European countries, addressing the content of adolescent health issues. Data was obtained from all 36 countries. At the undergraduate level, seven countries reported some mandatory stand-alone teaching (sessions dealing specifically with adolescents), while seven countries reported optional stand-alone teaching. In only 7 out of 36 countries were issues critical to adolescents covered as stand-alone sessions. At the postgraduate level, 15 countries delivered stand-alone mandatory training sessions to primary, secondary, or tertiary care paediatricians, covering most of the five critical areas listed in the questionnaire. In another 13 countries, such sessions were not mandatory and were inexistent in eight of them. The coverage among school physicians was similar but was much lower among general practitioners.Conclusion: Paediatric associations and academic institutions should advocate for a better coverage of adolescent health and medicine in the training curricula of health care providers. What is known: • In most European countries, adolescent medicine is still poorly represented as a discipline. • Experts have recently published recommendations regarding what form the structure and content of a training curriculum in this field should take. What is new: • This paper gives information on the extent and content of training in adolescent medicine and health as currently offered within under- and postgraduate European training curricula, in terms of stand-alone mandatory (versus optional) sessions. • In many European countries, both medical students and residents are poorly exposed to the basic knowledge and skills pertaining to adolescent health care.
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Sawyer SM, McNeil R, Thompson K, Orme LM, McCarthy M. Developmentally appropriate care for adolescents and young adults with cancer: how well is Australia doing? Support Care Cancer 2018; 27:1783-1792. [PMID: 30155569 DOI: 10.1007/s00520-018-4420-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 08/12/2018] [Indexed: 01/23/2023]
Abstract
PURPOSE Developmentally appropriate care underpins quality cancer treatment. This study aimed to describe how well Australian cancer services deliver patient-focussed, developmentally appropriate care to adolescents and young adults (AYAs) with cancer. METHODS In a national, cross sectional study, 196 AYAs with cancer aged between 15 and 25 years at diagnosis reported their general experiences of the cancer care team (Cancer Needs Questionnaire), access to age-appropriate treatment environments (Cancer Needs Questionnaire) and frequency of psychosocial assessment (Adolescent Friendly Hospital Survey). RESULTS Very positive responses were reported around engagement and communication with staff who were reported as approachable, friendly and trustworthy; 11 of the 14 items were positively rated by over 90% of respondents. In contrast, over 70% of AYAs expressed unmet need around their physical and social environments, whether in relation to the opportunity to be nursed in wards designed for AYAs, spend time with other young people with cancer, or talk to young people their own age; less than a third reported their needs had been met on the majority of these items. The frequency that specific psychosocial assessment domains were discussed was highly variable; responses suggested that AYAs were less commonly questioned about overtly sensitive topics. AYAs who experienced private consultations with health care providers (41%) were significantly more likely to experience thorough psychosocial assessment. CONCLUSION Australian cancer services are generally communicating well with AYAs. There is room for improvement around more developmentally specific aspects of healthcare quality, such as psychosocial assessment, and around treatment environments that promote greater social interaction between AYAs.
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Affiliation(s)
- S M Sawyer
- Centre for Adolescent Health, Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, Australia.
- Murdoch Children's Research Institute, Parkville, VIC, Australia.
- Department of Paediatrics, The University of Melbourne, Parkville, Australia.
| | - R McNeil
- Centre for Adolescent Health, Royal Children's Hospital, 50 Flemington Rd, Parkville, VIC, Australia
- Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - K Thompson
- Victorian Youth Cancer Service, Peter MacCallum Hospital, Parkville, VIC, Australia
| | - L M Orme
- Victorian Youth Cancer Service, Peter MacCallum Hospital, Parkville, VIC, Australia
- Children's Cancer Centre, Royal Children's Hospital, Parkville, VIC, Australia
| | - M McCarthy
- Murdoch Children's Research Institute, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
- Children's Cancer Centre, Royal Children's Hospital, Parkville, VIC, Australia
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Health professional perceptions of communicating with adolescents and young adults about bone cancer clinical trial participation. Support Care Cancer 2018; 27:467-475. [DOI: 10.1007/s00520-018-4337-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 06/26/2018] [Indexed: 01/02/2023]
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Abreu N, Dias I, Cascais M, Luz A, Moleiro P. What are the most frequent diagnoses in adolescence? The reality of an Adolescent Medicine Clinic. ACTA ACUST UNITED AC 2018; 16:eAO4225. [PMID: 29972440 PMCID: PMC6019239 DOI: 10.1590/s1679-45082018ao4225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 01/25/2018] [Indexed: 03/21/2023]
Abstract
Objective To characterize the care flow and the primary diagnoses of an Adolescent Medicine Clinic. Methods A retrospective descriptive study, with analysis of clinical processes of adolescents (10-18 years) seen at the Adolescent Medicine Clinic, from January 2006 to December 2013. The following variables were analyzed: sex, age, number of visits, referring service and primary diagnoses according to the International Statistical Classification of Diseases and Related Health Problems. As to the variable age, the adolescents were divided into two groups: Group I comprised those aged 10-14 years, and Group II, 15-18 years. Results A total of 7,692 visits were carried out, in that, 1,659 first visits (22%), with an annual growth rate of 6%. The mean age was 14.2 years, and 55% of patients were female. The group of endocrine, nutritional and metabolic diseases was the most representative in our sample (34%), with obesity being the most frequent diagnosis in both sexes and age groups (23%), with a higher prevalence in males (13% male versus 10% female, p<0.001) and younger adolescents (18% in Group I versus 5% in Group II p<0.001). The group of mental and behavioral disorders was the second most prevalent (32%), affecting mainly females (39% female versus 22% male, p<0.001) and the older age group (39% Group II versus 27% Group I, p<0.001). Social problems were the primary diagnosis in 8% of visits. Conclusion Most diseases diagnosed have a strong behavioral and social component, particularly mental disorders and obesity. This specific type of diagnoses reinforces the need for a global approach for adolescents and specialized adolescent medicine units/clinics.
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Affiliation(s)
- Nina Abreu
- Centro Hospitalar Leiria, Leiria, Portugal
| | - Inês Dias
- Centro Hospitalar Leiria, Leiria, Portugal
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Bhalakia AM, Talib HJ, Choi J, Watnick D, Bochner R, Futterman D, Gross E. Acceptance of Routine HIV Testing by Hospitalized Adolescents and Young Adults. Hosp Pediatr 2018; 8:187-193. [PMID: 29599198 PMCID: PMC5869342 DOI: 10.1542/hpeds.2017-0194] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Youth carry a disproportionate burden of new HIV infections. With our study, we aimed to characterize HIV testing experiences among adolescents and young adults admitted to a children's hospital that is located in a high HIV-prevalent community and implemented routine HIV testing for all patients ≥13 years of age. METHODS A total of 120 patients aged 13 to 24 years old who were admitted to our hospital and had a documented offer of routine HIV testing on admission were invited to complete a self-administered survey that asked about sex, race and/or ethnicity, HIV risk behaviors, and attitudes toward routine HIV testing in the hospital. Date of birth, admission diagnosis, and verification of HIV testing and results were collected by chart review. RESULTS Study participants (N = 99) were 17.4 ± 2.3 years old, 52% female, 47% Hispanic, and 29% African American. Additional characteristics include the following: 65% had previous sexual activity, 11% had a history of sexually transmitted infections, and 12% were worried about their risk for HIV. Forty-seven percent of participants accepted HIV testing, with older patients (P < .01) and those reporting previous sexual activity (P < .01) and a previous HIV test (P < .01) being more likely to accept testing. A total of 96% of participants agreed that the hospital is a good place to offer HIV testing. CONCLUSIONS Our findings support offering routine HIV testing to youth admitted to children's hospital. Given the high incidence of new and undiagnosed HIV infections among youth, additional venues for HIV testing are essential.
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Affiliation(s)
- Avni M Bhalakia
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas;
| | - Hina J Talib
- Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York
| | - Jaeun Choi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York; and
| | - Dana Watnick
- Center for AIDS Research, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Risa Bochner
- Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York
| | - Donna Futterman
- Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York
| | - Elissa Gross
- Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York
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Michaud PA, Schrier L, Ross-Russel R, van der Heijden L, Dossche L, Copley S, Alterio T, Mazur A, Dembinski L, Hadjipanayis A, Del Torso S, Fonseca H, Ambresin AE. Paediatric departments need to improve residents' training in adolescent medicine and health: a position paper of the European Academy of Paediatrics. Eur J Pediatr 2018; 177:479-487. [PMID: 29270826 DOI: 10.1007/s00431-017-3061-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 11/27/2017] [Accepted: 11/29/2017] [Indexed: 11/28/2022]
Abstract
UNLABELLED In many European countries, paediatric junior staff has no formal training in adolescent medicine and is ill-equipped to deal with issues and health problems such as substance use, unprotected sex, eating disorders and transition to adult care. This position paper of the European Academy of Paediatrics proposes a set of competency-based training goals and objectives as well as pedagogic approaches that are expected to improve the capacity of paediatricians to meet the needs of this important segment of the paediatric population. The content has been developed from available publications and training programmes and mostly covers the generic aspects of adolescent healthcare, such as how to communicate effectively, how to review and address lifestyles, how to perform a respectful and relevant physical examination, how to address common problems of adolescents and how to support adolescents in coping with a chronic condition. CONCLUSION The European Academy of Paediatrics urges national bodies, paediatric associations and paediatric teaching departments to adopt these training objectives and put them into practice, so that paediatricians will be better prepared in the future to meet the challenge of delivering appropriate and effective healthcare to adolescents.
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Affiliation(s)
| | - Lenneke Schrier
- Department of Pediatrics, Leiden University Medical Centre, Leiden, Netherlands
| | | | - Laila van der Heijden
- Department of Pediatrics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lien Dossche
- Department of Pediatrics and Medical Genetics, Ghent University, Ghent, Belgium
| | - Sian Copley
- Neonatal Unit, Royal Victoria Infirmary, Upon Tyne, Newcastle, UK
| | - Tommaso Alterio
- Hepatology, Gastroenterology and Nutrition Unit, Bambino Gesù Children's Hospital, Rome, Italy.,National Observatory for Trainees and Young Paediatricians, ONSP, Padua, Italy
| | - Artur Mazur
- Medical Faculty, University of Rzeszow, Rzeszów, Poland
| | - Lukasz Dembinski
- Department of Paediatric Gastroenterology and Nutrition Medical University of Warsaw, Warsaw, Poland
| | - Adamos Hadjipanayis
- Faculty of Medicine, Cyprus & Paediatric Department, Larnaca General Hospital, European University of Cyprus, Engomi, Cyprus
| | | | - Helena Fonseca
- Adolescent Medicine Division, Department of Paediatrics, University Hospital Santa Maria, Lisbon, Portugal
| | - Anne-Emmanuelle Ambresin
- Interdisciplinary Division for Adolescent Health (DISA), University Hospital of Lausanne, Lausanne, Switzerland
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Zlotnick C, Birenbaum-Carmeli D, Goldblatt H, Dishon Y, Taychaw O, Shadmi E. Health indicators and social gradient in adolescent immigrants' health risk and healthcare experiences. Eur J Pediatr 2018; 177:221-228. [PMID: 29204853 DOI: 10.1007/s00431-017-3052-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 11/16/2017] [Accepted: 11/19/2017] [Indexed: 01/20/2023]
Abstract
UNLABELLED Few studies have assessed healthcare experiences in apparently healthy adolescents, or whether healthcare attitudes are linked to the two leading adolescent health indicators, smoking and obesity. Even fewer have examined these relationships in adolescent immigrant groups or made comparisons to adolescent non-immigrants. Using a cross-sectional study, healthcare experiences were compared among three groups of adolescents (n = 589) including Russian immigrants (n = 154), Ethiopian immigrants (n = 54), and non-immigrants (n = 381). Bootstrap estimates indicated positive healthcare experiences were less common among Russian adolescent immigrants (OR = 0.38, CI = 0.17, 0.86) compared to non-immigrants, unless the Russian adolescent immigrants reported above average socioeconomic status, in which case they were more likely than non-immigrant adolescents to report positive healthcare experiences (OR = 3.22, CI = 1.05, 9.85). Positive healthcare experiences were less likely among adolescents who were smokers (OR = 0.50, CI = 0.27, 0.91), and more likely for adolescents with a normal or low BMI (OR = 3.16, CI = 1.56, 6.40) and for those relying on parents for health information (OR = 1.97, CI = 1.05, 3.70). CONCLUSION Findings suggest a social gradient in which positive healthcare experiences were more common among adolescence with higher socioeconomic status for some immigrants (Russian adolescents) but not for others. The two leading health indicators were related to healthcare experiences, but as adolescent smokers were less likely to have positive healthcare experiences, proactive efforts are needed to engage this group. What is Known: • Health indicators (such as obesity) and healthcare attitudes are linked to healthcare service use among adolescents sampled from outpatient and inpatient populations. What is New: • A social gradient involving socioeconomic status and being an adolescent immigrant was found regarding risky health indicators (i.e., smoking, use of internet as the primary source of health information). • Problematic health indicators, such as smoking, is linked to less positive healthcare attitudes in apparently healthy adolescents (both immigrants and non-immigrants).
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Affiliation(s)
- Cheryl Zlotnick
- Cheryl Spencer Department of Nursing, Faculty of Health and Welfare Sciences, University of Haifa, 199 Abba Khushi Avenue, 3498838, Haifa, Israel.
| | - Daphna Birenbaum-Carmeli
- Cheryl Spencer Department of Nursing, Faculty of Health and Welfare Sciences, University of Haifa, 199 Abba Khushi Avenue, 3498838, Haifa, Israel
| | - Hadass Goldblatt
- Cheryl Spencer Department of Nursing, Faculty of Health and Welfare Sciences, University of Haifa, 199 Abba Khushi Avenue, 3498838, Haifa, Israel
| | - Yael Dishon
- Cheryl Spencer Department of Nursing, Faculty of Health and Welfare Sciences, University of Haifa, 199 Abba Khushi Avenue, 3498838, Haifa, Israel
| | - Omer Taychaw
- Cheryl Spencer Department of Nursing, Faculty of Health and Welfare Sciences, University of Haifa, 199 Abba Khushi Avenue, 3498838, Haifa, Israel
| | - Efrat Shadmi
- Cheryl Spencer Department of Nursing, Faculty of Health and Welfare Sciences, University of Haifa, 199 Abba Khushi Avenue, 3498838, Haifa, Israel
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Chang J, Ipp LS, de Roche AM, Catallozzi M, Breitkopf CR, Rosenthal SL. Adolescent-Parent Dyad Descriptions of the Decision to Start the HPV Vaccine Series. J Pediatr Adolesc Gynecol 2018; 31:28-32. [PMID: 29037930 PMCID: PMC5785551 DOI: 10.1016/j.jpag.2017.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/28/2017] [Accepted: 10/05/2017] [Indexed: 01/15/2023]
Abstract
STUDY OBJECTIVE To examine how adolescent-parent dyads describe decision-making regarding initiation of the human papillomavirus (HPV) vaccine series, specifically who they viewed as making the final decision. DESIGN Semistructured interviews with adolescent-parent dyads were audio-recorded and transcribed. Responses to the question: "How did you make a decision about whether or not to receive the HPV vaccine series?" were content-coded for each individual member of the dyad. SETTING Adolescent medicine clinics of 2 large urban medical centers and through snowball sampling. PARTICIPANTS Adolescents 14-17 years of age and a parent (N = 262). Qualitative analyses were conducted for those who agreed that they were offered and started the HPV vaccine series (n = 109). INTERVENTIONS None. MAIN OUTCOME MEASURES Descriptions of the decision-making included 1 person (adolescent or parent) making the decision or joint decision-making by the adolescent and parent together. RESULTS More than half of the dyads did not agree on who made the decision to start the vaccine. Most adolescents and parents described a similar account about when they were offered the HPV vaccine, although the interpretation of the event in terms of the decision-maker might have differed. More than half of adolescents and parents individually mentioned the health care provider in their description of the HPV vaccine decision-making process even though they were not queried about the role of the provider. CONCLUSION Understanding the range of descriptions of these dyads is helpful to guide interventions to promote vaccine uptake in a manner that balances provider expertise, adolescent autonomy, and parental involvement.
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Affiliation(s)
- Jane Chang
- Department of Pediatrics, Weill Cornell Medical College/New York-Presbyterian Hospital, New York, New York.
| | - Lisa S Ipp
- Department of Pediatrics, Weill Cornell Medical College/New York-Presbyterian Hospital, New York, New York
| | - Ariel M de Roche
- Department of Pediatrics, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York
| | - Marina Catallozzi
- Department of Pediatrics, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York; Heilbrunn Department of Population and Family Health, Mailman School of Public Health, New York, New York
| | | | - Susan L Rosenthal
- Department of Pediatrics, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York; Department of Psychiatry, Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, New York
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Wood D, Geoghegan S, Ramnarayan P, Davis PJ, Pappachan JV, Goodwin S, Wray J. Eliciting the experiences of the adolescent-parent dyad following critical care admission: a pilot study. Eur J Pediatr 2018; 177:747-752. [PMID: 29468417 PMCID: PMC5899104 DOI: 10.1007/s00431-018-3117-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/31/2018] [Accepted: 02/09/2018] [Indexed: 11/29/2022]
Abstract
UNLABELLED Critically ill adolescents are usually treated on intensive care units optimised for much older adults or younger children. The way they access and experience health services may be very different to most adolescent service users, and existing quality criteria may not apply to them. The objectives of this pilot study were, firstly, to determine whether adolescents and their families were able to articulate their experiences of their critical care admission and secondly, to identify the factors that are important to them during their intensive care unit (ICU) or high dependency unit (HDU) stay. Participants were 14-17 year olds who had previously had an emergency admission to an adult or paediatric ICU/HDU in one of four UK hospitals (two adult, two paediatric) and their parents. Semi-structured interviews were conducted with eight mother-adolescent dyads and one mother. Interviews were transcribed and analysed using framework analysis. CONCLUSION The main reported determinant of high-quality care was the quality of interaction with staff. The significance of these interactions and their environment depended on adolescents' awareness of their surroundings, which was often limited in ICU and changed significantly over the course of their illness. Qualitative interview methodology would be difficult to scale up for this group. What is known • Critically ill adolescents are usually treated on intensive care units optimised for older adults or younger children. • The way they access and experience health services may be different to most adolescent patients; existing quality criteria may not apply. What is new • Reported determinants of high-quality care were age-appropriateness of the environment, respectfulness and friendliness of staff, communication and inclusion in healthcare decisions. • The significance of these depended on adolescents' awareness of their surroundings, which was often limited and changed over the course of their illness.
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Affiliation(s)
- Dora Wood
- Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, Bristol, BS2 8HW, UK.
| | - Sophie Geoghegan
- Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability, Great Ormond Street Hospital, WC1N 3JH, London, UK
| | | | - Peter J. Davis
- Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, Bristol, BS2 8HW UK
| | - John V. Pappachan
- Department of Paediatric Intensive Care, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD UK
| | - Sarah Goodwin
- Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, Bristol, BS2 8HW UK
| | - Jo Wray
- Critical Care and Cardiorespiratory Division, Great Ormond Street Hospital, WC1N 3JH, London, UK
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Becker TD, Lin HC, Miller VA. A pilot study of observed physician-parent-child communication and child satisfaction in a gastroenterology clinic. Patient Prefer Adherence 2018; 12:1327-1335. [PMID: 30100709 PMCID: PMC6065589 DOI: 10.2147/ppa.s171620] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Child participation in pediatric medical visits is low. In this pilot study, we sought to better understand relationships between observed communication and child-reported perceptions of communication in a clinical setting. MATERIALS AND METHODS For this cross-sectional observational study, pediatric gastroenterology appointments (n=39) were videotaped and coded to quantify various adult affective (eg, chit-chat, empathy) and facilitative (eg, asking questions, encouraging responses) behaviors toward the child, interference with child participation (eg, interrupting or ignoring child), and child verbal participation. Post-visit surveys assessed child perceptions of having voice in the clinical encounter, ease of understanding, and satisfaction with communication. RESULTS Parent and provider chit-chat was associated with child-reported ease of understanding. Provider facilitation was positively associated with child participation, but affective communication strategies were not. Physician interference was negatively associated with ease of understanding but positively associated with perception of voice. CONCLUSION Facilitative communication may improve outcomes by enhancing child participation and thus exchange of medical information, whereas chit-chat appears to positively impact children's perceptions of communication.
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Affiliation(s)
- Timothy D Becker
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Henry C Lin
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Victoria A Miller
- Division of Adolescent Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,
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Hoopes AJ, Benson SK, Howard HB, Morrison DM, Ko LK, Shafii T. Adolescent Perspectives on Patient-Provider Sexual Health Communication: A Qualitative Study. J Prim Care Community Health 2017; 8:332-337. [PMID: 28929860 PMCID: PMC5932737 DOI: 10.1177/2150131917730210] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Adolescents in the United States are disproportionately affected by sexually transmitted infections and unintended pregnancy. Adolescent-centered health services may reduce barriers to health care; yet, limited research has focused on adolescents' own perspectives on patient-provider communication during a sexual health visit. METHODS Twenty-four adolescents (14-19 years old) seeking care in a public health clinic in Washington State participated in one-on-one qualitative interviews. Interviews explored participants' past experiences with medical providers and their preferences regarding provider characteristics and communication strategies. RESULTS Interviews revealed that (1) individual patient dynamics and (2) patient-provider interaction dynamics shape the experience during a sexual health visit. Individual patient dynamics included evolving level of maturity, autonomy, and sexual experience. Patient-provider interaction dynamics were shaped by adolescents' perceptions of providers as sources of health information who distribute valued sexual health supplies like contraception and condoms. Participant concerns about provider judgment, power differential, and lack of confidentiality also emerged as important themes. CONCLUSIONS Adolescents demonstrate diverse and evolving needs for sexual health care and interactions with clinicians as they navigate sexual and emotional development.
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Affiliation(s)
| | | | | | | | - Linda K. Ko
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Taraneh Shafii
- University of Washington School of Medicine, Seattle, WA, USA
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Talib HJ, Silver EJ, Alderman EM. Challenges to Adolescent Confidentiality in a Children's Hospital. Hosp Pediatr 2016; 6:490-5. [PMID: 27461762 DOI: 10.1542/hpeds.2016-0011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Protecting confidentiality for hospitalized adolescents can be challenging and may interfere with optimal adolescent-friendly care. The goal of this study was to explore physician trainees' experience with adolescent confidentiality at an academic children's hospital. METHODS A total of 175 trainees were invited to complete an online survey about knowledge, attitudes, and experiences with confidential adolescent concerns in the inpatient setting. A total of 133 (76%) responded: 78% female; 65% pediatric or family medicine residents; and 35% medical students. RESULTS In the past year, 56 (42%) of 133 trainees cared for a hospitalized adolescent whose confidentiality had been breached. Barriers to ensuring confidentiality included: patient/family not knowledgeable about minor consent law (50%); trainees not knowledgeable about minor consent law (47%); and hospital discharge summary requiring parental signature (47%). On patient- and family-centered rounds (PFCR), respondents reported that minor adolescents (aged <18 years) compared with young adults (aged ≥18 years) were more likely to have social history discussed away from the bedside (91% vs 84%; P < .001) and less likely to have confidential time with the medical team (28% vs 47%; P < .001). Barriers to participation in PFCR included the following: patient was sleeping (61%), patient declined to participate (51%), and confidentiality concerns (32%). CONCLUSIONS Breaches in confidentiality for hospitalized adolescents are a common trainee experience. On PFCR, adolescents are less likely to have confidential time with the medical team than young adults. In trainees' experience, hospital systems such as PFCR and discharge procedures pose inherent challenges to confidentiality for minor adolescent patients, as do lack of knowledge of minor consent laws by both clinicians and families.
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Affiliation(s)
| | - Ellen J Silver
- Division of General Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, Bronx, New York
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Sawyer SM, McCarthy MC, Dunt D, McNeil R, Thompson K, Orme L, Drew SE. Fulfilling the Vision of Youth-Friendly Cancer Care: A Study Protocol. J Adolesc Young Adult Oncol 2016; 5:267-77. [DOI: 10.1089/jayao.2015.0050] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Susan M. Sawyer
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, Australia
- Murdoch Childrens Research Institute, Parkville, Australia
| | - Maria C. McCarthy
- Murdoch Childrens Research Institute, Parkville, Australia
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Australia
| | - David Dunt
- School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Robyn McNeil
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, Australia
- Murdoch Childrens Research Institute, Parkville, Australia
| | - Kate Thompson
- ONTrac at Peter Mac Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, East Melbourne, Australia
| | - Lisa Orme
- Children's Cancer Centre, Royal Children's Hospital, Parkville, Australia
- ONTrac at Peter Mac Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, East Melbourne, Australia
| | - Sarah E. Drew
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Australia
- Department of Pediatrics, The University of Melbourne, Parkville, Australia
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Sawyer SM, Farrant B, Hall A, Kennedy A, Payne D, Steinbeck K, Vogel V. Adolescent and young adult medicine in Australia and New Zealand: towards specialist accreditation. Int J Adolesc Med Health 2016; 28:253-261. [PMID: 26115493 DOI: 10.1515/ijamh-2016-5006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 02/22/2015] [Indexed: 06/04/2023]
Abstract
In Australia and New Zealand, a critical mass of academic and clinical leadership in Adolescent Medicine has helped advance models of clinical services, drive investments in teaching and training, and strengthen research capacity over the past 30 years. There is growing recognition of the importance of influencing the training of adult physicians as well as paediatricians. The Royal Australasian College of Physicians (RACP) is responsible for overseeing all aspects of specialist physician training across the two countries. Following advocacy from adolescent physicians, the RACP is advancing a three-tier strategy to build greater specialist capacity and sustain leadership in adolescent and young adult medicine (AYAM). The first tier of the strategy supports universal training in adolescent and young adult health and medicine for all basic trainees in paediatric and adult medicine through an online training resource. The second and third tiers support advanced training in AYAM for specialist practice, based on an advanced training curriculum that has been approved by the RACP. The second tier is dual training; advanced trainees can undertake 2 years training in AYAM and 2 years training in another area of specialist practice. The third tier consists of 3 years of advanced training in AYAM. The RACP is currently seeking formal recognition from the Australian Government to have AYAM accredited, a process that will be subsequently undertaken in New Zealand. The RACP is expectant that the accreditation of specialist AYAM physicians will promote sustained academic and clinical leadership in AYAM to the benefit of future generations of young Australasians.
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Al-Yateem N, Docherty C, Rossiter R. Determinants of Quality of Care for Adolescents and Young Adults With Chronic Illnesses: A Mixed Methods Study. J Pediatr Nurs 2016; 31:255-66. [PMID: 26783050 DOI: 10.1016/j.pedn.2015.12.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/12/2015] [Accepted: 12/12/2015] [Indexed: 11/19/2022]
Abstract
UNLABELLED Measuring the quality of service and user experience is an acknowledged priority for healthcare services; however it seems that healthcare systems have to work very hard to achieve this goal as evidenced by reports of gaps and disparities in the quality of care provided to clients, especially within pediatric and adolescent populations. OBJECTIVES To identify quality determinants for healthcare services for adolescents and young adults with chronic conditions based on the perceptions and the experiences of adolescents and young adults themselves. METHODOLOGY A sequential exploratory mixed method design guided this study. The initial qualitative phase employed semi-structured in-depth interviews to elicit the elements and determinants of quality of care as identified by adolescents and young adults living with chronic conditions. The second phase employed a questionnaire developed from the data gathered during the qualitative phase to survey the target population. This was distributed to a larger sample of adolescents and young adults with chronic conditions to determine and confirm the relevance of the identified care elements and quality determinants. RESULTS The study revealed 4 main determinants: the provision of adolescent friendly information relating to all aspects of living with chronic conditions, services that facilitate and encourage independence, services characterized by structure with the capacity to be both dynamic and responsive, and finally health care professionals knowledgeable and skilled in relation to adolescent specific issues.
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Affiliation(s)
- Nabeel Al-Yateem
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.
| | - Charles Docherty
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Rachel Rossiter
- Visiting academic, University of Sharjah, UAE, Faculty of Science, Charles Sturt University, Australia
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McGrady ME, Ryan JL, Gutiérrez-Colina AM, Fredericks EM, Towner EK, Pai ALH. The impact of effective paediatric adherence promotion interventions: systematic review and meta-analysis. Child Care Health Dev 2015; 41:789-802. [PMID: 26255643 DOI: 10.1111/cch.12271] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 05/14/2015] [Accepted: 05/27/2015] [Indexed: 01/17/2023]
Abstract
BACKGROUND Understanding the impact of effective paediatric adherence promotion interventions on patients, families and the healthcare system is necessary to inform efforts to improve healthcare quality and control costs. Building on previous research suggesting that improving adherence may have far-reaching benefits, the objective of this study was to quantify the impact of effective adherence promotion interventions for children and adolescents with a chronic medical condition on patients, families and the healthcare system. METHODS Authors systematically reviewed articles indexed in PubMed, PsycINFO and CINAHL to identify randomized controlled trials of paediatric adherence promotion interventions. Interventions that improved paediatric adherence and examined patient-level, family-level or healthcare system-level outcomes in children and adolescents (M age ≤ 18 years) with a chronic medical condition were included. Two authors independently extracted and classified outcome variables as patient-level (quality of life and disease-related activity restrictions), micro-level (family functioning, family conflict, caregiver quality of life, caregiver sleep interruption, caregiver days away from work and patient missed school days) or macro-level variables (emergency department visits, hospitalizations, outpatient visits and urgent care visits). Outcome variables detailed in previously published reviews (i.e. disease severity) were excluded. RESULTS Twenty studies representing 19 unique samples met inclusion criteria. An additional eight articles representing trials that did not significantly improve adherence were included in post hoc analyses. Compared with control interventions, effective paediatric adherence promotion interventions improved patient quality of life and family-level outcomes and decreased healthcare utilization among children and adolescents with a chronic medical condition. CONCLUSIONS Interdisciplinary efforts to improve healthcare quality and reduce spending among children and adolescents with a chronic medical condition may be enhanced by incorporating effective paediatric adherence promotion interventions. As relatively few chronic medical conditions were represented in included studies, future research should examine the impact of paediatric adherence promotion interventions in other populations.
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Affiliation(s)
- M E McGrady
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - J L Ryan
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - E M Fredericks
- Child Health Evaluation and Research Unit (CHEAR), Division of Child Behavioral Health, University of Michigan and C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - E K Towner
- Pediatric Prevention Research Center, Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA
| | - A L H Pai
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Patient and Family Wellness Center, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Weil LG, Lemer C, Webb E, Hargreaves DS. The voices of children and young people in health: where are we now? Arch Dis Child 2015; 100:915-7. [PMID: 26044136 DOI: 10.1136/archdischild-2014-307492] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 05/13/2015] [Indexed: 11/03/2022]
Affiliation(s)
| | - Claire Lemer
- Department of General Paediatrics, Evelina London Children's Hospital, London, UK
| | - Elspeth Webb
- Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Dougal S Hargreaves
- Department of Population, Policy & Practice Programme, UCL Institute of Child Health, London, UK
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Hargreaves DS, Greaves F, Levay C, Mitchell I, Koch U, Esch T, Denny S, Frich JC, Struijs J, Sheikh A. Comparison of Health Care Experience and Access Between Young and Older Adults in 11 High-Income Countries. J Adolesc Health 2015. [PMID: 26205758 DOI: 10.1016/j.jadohealth.2015.05.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Young adults (18-24 years) frequently report poorer health care access and experience than older adults. We aimed to investigate how differences between young and older adults vary across 11 high-income countries. METHODS A total of 20,045 participants from 11 high-income countries (i.e., Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, United Kingdom, United States) participating in the Commonwealth Fund 2013 International Health Policy Survey. We compared young adults (18-24 years) with older adults (25-34; 35-49; 50-64; 65+ years) on three aspects of health care: overall satisfaction, cost barriers to access, and four indicators of consultation quality relating to adequate information, time, involvement, and explanation. RESULTS Across all participants, young adults reported significantly worse overall satisfaction (63.6% vs. 70.3%; p < .001) and more frequent cost barriers (21.3% vs. 15.2%; p < .001) than older adults. Country-level analyses showed that young adults reported lower overall satisfaction than older adults in five of 11 countries (Australia, Canada, Norway, Switzerland, United States) and more frequent cost barriers in six of 11 countries (Canada, France, Germany, Switzerland, Norway, United States). In five countries (Australia, Canada, France, Norway, Switzerland), most patient experience indicators were less positive among young adults than those among older adults. In three countries (Netherlands, New Zealand, United Kingdom), there was no significant difference between young and older adults on any indicator. CONCLUSIONS Associations between age and health care access/experience varied markedly between countries, suggesting that poor access and experience among young adults is not inevitable and may be amenable to policy/practice interventions.
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Affiliation(s)
- Dougal S Hargreaves
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts; Population, Policy & Practice Programme, UCL Institute of Child Health, London, United Kingdom.
| | - Felix Greaves
- Department of Primary Care and Public Health, Imperial College London, Charing Cross Hospital, London, United Kingdom
| | - Charlotta Levay
- Department of Business Administration, Lund University, Lund, Sweden
| | - Imogen Mitchell
- Department of Medicine, Australian National University, Canberra Hospital, Canberra, Australia
| | - Ursula Koch
- Institute for Primary Care, University of Zürich, UniversitätsSpital Zürich, Zürich
| | - Tobias Esch
- Division of Integrative Health Promotion, Coburg University of Applied Sciences, Coburg, Germany; Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Simon Denny
- Department of Paediatrics, Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jan C Frich
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Jeroen Struijs
- National Institute for Public Health and Environment (RIVM), Bilthoven, The Netherlands
| | - Aziz Sheikh
- Centre for Population Health Sciences, Medical School, Edinburgh, United Kingdom
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What can be learned from adolescent time diary research. J Adolesc Health 2015; 56:259-66. [PMID: 25592884 DOI: 10.1016/j.jadohealth.2014.11.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 11/08/2014] [Accepted: 11/10/2014] [Indexed: 11/24/2022]
Abstract
Time use is increasingly being recognized as a determinant and indicator of adolescent well-being internationally. Three existing literature reviews of time-use research with children and adolescents have identified time-use diaries as the preferred data collection method. Furthermore, they have encouraged researchers to examine multidimensional patterns of overall time use in large-sample whole child populations to better understand the health, well-being, and quality of life of children and young people. However, these three existing reviews differ in the time frames covered; the age ranges targeted; the categories of time use examined; and the time-use data collection and analysis methods used. This study aimed to map the extent and nature of time diary studies with well adolescents (aged 10-19 years) and the use of person-centered data analysis of overall time use as a multidimensional unit. Finally, it explores whether and how the included studies analyzed the relationship between time use and health, well-being, and quality of life. A scoping review method was employed using Arksey and O'Malley's five-step framework. Thirty-three studies met the inclusion criteria. Most studies were secondary analyses of cross-sectional population-level time-use or lifestyle survey data. One-third of studies (n = 11) captured data representing 24 hours of the day. Two studies (6%) used person-centered analyses, while six studies (18%) empirically examined time use in relation to health and well-being. No studies examined adolescent 24-hour time use and quality of life. Adolescent time-use researchers are encouraged to be explicit in identifying the stage of adolescence to which their studies relate; capture 24-hour time-use data; analyze overall activity patterns as multidimensional units using person-centered methods; and use robust, reliable, valid, sensitive, and age-appropriate instruments to empirically examine time use and health, well-being, and quality of life. Through this, healthy patterns of everyday activity for adolescents can be illuminated.
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Hargreaves DS. Learning to listen: delivering patient-centered care for adolescents. J Adolesc Health 2014; 55:463-4. [PMID: 25245935 DOI: 10.1016/j.jadohealth.2014.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 07/15/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Dougal S Hargreaves
- General & Adolescent Paediatrics Unit, UCL Institute of Child Health, London, United Kingdom; Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
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