Adolescent Health Provision in the Australian School Setting: perspectives of Primary Care Physicians on their preparedness.
Problem
Health problems and health related behaviours arising from adolescence shape adult health. Adolescents have the lowest primary care attendance acrosss the life span resulting in unmet needs and missed opportunities of early detection and health promotion. Globally, ensuring adolescents can access and receive appropriate “youth-friendly” primary healthcare can be challenging. School Based Health Services have potential to achieve universal healthcare coverage and in 2017, the Australian Victorian State Government funded, in the first of it's kind in Australia, a large scale multi-million dollar School Based Health Service initiative.
The “Doctors in Secondary Schools” program supported the convergence of education and health systems to aid the development of healthy resilent adolescents and to contribute to existing wellbeing school programs. It enables students attending one of a 100 disadvantaged high schools to access primary care on their school site on a weekly basis.
My research involved the doctors in the program and explored their readiness and motivation to get involved and their experiences of the school-based clinic.
Approach
Primary Care Physicians were invited to participate in a semi-structured one-on-one interviews of 30-45 minutes duration. Interviews covered motivations of joining the program, evaluation of training received, enablers and barriers in providing healthcare on a school site and experiences of collaboration within the team. Interviews were digitally recorded and transcribed with analysis for themes using N-Vivo software.
Findings
Eleven interviews were completed with in-depth analysis ongoing. Preliminary themes emerging include:
(Motivations):
-Sense of giving back to the community
-Building a connection with young people and having a positive influence
-Interest in adolescent medicine
(Perceived Role):
A mixture of views emerged. Some thought the role would be mainly clinical. Others felt they would play a significant role linking with stakeholders and in school based health promotion programs. Another group were unsure.
(Impact on their home clinic and the community)
- Seeing more adolescents in practice and booking them longer appointments
-Upskilled by undertaking further educational studies
-Applying skills they had learnt while working in the program to other patients across
generations
On the community:
-Group of confident Primary Care Physicians in looking after adolescents in applying a HEADSS approach and using confidentiality statements
-A cohort of the population that would not seek medical attention in their usual primary care clinic were seeking primary care and had improved health literacy
Consequences
My research will add to the evidence base of School Based Health Services. Significant motivating factors to part-take in the program were identified and the demographic and altruistic nature of the doctors involved. We have identified an interested group of competent doctors who are willing and skilled in providing adolescent healthcare. School Based Health Services that have a close connection to local communities had a wider positive impact.