Table 3 Barriers and facilitators associated with Primary Health Care (PHC) roles

Role 1:

Being a “common thread” across the patient’s lifespan (continuous accessible care)

• Being involved as the PHC provider since birth and all life transitions

• Being accessible for routine follow-up appointments (e.g., every 3–6 months) depending on condition

• Managing appointments around school schedules (e.g., after-school hours, university breaks, etc.)

• AYA only followed by pediatrician prior to age 18

• Families/AYA do not attend regular appointments

• Minimal involvement by family physician with specialist care

• Families/AYA re-locating

• Continual family physician involvement not promoted as conventional practice

• AYA/family lack of understanding of role of “why” they need family physician; no “buy-in”

• Lack of access to psychosocial supports in primary care

• AYA/families continue to see family physician on regular basis

• Trust and long-standing relationship between AYA patient and PHC provider

• Convenient appointment times for AYAs

• Team-based PHC care

Role 2:

Providing “holistic care” to AYA (comprehensive team-based primary care)

• Assessing and managing mental health issues

• Discussing bullying and school

• Discussing sexual health

• Assessing safety (e.g., suicidal ideation)

• Identifying need for supports (e.g., financial assistance, housing)

• Not knowing available resources in primary care

• Age cut-offs for available psychosocial supports in primary care; e.g., Nurse only on adult side, or supports only for pediatric populations

• Lack of specialist recommendations for managing within primary care

• Lack of familiarity with less common, complex medical conditions (e.g., cystic fibrosis, non-verbal AYAs)

• Resources not accessible for AYA (e.g., location, resource fees)

• Having multidisciplinary resources within primary care

• Accessible mental health resources and supports

• PHC provider role recognized/trusted by other providers on team

• ‘Team’ works under one roof

Role 3:

“We know the families”

(family-partnered care)

• Caring for parents and/or extended family members of AYA

• Checking-in with parents about AYA’s condition

• Providing parenting supports (e.g., family counselling)

• Family members do not belong to PCN

• Uncertainty with addressing legal concerns (e.g., confidentiality)

• Practices not “family friendly” or “welcoming” to AYA

• Family prepared to transfer some responsibility of care to AYA patient

Role 4: “Empowering” AYA patients to develop “personal responsibility” (developmentally-appropriate care)

• Helping AYAs develop more responsibility for care

• Teaching self-management skills

• Meeting with AYAs on their own without parents

• Taking a harm-reduction approach

• Assessing and documenting mature minor status

• Parents who are “challenging” or “will not let go”

• Lack of adolescent health specific training

• Practices not “family friendly” or “welcoming” to AYA

• Lack of time during appointments

• Involvement of parents/family members in process of AYA independence

• Specialist providers preparing some support for the transfer to adult care

Role 5: “Quarterback-ing” for AYA (coordinating specialist and community-based care)

• Making referrals to specialists

• Connecting patients with community-based supports

• Helping patients navigate the health system

• Getting a ‘team’ around patient

• Considerable time required

• Lack of specialist support during coordination

• No knowledge of available community resources

• Lengthy wait-lists for mental health services

• Organizing clear treatment plans from other care providers

• Alternate payment models to allow for time required for ‘complex’ cases