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

From: Perspectives from primary health care providers on their roles for supporting adolescents and young adults transitioning from pediatric services

PHC role Examples in practice Barriers to this role Facilitators to this role
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
  1. PHC Primary Health Care