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 |