It is useful to further consider the idea that adolescents are "new users" of health services. In infancy and childhood, health services are accessed by parents on behalf of their sons/daughters. During adolescence, however, young people increasingly access health services independently. A potential predictor of the effectiveness of such utilization is the young person's acquisition of the necessary skills for doing so. In the context of chronic rheumatic disease, such skills training may be negatively affected by overprotective parenting, as is exemplified by the fact that a minority of adolescents are seen in adolescent clinics independently of their parents (33-35). Young people want to be assured privacy and confidentiality before choosing to be seen alone (1,36). Confidentiality has been reported as the main attribute of an adolescent-friendly service by young people (37,38); some young people will actually forgo health care if they think their parents
Table 4 Key Principles of Adolescent Health Care
Acknowledges the reciprocal influences of health and disease on adolescent development (physical, psychosocial, cognitive) Promotes health and prevents disease Transitional care
Views adolescents as "new users" of health services Multidisciplinary and interagency will find out (39). Commencement of such skills training starts early, as doctors involve children more in the consultation. In an interesting study of 302 consecutive outpatient pediatric encounters, children's contributions were limited to 4%, and pediatricians directed only one in every four statements to the child (40). Although pediatricians asked children a lot of medical questions (26%), only a small amount of the medical information (13%) was directed at the children (40). Other key skills young people need include self-medication and other forms of self-management, to know how to contact health care providers directly, get prescriptions and so on; these are integral components of transitional care (41). They are further discussed in Chapter 16. It remains important to acknowledge the differences between self-management for adolescents with chronic illness from that of adults (42) and to involve young people directly in service development in this area.
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