Environment

Young people with JIA in the United Kingdom have reported that pediatric environments were patronizing, adult environments distressing, and both isolating (17). They called for age-appropriate dedicated areas in hospitals where they would feel normal and valued (17). Unfortunately, although adolescent-focused environments were determined to be best practice by young people with JIA, their parents, and health professionals alike, they also considered them to be feasible in only a few U.K. hospitals in a Delphi study (3). In a U.K. study of secondary school students, 30% had been admitted to hospital after age of 13 years, 53% to a pediatric ward, 81% to an adult ward (40). Irrespective of where there were admitted, the majority felt out of place (40).

In the ambulatory-care setting, the need for longer clinic appointments for adolescents compared to both pediatric and adult clinics has been highlighted at a national level in the United Kingdom (39), and this has obvious implications for resource allocation in a financially constrained

Table 3 The Virtual Adolescent Rheumatology Team

Young person Their family Their friends

Primary health-care providers, including school nurses and counselors Secondary health-care providers (medical workers, nurses, occupational therapists, physiotherapists, psychologists) School teachers Vocational services Social services Youth services Voluntary sector system of care. Time is vital to allow an unhurried approach, particularly for the anxious, quiet teenager or for young people with complex problems. Furthermore, during the transition from triadic consultations typical of pediatric practice to the more adult dyadic consultations, an individual clinic visit may start with the family interview, then the young person is seen independently, and then ending with a family briefing in other words, three separate consultations. In the context of multidisciplinary team, a hospital visit to an adolescent rheumatology department may involve consultations with various team members. Robertson et al. reported a significant difference in rheumatology-consultation duration between pediatric and adult clinics (34 vs. 15 minutes, respectively, p < 0.001) (19). In primary care, consultations involving 11- to 19-year-olds were the shortest of any age group by 23% (41)!

Difficulty getting a quick appointment has also been reported by young people as a major difficulty in accessing health services (5) which may impact their communication when eventually they are seen! It is important to realize that a lengthy wait is not only interpreted by users as a sign of inefficiency, but also as a lack of respect, in that it implies that the time of health professionals is more important than that of service users (30). Providing timely explanations for delays and making better use of waiting time (e.g., facilitating social networking among patients, completing transitional assessment forms) may help to minimize such feelings.

Examples of simple development strategies for adolescent-friendly rheumatology services are detailed in Table 4. Perhaps the most important strategy of all, however, is to involve young people themselves in any service developments (42)! The U.K. Department of Health have developed a useful summary document, highlighting the range of factors to address when developing adolescent-friendly health services (43)—and rheumatology services should be no exception!

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