From the studies described above despite their limitations, it can be concluded that adolescent health care delivery has been highlighted as important and further attention is required in the training of current and future generations of health professionals to facilitate confidence and competence. However, there are also perceived barriers not only to gaining the necessary knowledge and skills but also in implementing them. Britto et al. found that pediatric rheumatologists had difficulties in promoting adolescent health in their clinics. Levels of screening young people for alcohol use and sexual activity was linked to lack of time, organizational problems, discomfort in dealing with the subject area, ambivalence as to whether the role was within the remit of a pediatrician, and doubts as to the relevance of the subject to their patient group (20). In units dedicated to the care of adolescents, Sawyer reported comorbidities such as underlying behavioral or mental health problems that can often affect the presentation to the hospital or, indeed, be the cause of an admission (e.g., overdose). In such units these issues can be more easily identified and managed and can give a focus for training and continuing professional development in the field that, in more general medical environments, is otherwise difficult to deliver (21).
With respect to involvement in transition, 45% of health professionals in a U.K. national survey cited lack of training to be a barrier to providing transitional services (18). In a survey of 743 parents of young people with special health care needs and 141 health professionals (primary pediatricians), Geenen et al. found that time, training, financial constraints, and other issues, such as discomfiture, lack of applicability, difficulty accessing resources were the barriers perceived by the health professionals. Furthermore, there were significant differences between providers and parents concerning both the level of provider involvement and the extent to which it was the provider's responsibility to assist in various transition activities. The health providers reported significantly more involvement than did parents perceived them to have for most transition activities (22).
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