Young People In Primary Care Research Articles

Brief cognitive behavioural therapy for eating disorders symptomatology among a mixed sample of adolescents and young adults in primary care: A non-randomised feasibility and pilot study.

Brief and accessible therapies for people with an eating disorder is an important health target. Ten-session cognitive behavioural therapy (CBT-T) is a brief treatment evaluated in people with a non-underweight eating disorder. This study aimed to evaluate the feasibility and preliminary effectiveness of CBT-T for young people in primary care. This cohort pilot study used group (adolescents vs. young adults) by time (over four time points) Generalised Linear Mixed Model analysis. Participants included 13-25-year-olds attending an early intervention mental health service, receiving 10 sessions of CBT-T. Feasibility was assessed using recruitment, retention and satisfaction. Eating and other pathology measures were administered at baseline, weeks four and 10, and 12-week follow-up. Of the 63 commencing treatment, 38 completed 10 CBT-T sessions (60%). Most (94%) reported high treatment satisfaction. Significant reductions in eating pathology, depression and stress were found. Age group did not yield differences in CBT-T outcome, with large to very large effect sizes across outcome variables. Anxiety was associated with attrition. This study provides preliminary support for the use of CBT-T in primary care, across adolescence and early adulthood. Findings require replication in other clinical settings and comparison to other clinical approaches and control populations.

Assessment and management of endometriosis in young people in primary care.

Assessment and management of endometriosis in young people in primary care.

Deriving and validating an asthma diagnosis prediction model for children and young people in primary care.

Introduction: Accurately diagnosing asthma can be challenging. We aimed to derive and validate a prediction model to support primary care clinicians assess the probability of an asthma diagnosis in children and young people. Methods: The derivation dataset was created from the Avon Longitudinal Study of Parents and Children (ALSPAC) linked to electronic health records. Participants with at least three inhaled corticosteroid prescriptions in 12-months and a coded asthma diagnosis were designated as having asthma. Demographics, symptoms, past medical/family history, exposures, investigations, and prescriptions were considered as candidate predictors. Potential candidate predictors were included if data were available in ≥60% of participants. Multiple imputation was used to handle remaining missing data. The prediction model was derived using logistic regression. Internal validation was completed using bootstrap re-sampling. External validation was conducted using health records from the Optimum Patient Care Research Database (OPCRD). Results: Predictors included in the final model were wheeze, cough, breathlessness, hay-fever, eczema, food allergy, social class, maternal asthma, childhood exposure to cigarette smoke, prescription of a short acting beta agonist and the past recording of lung function/reversibility testing. In the derivation dataset, which comprised 11,972 participants aged <25 years (49% female, 8% asthma), model performance as indicated by the C-statistic and calibration slope was 0.86, 95% confidence interval (CI) 0.85-0.87 and 1.00, 95% CI 0.95-1.05 respectively. In the external validation dataset, which included 2,670 participants aged <25 years (50% female, 10% asthma), the C-statistic was 0.85, 95% CI 0.83-0.88, and calibration slope 1.22, 95% CI 1.09-1.35. Conclusions: We derived and validated a prediction model for clinicians to calculate the probability of asthma diagnosis for a child or young person up to 25 years of age presenting to primary care. Following further evaluation of clinical effectiveness, the prediction model could be implemented as a decision support software.

Deriving and validating an asthma diagnosis prediction model for children and young people in primary care

Introduction: Accurately diagnosing asthma can be challenging. We aimed to derive and validate a prediction model to support primary care clinicians assess the probability of an asthma diagnosis in children and young people. Methods: The derivation dataset was created from the Avon Longitudinal Study of Parents and Children (ALSPAC) linked to electronic health records. Participants with at least three inhaled corticosteroid prescriptions in 12-months and a coded asthma diagnosis were designated as having asthma. Demographics, symptoms, past medical/family history, exposures, investigations, and prescriptions were considered as candidate predictors. Potential candidate predictors were included if data were available in ≥60% of participants. Multiple imputation was used to handle remaining missing data. The prediction model was derived using logistic regression. Internal validation was completed using bootstrap re-sampling. External validation was conducted using health records from the Optimum Patient Care Research Database (OPCRD). Results: Predictors included in the final model were wheeze, cough, breathlessness, hay-fever, eczema, food allergy, social class, maternal asthma, childhood exposure to cigarette smoke, prescription of a short acting beta agonist and the past recording of lung function/reversibility testing. In the derivation dataset, which comprised 11,972 participants aged &lt;25 years (49% female, 8% asthma), model performance as indicated by the C-statistic and calibration slope was 0.86, 95% confidence interval (CI) 0.85–0.87 and 1.00, 95% CI 0.95–1.05 respectively. In the external validation dataset, which included 2,670 participants aged &lt;25 years (50% female, 10% asthma), the C-statistic was 0.85, 95% CI 0.83–0.88, and calibration slope 1.22, 95% CI 1.09–1.35. Conclusions: We derived and validated a prediction model for clinicians to calculate the probability of asthma diagnosis for a child or young person up to 25 years of age presenting to primary care. Following further evaluation of clinical effectiveness, the prediction model could be implemented as a decision support software.

The management of acne vulgaris in young people in primary care: A retrospective cohort study.

Acne vulgaris (acne) is common among young persons (YPs). Clinical practice guidelines are available for acne management to minimize their physical and psychological impact. However, evidence of adherence to these guidelines is sparse in primary care practices. The study aimed to determine the demographic profile of YPs who sought primary care consultations for acne, their related prescriptions and referrals to specialists for further management. A retrospective study was conducted using data from a cluster of eight public primary care clinics in Singapore. Demographic, clinical, prescription, and referral data were extracted from the electronic health records of YPs aged 10-29 years with a documented diagnosis of acne (ICD-10 classification) from 1st July 2018 to 30th June 2020. The data were reviewed, audited for eligibility criteria, and de-identified before analysis. Complete data from 2,700 YPs with acne were analyzed. Male (56.1%) YPs and those of Chinese ethnicity (73.8%) had the most frequent attendances for acne. The mean and median age at presentation was 19.2 (standard deviation = 4.3) and 19 (interquartile range = 16-22) years, respectively. Only 69.7% of YPs received an acne-related medication; 33.5% received antibiotic monotherapy; 53.0% were prescribed oral doxycycline, 35.0% acne cream (combination of sulfur, salicylic acid, and resorcinol), and 28.4% benzoyl peroxide 5% gel; 54.3% of those treated with antibiotics were prescribed with a shorter duration than recommended; 51.3% were referred to a dermatologist on their first visit, and 15.8% had more than one visit. Acne management for YPs can be enhanced with refresher training among primary care physicians for better adherence to its clinical practice guidelines.

Impact of the COVID-19 pandemic on incidence of tics in children and young people: a population-based cohort study.

Since the onset of the coronavirus (COVID-19) pandemic, clinicians have reported an increase in presentations of sudden and new onset tics particularly affecting teenage girls. This population-based study aimed to describe and compare the incidence of tics in children and young people in primary care before and during the COVID-19 pandemic in England. We used information from the UK Clinical Practice Research Datalink (CPRD) Aurum dataset and included males and females aged 4-11 years and 12-18 years between Jan 1, 2015, and Dec 31, 2021. We grouped the pre-pandemic period (2015-2019) and presented the pandemic years (2020, 2021) separately. We described the characteristics of children and young people with a first record of a motor or vocal tic in each time period. Incidence rates of tics by age-sex groups in 2015-2019, 2020, and 2021 were calculated. Negative binomial regression models were used to calculate incidence rate ratios. We included 3,867,709 males and females aged 4-18 years. Over 14,734,062 person-years of follow-up, 11,245 people had a first tic record during the whole study period. The characteristics of people with tics differed over time, with the proportion of females aged 12-18 years and the proportion with mental health conditions including anxiety increasing during the pandemic. Tic incidence rates per 10,000 person-years were highest for 4-11-year-old males in all three time periods (13.4 [95% confidence interval 13.0-13.8] in 2015-2019; 13.2 [12.3-14.1] in 2020; 15.1 [14.1-16.1] in 2021) but increased markedly during the pandemic in 12-18-year-old females, from 2.5 (2.3-2.7) in 2015-2019, to 10.3 (9.5-11.3) in 2020 and 13.1 (12.1-14.1) in 2021. There were smaller increases in incidence rates in 12-18-year-old males (4.6 [4.4-4.9] in 2015-2019; 4.7 [4.1-5.3] in 2020; 6.2 [5.5-6.9] in 2021) and 4-11-year-old females (4.9 [4.7-5.2] in 2015-2019; 5.7 [5.1-6.4] in 2020; 7.6 [6.9-8.3] in 2021). Incidence rate ratios comparing 2020 and 2021 with 2015-2019 were highest in the 12-18-year-old female subgroup (4.2 [3.6-4.8] in 2020; 5.3 [4.7-6.0] in 2021). The incidence of tics in children and young people increased across all age and sex groups during the COVID-19 pandemic, with a differentially large effect in teenage girls (a greater than four-fold increase). Furthermore, in those with tic symptoms, proportions with mental health disorders including anxiety increased during the pandemic. Further research is required on the social and contextual factors underpinning this rise in onset of tics in teenage girls. National Institute for Health Research Nottingham Biomedical Research Centre.

Protocol for the derivation and validation of a clinical prediction model to support the diagnosis of asthma in children and young people in primary care

Background: Accurately diagnosing asthma can be challenging. Uncertainty about the best combination of clinical features and investigations for asthma diagnosis is reflected in conflicting recommendations from international guidelines. One solution could be a clinical prediction model to support health professionals estimate the probability of an asthma diagnosis. However, systematic review evidence identifies that existing models for asthma diagnosis are at high risk of bias and unsuitable for clinical use. Being mindful of previous limitations, this protocol describes plans to derive and validate a prediction model for use by healthcare professionals to aid diagnostic decision making during assessment of a child or young person with symptoms suggestive of asthma in primary care. Methods: A prediction model will be derived using data from the Avon Longitudinal Study of Parents and Children (ALSPAC) and linked primary care electronic health records (EHR). Data will be included from study participants up to 25 years of age where permissions exist to use their linked EHR. Participants will be identified as having asthma if they received at least three prescriptions for an inhaled corticosteroid within a one-year period and have an asthma code in their EHR. To deal with missing data we will consider conducting a complete case analysis. However, if the exclusion of cases with missing data substantially reduces the total sample size, multiple imputation will be used. A multivariable logistic regression model will be fitted with backward stepwise selection of candidate predictors. Apparent model performance will be assessed before internal validation using bootstrapping techniques. The model will be adjusted for optimism before external validation in a dataset created from the Optimum Patient Care Research Database. Discussion: This protocol describes a robust strategy for the derivation and validation of a prediction model to support the diagnosis of asthma in children and young people in primary care.

Protocol for the derivation and validation of a clinical prediction model to support the diagnosis of asthma in children and young people in primary care.

Background: Accurately diagnosing asthma can be challenging. Uncertainty about the best combination of clinical features and investigations for asthma diagnosis is reflected in conflicting recommendations from international guidelines. One solution could be a clinical prediction model to support health professionals estimate the probability of an asthma diagnosis. However, systematic review evidence identifies that existing models for asthma diagnosis are at high risk of bias and unsuitable for clinical use. Being mindful of previous limitations, this protocol describes plans to derive and validate a prediction model for use by healthcare professionals to aid diagnostic decision making during assessment of a child or young person with symptoms suggestive of asthma in primary care. Methods: A prediction model will be derived using data from the Avon Longitudinal Study of Parents and Children (ALSPAC) and linked primary care electronic health records (EHR). Data will be included from study participants up to 25 years of age where permissions exist to use their linked EHR. Participants will be identified as having asthma if they received at least three prescriptions for an inhaled corticosteroid within a one-year period and have an asthma code in their EHR. To deal with missing data we will consider conducting a complete case analysis. However, if the exclusion of cases with missing data substantially reduces the total sample size, multiple imputation will be used. A multivariable logistic regression model will be fitted with backward stepwise selection of candidate predictors. Apparent model performance will be assessed before internal validation using bootstrapping techniques. The model will be adjusted for optimism before external validation in a dataset created from the Optimum Patient Care Research Database. Discussion: This protocol describes a robust strategy for the derivation and validation of a prediction model to support the diagnosis of asthma in children and young people in primary care.

Substance Use Screening to Encourage Behavior Change Among Young People in Primary Care

Substance Use Screening to Encourage Behavior Change Among Young People in Primary Care

Excessive substance use screening to encourage behaviour change among young people in primary care: Pilot study in preparation for a randomized trial

IntroductionAlcohol, cannabis and other substance use affects young people's health. Primary care physicians are encouraged to screen and provide brief interventions for substance use in this population, but implementation is often limited. Pre-consultation self-administered screening may decrease at-risk substance use and could have population-level benefits. A randomized controlled trial is planned to test this hypothesis. The present pilot study's objective was to assess the feasibility of methods for the future trial. MethodsThe parallel-group randomized controlled pilot trial was undertaken in 6 primary care practices in Geneva, Switzerland, over 2 months. 29 patients aged 15–24 years consulting for any reason were randomly assigned to intervention (substance use screening, n = 14) or control (physical activity questionnaire, n = 15) using computer-generated random number tables. Outcomes were assessed one month later by telephone questionnaire. Physicians, practice staff and outcome assessors were blinded to allocation. The primary outcomes were feasibility of procedures and acceptability to participants, primary care physicians and practice staff. ResultsOf 16 participants reached at follow-up, 3 reported excessive substance use. Methods were acceptable to all participants, especially regarding confidentiality. Three participants were lost due to technical difficulties with the consent form. No major problems with study methods were reported in the practices. 4 practices did not meet recruitment targets. ConclusionThe study procedures proved to be feasible in primary care practices and acceptable to young people who were readily available to participate. The main challenge for the future full-sized trial will be to ensure that recruitment targets can be met.

The earlier identification of mental health problems in children and young people in primary care using their linked GP-hospital records

BackgroundAttention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder affecting 3–5% of the population of children and young people (CYP). CYP with mental health problems report long delays in the diagnosis of mental health problems. ADHD is recognised in just under 1% of children and young people in English primary care and qualitative work suggests that parents (carers) report to their GPs prior to obtaining a diagnosis of ADHD but a detailed knowledge of reasons for presenting to health care is lacking.AimTo ascertain the reasons for attendance to health care for CYP with compared to CYP without ADHD.MethodUsing the Clinical Practice Research Datalink (CPRD) with linked Hospital Episodes Statistics (HES) data, all medical records for CYP with ADHD were extracted. Up to five CYP without ADHD were selected at random matched by age, sex, and GP practice. All GP and hospital medical records were extracted and inspected in the 2 years prior to the date of diagnosis of ADHD in the index case.ResultsThere were 8135 CYP with ADHD and 40 614 CYP without ADHD. Medical records from GP, hospital diagnosis codes, and operative procedure codes have been extracted. A description of the reasons for attendance to healthcare in the 2 years prior to diagnosis (index date) will be presented at the conference.ConclusionA detailed knowledge of reasons for attendance to healthcare for CYP with versus CYP without CYP will assist GPs, paediatrics, educationalists, and CYP’s parents (carers) may help to identify ADHD earlier than is currently possible.

Talk About Self-Harm (TASH): participatory action research with young people, GPs and practice nurses to explore how the experiences of young people who self-harm could be improved in GP surgeries.

The incidence of self-harm in young people in primary care is increasing dramatically, and many young people who self-harm visit their GP surgery as a first point of contact for help. To explore with young people, GPs and practice nurses (PNs): (i) why young people present with self-harm to primary care and (ii) whether young people, GPs and PNs can take steps to have more helpful consultations about self-harm in GP surgeries that include self-help materials developed by young people being used to support such consultations to take place. Participatory action research with GPs, PNs and young people employed mixed methods to collect statistical and narrative data. Statistics from 285 young people's medical records were captured, including more detailed analyses of a random sample of 75 of these records. A series of 24 focus groups with a total of 45 GPs, PNs and young people, with an average number of eight participants in each group, was conducted. Statistical data were subject to descriptive and inferential analyses, and thematic analysis was applied to the transcripts from the focus groups. The type of self-harm young people presented with influenced whether they would see a GP or PN. While self-help materials were welcomed and deemed helpful, young people, GPs and PNs were ambivalent about using these in short consultations where time was an overriding constraint. More research is needed on the feasibility of adopting self-help assisted interventions in GP surgeries.

Check Up GP: Implementing a Co-Designed Health and Lifestyle Screening app to Improve Patient-Centred Care for Young People in Primary Care

Check Up GP: Implementing a Co-Designed Health and Lifestyle Screening app to Improve Patient-Centred Care for Young People in Primary Care

Check Up GP: A Co-Designed Health and Lifestyle Screening App to Improve Patient-Centered Care for Young People in Primary Care

Background: During adolescence and young adulthood, a wide range of mental health disorders and risky behaviors can emerge and co-occur. Primary care practitioners (PCPs) are ideally positioned to identify areas of concern as part of young people’s routine health care, and screening tools can help to surface problems the young person may be facing. When administered via technology, screening tools are more readily adopted by young people and can deliver results immediately to the PCP. Technology-based screening tools help PCPs to normalize sensitive issues, guide discussion about risky behavior, and promote healthy lifestyles, and they make young people more likely to disclose sensitive health issues. Despite these advantages, there is a paucity of research about how using these screening tools may affect the patient-doctor relationship and whether young people would like to use such tools again in the future.

Derivation of a prediction model for a diagnosis of depression in young adults: a matched case-control study using electronic primary care records.

Approximately 80 000 children and young people in the UK suffer from depression, but many are untreated because of poor identification of early warning signs and risk factors. This study aimed to derive and to investigate discrimination characteristics of a prediction model for a first recorded diagnosis of depression in young people aged 15-24 years. This study used a matched case-control method using electronic primary care records. Stepwise conditional logistic regression modelling investigated 42 potential predictors including symptoms, co-morbidities, social factors and drug and alcohol misuse. Of the socio-economic and symptomatic predictors identified, the strongest associations were with depression symptoms and other psychological conditions. School problems and social services involvement were prominent predictors in men aged 15-18 years, work stress in women aged 19-24 years. Our model is a first step in the development of a predictive model identifying early warning signs of depression in young people in primary care.

Exploring general practitioners' views and experiences on suicide risk assessment and management of young people in primary care: a qualitative study in the UK.

ObjectiveTo explore general practitioner (GP) views and experiences of assessing, communicating with and managing suicidal young people with the aim of co-producing an educational intervention on youth suicide prevention tailored to GPs’ perceived needs.DesignQualitative focus group study using framework analysis.Setting5 inner city general practices in Nottingham.Participants28 GPs took part (9 males) with mean age of 37 years. The median number of years of professional experience was 13. Participants were recruited through convenience sampling based on accessibility, interest in the study and willingness to participate.Results3 themes emerged from the data in relation to GP's attitudes and beliefs towards suicide; the challenges GPs experience when it comes to the assessment and management of suicide risk in young people; and optimal ways of addressing some of these challenges through the provision of specialist education and training targeting GPs’ knowledge and clinical skills in this field.ConclusionsThe findings revealed wide variations in the understanding and operationalisation of risk among GPs, which has subsequent implications to how GPs perceive risk should be assessed. GP education on suicide risk assessment and management in youth should promote a holistic understanding and assessment of risk and its individual, social and contextual influences.

Diagnosis of depressed young people--criterion validity of WHO-5 and HSCL-6 in Denmark and Norway.

According to the World Health Organization, depression ranks as a major contributor to the global burden of disease. A large proportion of adult depressions had their first appearance in adolescence. Brief and reliable rating scales are needed for early detection. The aim of this study is to validate the WHO-5 and the HSCL-6 for detection of depression among adolescents. The project is a GP multicentre study conducted in Denmark and Norway. A total of 294 adolescents (14-16 years) responded by answering a paper- or web-based questionnaire and later completed a Composite International Diagnostic Interview, which was used as the gold standard. Depression was defined by ICD-10 criteria. Criterion validity was examined, the likelihood ratios measured and cut-offs for depression were calculated using the Youden index. The prevalence of depression was 11.8% in our sample. The optimal cut-off point was 11 for the WHO-5 test and 9 for the HSCL-6 test. There were no gender differences. For the WHO-5 and the HSCL-6, respectively, the sensitivity was 0.88 [95% confidence interval (CI): 0.74-0.96] and 0.85 (95% CI: 0.70-0.94), the specificity was 0.80 (95% CI: 0.75-0.85) and 0.79 (95% CI: 0.74-0.84) and the likelihood ratio was 4.5 and 3.8 (P = 0.39). We observed no statistically significant diagnostic differences with respect to nationality or administration procedure. The WHO-5 and the HSCL-6 may both serve as valid case finding instruments for depression in young people in primary care.

A practical approach for UK primary care on the management of cow's milk allergy in infants.

The term ‘Cow’s Milk Allergy’ (CMA) is used in this guidance, although the term ‘Cow’s Milk Protein Allergy’ (CMPA) is also widely used in the literature. CMA is the commonest food allergy among children in the UK. Data from 2008 indicated 2.3% of 1–3 year-olds in the UK suffer from CMA.1 In 2011, National Institute for Health and Care Excellence (NICE) published Clinical Guideline (CG)116 on the Diagnosis and Assessment of Food Allergy in Children and Young People in Primary Care and Community Settings.2 It has become increasingly evident that for effective implementation, there needs to be further practical advice, which was outside of the scope of the current NICE guideline, on establishing the initial diagnosis and the further management of infants with CMA. A health economic analysis published in 2010 concluded that CMA imposes a, ‘substantial burden on the NHS’.3 The ‘cost’ of this burden can be kept at a minimum by improving the care provided in the community. As clinicians involved in the development of the NICE guideline, we have therefore aimed to provide a practical tool for the management of CMA in primary care. The algorithm we have produced is intended as an adjunct to the published NICE guideline2 …

Diagnosis and assessment of food allergy in children and young people in primary care and community settings: NICE clinical guideline

Food allergy is recognised as a major paediatric health problem in western countries. The true prevalence is unknown but Europe and the US report ranges from 6% to 8% in children aged up to 3 years. The National Institute for Health and Clinical Excellence (NICE) has developed a guideline on the symptoms that should prompt consideration of food allergy when a child or young person presents in primary or community care.1 Food allergy is an adverse immune response to food allergens. Reactions can be classified into those that are immunoglobulin E (IgE) mediated or non-IgE mediated. Some children may have both IgE and non-IgE mediated reactions to food; in this guideline, these are referred to as mixed reactions. In both IgE and non-IgE reactions, there is a response by the immune system to a protein within food. IgE mediated reactions are immediate type 1 hypersensitivity reactions while non-IgE mediated reactions usually occur several hours after allergen exposure. The exact mechanism is not clearly understood but, in both reactions, elimination of the allergenic food protein is required to prevent symptoms. The correct diagnosis of food allergy should decrease the incidence of adverse food reactions that are a result of true food allergies; and help prevent the unnecessary exclusion of foods that are safe and that should be eaten as part of a normal, healthy diet. This guideline does not cover children and young people with food intolerances (such as intolerance to lactose), reactions to pharmacological agents (such as salicylates), or reactions to those substances that naturally occur in foods (such as benzoic acid). When to suspect food allergy Food allergy should be suspected when the following are present: persistent eczema, gastro-oesophageal reflux disease and bowel symptoms, including constipation, that do not respond to normal …

‘Talking of Sex’: Developing and piloting a sexual health communication tool for use in primary care

Objective To develop and pilot a communication aid aimed at increasing the frequency with which sexual health issues are raised proactively with young people in primary care. Methods Group interviews among primary health care professionals to guide development of the tool, simulated consultations to pre-test it, and a pilot study to assess effectiveness. Results We developed an electronic consultation aid: Talking of Sex and piloted it in eight general practices across the UK. 188 patients and 58 practitioners completed questionnaires pre-intervention, and 92 patients and 45 practitioners post-intervention. There was a modest increase in the proportion of consultations in which sexual health was raised, from 28.1% pre-intervention to 32.6% post-intervention. In consultations with nurses the rise was more marked. More patients reported discussing preventive practices such as condom use post-intervention. Patients unanimously welcomed the opportunity to discuss sexual health matters with their practitioner. Conclusion The tool has capacity to increase the frequency with which sexual health is raised in primary care, particularly by nurses, to influence the topics discussed, and to improve patient satisfaction. Practice implications The tool has potential in increasing the proportion of young people whose sexual health needs are addressed in general practice.