General practice consultation patterns by teenagers and their associations with health risks, needs and attitudes

During the transition from childhood to adulthood young people are vulnerable to relatively unique health problems and risks, whilst also developing personal autonomy, and learning when and how to access health services. This thesis describes three studies, the overall aim of which was to gain a greater understanding of how teenagers use general practice, and to identify those factors that influence this behaviour and ultimate health outcomes. The aim of the first two studies was to identify demographic, health, and attitudinal factors associated with both overall general practice consultation rates and consultation for specific types of condition. The first study involved identifying annual consultation rates and reasons for consultation from the medical records of 836 (94.4%) of 886 teenagers aged 13 to 15 registered with five general practices across the East Midlands, covering the 12 month period prior to the second study. In the second study, 713 (80.5%) of the 886 teenagers from the first study responded to a postal questionnaire survey, carried out between May and August 1997, which explored health concerns, help-seeking behaviour, health related behaviour, use of health services, and attitudes to general practice. The results from each of the first two studies were linked, in order to identify associations between self-reported health status, attitudes and behaviour and recorded consultation behaviour, based on the 678 teenagers for whom complete data sets were available. The median annual consultation rate was two, with 76.1% of teenagers consulting at least once and 23.8% consulting on four or more occasions. Consultation rates increased with age amongst girls, who had significantly higher rates than boys by age 15. Most consultations were for respiratory and skin problems, with consultations for psychological problems being least frequent. Teenagers reported a wide range of health concerns and, whilst general practitioners were identified as the most frequent source of health advice from formal health services, friends and family were cited far more frequently. Although 91.8% of survey respondents rated confidentiality as important, there was no association between attitudes towards confidentiality and actual consultation behaviour. In contrast, teenage girls who expressed concerns about embarrassment were less likely to consult about gynaecological problems and contraception. The third study was a case control study in which the general practice consultation patterns of 240 young women who subsequently became pregnant (having a recorded termination, delivery or miscarriage between January 1995 and January 1998) were compared with those of 719 age-matched controls without a history of pregnancy. Cases were significantly more likely than controls to have consulted in the year prior to conception with 93% of cases consulting at least once and 71% having discussed contraception at some time. Teenagers whose pregnancy ended in a termination were significantly more likely than controls to have received emergency contraception. In conclusion, whilst teenagers have been shown to use general practice for a range of health problems, the results from these studies suggest that there is a need to facilitate access for teenagers with more sensitive problems, and to improve identification and follow-up of those at greatest risk of adverse outcomes