Nathawad Rita, Hanks Christopher
Department of Pediatrics, Division of Community and Societal Pediatrics, University of Florida College of Medicine, Jacksonville, FL; Jacksonville Health and Transition Services (JaxHATS), Jacksonville, FL.
Department of Internal Medicine, Division of General Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH; The Center for Autism Services and Transition (CAST), Hilliard, OH.
Curr Probl Pediatr Adolesc Health Care. 2017 Aug;47(8):182-189. doi: 10.1016/j.cppeds.2017.07.002. Epub 2017 Aug 26.
Youth with special health care needs (YSHCN) experience health care disparities and often need additional support to receive optimal medical care, particularly in adolescence as they prepare to transition to adult care. Many medical practices struggle to address their needs. Here, we discuss approaches to improve medical care in office-based settings for YSHCN. Office visits can be optimized by training staff in developmentally appropriate care and ensuring that the physical office space facilitates care. Participating in previsit preparation, including managing patient registries of YSHCN, engaging in regular team huddles, and incorporating previsit planning, can improve preparation and ensure that important needs are not overlooked. Additionally, approaches to improve patient and medical provider comfort with office visits with YSHCN, including approaches to measuring vital signs, examining patients, and communicating with patients with various disabilities, are reviewed. Finally, we discuss methods of supporting adolescents with special health care needs in developing self-management skills that will allow them to be better prepared to enter adult health care settings when appropriate. Although YSHCN can present challenges to medical teams, their care can be improved by developing office-based changes and processes to support improved care for these patients. This may help overcome the health care disparities they experience and increase comfort for all members of the medical team.
有特殊医疗需求的青少年（YSHCN）面临医疗保健差异，通常需要额外支持才能获得最佳医疗护理，尤其是在青春期准备过渡到成人护理阶段。许多医疗实践难以满足他们的需求。在此，我们讨论在基于办公室的环境中改善对YSHCN医疗护理的方法。通过对工作人员进行适合其发育阶段的护理培训，并确保实际办公空间便利护理，可以优化门诊就诊。参与就诊前准备，包括管理YSHCN患者登记册、定期进行团队碰头会以及纳入就诊前规划，可改善准备工作并确保重要需求不被忽视。此外，还回顾了提高患者和医疗服务提供者对YSHCN门诊就诊舒适度的方法，包括测量生命体征、检查患者以及与各类残疾患者沟通的方法。最后，我们讨论支持有特殊医疗需求的青少年培养自我管理技能的方法，这将使他们在适当的时候更好地为进入成人医疗保健环境做好准备。尽管YSHCN可能给医疗团队带来挑战，但通过在办公室进行改变和制定流程以支持对这些患者的改善护理，他们的护理情况可以得到改善。这可能有助于克服他们所面临的医疗保健差异，并提高医疗团队所有成员的舒适度。
