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Hickam T, White PH, Modrcin A, McManus M, Cox K. Implementing a Nationally Recognized Pediatric-to-Adult Transitional Care Approach in a Major Children's Hospital. HEALTH & SOCIAL WORK 2018; 43:3-6. [PMID: 29253121 DOI: 10.1093/hsw/hlx049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Teresa Hickam
- Teresa Hickam, ACSW, LCSW, LSCSW, CCM, is transition program manager, Transition to Adulthood Program, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108; e-mail: . Patience H. White, MD, MA, is professor of medicine and pediatrics, George Washington School of Medicine and Health Sciences, and codirector of Got Transition, Washington, DC. Ann Modrcin, MD, EMBA, is professor of pediatrics, University of Missouri-Kansas City School of Medicine, and director of the Rehabilitation Medicine and Transition to Adulthood Program, Children's Mercy Kansas City, MO. Margaret McManus, MHS, is president, National Alliance to Advance Adolescent Health, and codirector, Got Transition, Washington, DC. Karen Cox, RN, PhD, is executive vice president and chief operating officer, and V. Fred Burry, MD, and Sandra Hobart Burry Chair in Nursing Advocacy and Leadership, Children's Mercy Kansas City, MO
| | - Patience H White
- Teresa Hickam, ACSW, LCSW, LSCSW, CCM, is transition program manager, Transition to Adulthood Program, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108; e-mail: . Patience H. White, MD, MA, is professor of medicine and pediatrics, George Washington School of Medicine and Health Sciences, and codirector of Got Transition, Washington, DC. Ann Modrcin, MD, EMBA, is professor of pediatrics, University of Missouri-Kansas City School of Medicine, and director of the Rehabilitation Medicine and Transition to Adulthood Program, Children's Mercy Kansas City, MO. Margaret McManus, MHS, is president, National Alliance to Advance Adolescent Health, and codirector, Got Transition, Washington, DC. Karen Cox, RN, PhD, is executive vice president and chief operating officer, and V. Fred Burry, MD, and Sandra Hobart Burry Chair in Nursing Advocacy and Leadership, Children's Mercy Kansas City, MO
| | - Ann Modrcin
- Teresa Hickam, ACSW, LCSW, LSCSW, CCM, is transition program manager, Transition to Adulthood Program, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108; e-mail: . Patience H. White, MD, MA, is professor of medicine and pediatrics, George Washington School of Medicine and Health Sciences, and codirector of Got Transition, Washington, DC. Ann Modrcin, MD, EMBA, is professor of pediatrics, University of Missouri-Kansas City School of Medicine, and director of the Rehabilitation Medicine and Transition to Adulthood Program, Children's Mercy Kansas City, MO. Margaret McManus, MHS, is president, National Alliance to Advance Adolescent Health, and codirector, Got Transition, Washington, DC. Karen Cox, RN, PhD, is executive vice president and chief operating officer, and V. Fred Burry, MD, and Sandra Hobart Burry Chair in Nursing Advocacy and Leadership, Children's Mercy Kansas City, MO
| | - Margaret McManus
- Teresa Hickam, ACSW, LCSW, LSCSW, CCM, is transition program manager, Transition to Adulthood Program, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108; e-mail: . Patience H. White, MD, MA, is professor of medicine and pediatrics, George Washington School of Medicine and Health Sciences, and codirector of Got Transition, Washington, DC. Ann Modrcin, MD, EMBA, is professor of pediatrics, University of Missouri-Kansas City School of Medicine, and director of the Rehabilitation Medicine and Transition to Adulthood Program, Children's Mercy Kansas City, MO. Margaret McManus, MHS, is president, National Alliance to Advance Adolescent Health, and codirector, Got Transition, Washington, DC. Karen Cox, RN, PhD, is executive vice president and chief operating officer, and V. Fred Burry, MD, and Sandra Hobart Burry Chair in Nursing Advocacy and Leadership, Children's Mercy Kansas City, MO
| | - Karen Cox
- Teresa Hickam, ACSW, LCSW, LSCSW, CCM, is transition program manager, Transition to Adulthood Program, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO 64108; e-mail: . Patience H. White, MD, MA, is professor of medicine and pediatrics, George Washington School of Medicine and Health Sciences, and codirector of Got Transition, Washington, DC. Ann Modrcin, MD, EMBA, is professor of pediatrics, University of Missouri-Kansas City School of Medicine, and director of the Rehabilitation Medicine and Transition to Adulthood Program, Children's Mercy Kansas City, MO. Margaret McManus, MHS, is president, National Alliance to Advance Adolescent Health, and codirector, Got Transition, Washington, DC. Karen Cox, RN, PhD, is executive vice president and chief operating officer, and V. Fred Burry, MD, and Sandra Hobart Burry Chair in Nursing Advocacy and Leadership, Children's Mercy Kansas City, MO
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Al-Yateem N, Rossiter R, Robb W, Ahmad A, Elhalik MS, Albloshi S, Slewa-Younan S. Mental health literacy among pediatric hospital staff in the United Arab Emirates. BMC Psychiatry 2017; 17:390. [PMID: 29216871 PMCID: PMC5721387 DOI: 10.1186/s12888-017-1556-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 11/22/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In the United Arab Emirates (UAE) 35% of the population are aged 0-24 years. A significant proportion of these young people are living with chronic conditions (e.g., asthma, type 1 diabetes, cardiac conditions, and genetically-transmitted conditions such as thalassemia and cystic fibrosis). This group has increased vulnerability to developmental delays and mental health problems, and is increasingly coming to the attention of service providers in mainstream schools, primary healthcare centers, and pediatric hospitals. Despite the government directing attention to improving the mental health of the UAE population, there is concern that mental health services are not growing at the rate needed to meet the mental health needs of children and young people with chronic conditions. METHOD A cross sectional survey design was used to determine the mental health literacy of nurses and other healthcare professionals working with children with chronic illnesses. Participants completed a culturally-adapted mental health literacy questionnaire comprising three vignettes of fictional characters meeting diagnostic criteria for posttraumatic stress disorder, psychosis, and depression with suicidal thoughts. Participants also completed the Kessler Psychological Distress Scale (K10). RESULTS Participants were 317 healthcare professionals from across the UAE. The majority were nurses. Correct identification of the diagnosis for each vignette was limited, with the highest level of accuracy achieved for the psychosis vignette (n = 113, 54.3%). Accurate identification of appropriate evidence-based interventions was also limited. K10 scores indicated 40% of participants had moderate to high levels of psychological distress. CONCLUSIONS These findings are concerning and provide important data to inform the development of undergraduate and continuing education programs for nurses. The K10 scores suggest healthcare professionals are under considerable stress, highlighting the need to support healthcare professionals who experience multiple psychosocial stressors.
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Affiliation(s)
- Nabeel Al-Yateem
- Department of Nursing, College of Health Sciences, University of Sharjah, P O Box 27272, Sharjah, United Arab Emirates
- School of Nursing, Midwifery and Indigenous Health, Faculty of Science, Charles Sturt University, Orange, Australia
- Research Institute for Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Rachel Rossiter
- School of Nursing, Midwifery & Indigenous Health Charles Sturt University, Orange, Australia
| | - Walter Robb
- Menzies Health Institute, Griffith University, Brisbane, Australia
| | - Alaa Ahmad
- Shaikh KHalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates
| | | | - Sumaya Albloshi
- Ministry of Health and Prevention, Dubai, United Arab Emirates
| | - Shameran Slewa-Younan
- Mental Health, Centre for Health Research, School of Medicine, Western Sydney University, Sydney, Australia
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Shemesh E, Bucuvalas JC, Anand R, Mazariegos GV, Alonso EM, Venick RS, Reyes-Mugica M, Annunziato RA, Shneider BL. The Medication Level Variability Index (MLVI) Predicts Poor Liver Transplant Outcomes: A Prospective Multi-Site Study. Am J Transplant 2017; 17:2668-2678. [PMID: 28321975 PMCID: PMC5607074 DOI: 10.1111/ajt.14276] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 03/03/2017] [Accepted: 03/11/2017] [Indexed: 01/25/2023]
Abstract
Nonadherence to immunosuppressant medications is a leading cause of poor long-term outcomes in transplant recipients. The Medication Level Variability Index (MLVI) provides a vehicle for transplant outcome risk-stratification through continuous assessment of adherence. The MALT (Medication Adherence in children who had a Liver Transplant) prospective multi-site study evaluated whether MLVI predicts late acute rejection (LAR). Four hundred pediatric (1-17-year-old) liver transplant recipients were enrolled and followed for 2 years. The a-priori hypothesis was that a higher MLVI predicts LAR. Predefined secondary analyses evaluated other outcomes such as liver enzyme levels, and sensitivity analyses compared adolescents to pre-adolescents. In the primary analysis sample of 379 participants, a higher prerejection MLVI predicted LAR (mean prerejection MLVI with LAR: 2.4 [3.6 standard deviation] versus without LAR, 1.6 [1.1]; p = 0.026). Fifty-three percent of the adolescents with MLVI>2 in year 1 had LAR by the end of year 2, as compared with 6% of those with year 1 MLVI≤2. A higher MLVI was significantly associated with all secondary outcomes. MLVI, a marker of medication adherence that uses clinically derived information, predicts LAR in pediatric liver transplant recipients.
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Affiliation(s)
- Eyal Shemesh
- Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - John C Bucuvalas
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | | | | | | | | | - Rachel A Annunziato
- Icahn School of Medicine at Mount Sinai, New York, NY USA,Fordham University, Department of Psychology, New York, NY USA
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Gabriel P, McManus M, Rogers K, White P. Outcome Evidence for Structured Pediatric to Adult Health Care Transition Interventions: A Systematic Review. J Pediatr 2017; 188:263-269.e15. [PMID: 28668449 DOI: 10.1016/j.jpeds.2017.05.066] [Citation(s) in RCA: 159] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/17/2017] [Accepted: 05/24/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify statistically significant positive outcomes in pediatric-to-adult transition studies using the triple aim framework of population health, consumer experience, and utilization and costs of care. STUDY DESIGN Studies published between January 1995 and April 2016 were identified using the CINAHL, Ovid MEDLINE, PubMed, Scopus, and Web of Science databases. Included studies evaluated pre-evaluation and postevaluation data, intervention and comparison groups, and randomized clinic trials. The methodological strength of each study was assessed using the Effective Public Health Practice Project Quality Assessment Tool. RESULTS Out of a total of 3844 articles, 43 met our inclusion criteria. Statistically significant positive outcomes were found in 28 studies, most often related to population health (20 studies), followed by consumer experience (8 studies), and service utilization (9 studies). Among studies with moderate to strong quality assessment ratings, the most common positive outcomes were adherence to care and utilization of ambulatory care in adult settings. CONCLUSIONS Structured transition interventions often resulted in positive outcomes. Future evaluations should consider aligning with professional transition guidance; incorporating detailed intervention descriptions about transition planning, transfer, and integration into adult care; and measuring the triple aims of population health, experience, and costs of care.
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Affiliation(s)
- Phabinly Gabriel
- The National Alliance to Advance Adolescent Health, Washington, DC; Rutgers New Jersey Medical School, Newark, NJ
| | - Margaret McManus
- The National Alliance to Advance Adolescent Health, Washington, DC.
| | | | - Patience White
- The National Alliance to Advance Adolescent Health, Washington, DC
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55
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Steuer R, Opiola McCauley S. Maintaining the Gift of Life: Achieving Adherence in Adolescent Heart Transplant Recipients. J Pediatr Health Care 2017; 31:546-554. [PMID: 28410774 DOI: 10.1016/j.pedhc.2017.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Accepted: 01/25/2017] [Indexed: 10/19/2022]
Abstract
Since the beginning of United Network of Organ Sharing data collection in 1987, a total of 8,333 pediatric patients have received a heart transplant in the United States. Because these patients now have longer graft success with improved care and immunosuppression, many of them are entering adolescence and young adulthood. Primary care pediatric nurse practitioners need to be alert to the prevalence of noncompliance with treatment in heart transplant patients, which continues to be highest in adolescence. Low compliance in adolescence increases morbidity, contributes to decreasing quality of life, and is the leading reason for graft failure and mortality in this age group. This article will review common barriers to treatment adherence in the adolescent heart transplant patient, discuss the role of the primary care pediatric nurse practitioner in preventing noncompliance, and review strategies that the primary care pediatric nurse practitioner can implement to improve compliance in this patient population.
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Mahan JD, Betz CL, Okumura MJ, Ferris ME. Self-management and Transition to Adult Health Care in Adolescents and Young Adults: A Team Process. Pediatr Rev 2017; 38:305-319. [PMID: 28667233 DOI: 10.1542/pir.2016-0074] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
As health care continues to evolve, the need for more effective health care transition (HCT) for all youth, but particularly children with chronic conditions and special health care needs, becomes even more important. With more than 90% of adolescents with chronic medical conditions now surviving into adulthood, suboptimal transition can lead to poorer quality of life and less successful adulthood.Through a series of clinical vignettes, the challenges of HCT are presented herein and accompanied by comments that underscore how these adolescents can best be helped to transition to successful adulthood. Several methods are presented to assess the readiness of adolescents and young adults (AYA) for transition. The process of transition can be divided into 3 stages: 1) setting the stage: initiation of HCT services and transition readiness assessment, 2) moving forward: ongoing provision of HCT services, and 3) reaching the goal: transfer of care and transition to adulthood.Several valuable suggestions for incorporating the HCT process into the health care system and improving HCT programs through a quality improvement (QI) approach are outlined. Future challenges in HCT include developing more precise assessments of transition status or transition readiness, better understanding the status and specific needs of AYA with chronic health care needs, continued program evaluation and QI efforts, and more reliance on patients and families to teach us about the challenges and methods in HCT that most effectively work for them.
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Affiliation(s)
- John D Mahan
- Department of Pediatrics, Nationwide Children's Hospital/The Ohio State University College of Medicine, Columbus, OH
| | - Cecily L Betz
- University of Southern California Center for Excellence in Developmental Disabilities, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Megumi J Okumura
- Departments of Pediatrics and Internal Medicine, University of California San Francisco School of Medicine, San Francisco, CA
| | - Maria E Ferris
- University of North Carolina Health Care Transition Program, University of North Carolina School of Medicine, Chapel Hill, NC
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Different Demands, Same Goal: Promoting Transition Readiness in Adolescents and Young Adults With and Without Medical Conditions. J Adolesc Health 2017; 60:727-733. [PMID: 28274737 DOI: 10.1016/j.jadohealth.2017.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 01/02/2017] [Accepted: 01/03/2017] [Indexed: 01/19/2023]
Abstract
PURPOSE This study aimed to examine differences in transition readiness, self-involvement and parental involvement in completing medical tasks, and general self-efficacy between a sample of older adolescents and young adults (AYAs) with medical conditions and a sample of healthy peers. Relations among these variables were also examined. METHODS The sample included 494 AYAs (mean age = 19.30 years, standard deviation = 1.33) who reported on their levels of transition readiness, self-involvement and parental involvement in completing medical tasks, and general self-efficacy. RESULTS AYAs with medical conditions reported significantly higher levels of transition readiness and self-involvement in completing medical tasks and lower levels of parent involvement in completing medical tasks than healthy peers. Parent involvement in completing medical tasks indirectly related to transition readiness through AYA self-involvement in completing medical tasks for both AYAs with medical conditions and healthy peers. CONCLUSIONS AYAs with medical conditions appear to have greater transition readiness skills and demonstrate more independence in completing medical tasks than healthy peers. For AYAs with medical conditions and healthy peers, transition readiness appears to be enhanced as parents decrease their involvement in completing AYAs' medical tasks and AYAs increase self-involvement in completing these tasks. AYAs with medical conditions, as well as healthy peers, may benefit from programming delivered in primary care, specialty clinic, or educational settings that focuses on increasing AYAs' involvement in and responsibility for managing their health care.
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Brooks AJ, Smith PJ, Cohen R, Collins P, Douds A, Forbes V, Gaya DR, Johnston BT, McKiernan PJ, Murray CD, Sebastian S, Smith M, Whitley L, Williams L, Russell RK, McCartney SA, Lindsay JO. UK guideline on transition of adolescent and young persons with chronic digestive diseases from paediatric to adult care. Gut 2017; 66:988-1000. [PMID: 28228488 PMCID: PMC5532456 DOI: 10.1136/gutjnl-2016-313000] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 01/10/2017] [Accepted: 01/24/2017] [Indexed: 12/12/2022]
Abstract
The risks of poor transition include delayed and inappropriate transfer that can result in disengagement with healthcare. Structured transition care can improve control of chronic digestive diseases and long-term health-related outcomes. These are the first nationally developed guidelines on the transition of adolescent and young persons (AYP) with chronic digestive diseases from paediatric to adult care. They were commissioned by the Clinical Services and Standards Committee of the British Society of Gastroenterology under the auspices of the Adolescent and Young Persons (A&YP) Section. Electronic searches for English-language articles were performed with keywords relating to digestive system diseases and transition to adult care in the Medline (via Ovid), PsycInfo (via Ovid), Web of Science and CINAHL databases for studies published from 1980 to September 2014. The quality of evidence and grading of recommendations was appraised using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The limited number of studies in gastroenterology and hepatology required the addition of relevant studies from other chronic diseases to be included.These guidelines deal specifically with the transition of AYP living with a diagnosis of chronic digestive disease and/or liver disease from paediatric to adult healthcare under the following headings;1. Patient populations involved in AYP transition2. Risks of failing transition or poor transition3. Models of AYP transition4. Patient and carer/parent perspective in AYP transition5. Surgical perspective.
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Affiliation(s)
- Alenka J Brooks
- Academic Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Philip J Smith
- Academic Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK,Centre for Gastroenterology and Hepatology, Royal Free Hospital, London, UK
| | | | - Paul Collins
- Royal Liverpool University Hospital, Liverpool, UK
| | - Andrew Douds
- Queen Elizabeth Hospital NHS Foundation Trust, University of East Anglia,King's Lynn, Norfolk, UK
| | - Valda Forbes
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | | | - Brian T Johnston
- Deparment of Gastroenterology, Royal Victoria Hospital, Belfast, UK
| | | | - Charles D Murray
- Centre for Gastroenterology and Hepatology, Royal Free Hospital, London, UK
| | - Shaji Sebastian
- NIHR LCRN (Y&H) Gastroenterology Speciality Co-Lead, Hull & East Yorkshire NHS Trust, Hull, UK
| | - Monica Smith
- Queen Elizabeth Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Lisa Whitley
- GI Services Division, University College London Hospital, London, UK
| | | | - Richard K Russell
- Department of Paediatric Gastroenterology, The Royal Hospital for Children Glasgow, Glasgow, UK
| | | | - James O Lindsay
- Bart's Health NHS Trust, The Royal London Hospital, London, UK,Centre for Immunology and Infectious Disease, Blizard Institute, Barts and the London School of Medicine, Queen Mary University of London, London, UK
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Abstract
The importance of a specific transition process is recognized by many health organizations. Got Transition, a cooperative endeavor aimed at improving the transition from pediatric to adult health care, developed Six Core Elements defining the basic components of health care transition support. In this article, we review the Six Core Elements by presenting a model that combines resident quality improvement and transition care training. In this Internal Medicine-Pediatrics residency program, ambulatory training for residents takes place in a combined adult and pediatric clinic. Aligned with the Six Core Elements, the program has crafted and disseminated a transition policy for the practice, designed a portable health summary template for the electronic medical record (EMR), created EMR tools for assessing transition readiness and setting transition goals, formed a registry of patients, and audited charts. [Pediatr Ann. 2017;46(5):e203-e206.].
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Weissberg-Benchell J, Shapiro JB. A Review of Interventions Aimed at Facilitating Successful Transition Planning and Transfer to Adult Care Among Youth with Chronic Illness. Pediatr Ann 2017; 46:e182-e187. [PMID: 28489223 DOI: 10.3928/19382359-20170421-01] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This article reviews studies that developed interventions aimed at facilitating the transition process and/or the transfer of youth with chronic illness to adult programs during the past decade. Three key intervention approaches have been studied. Data assessing the impact of transition coordinators suggest that the most successful outcomes occur when coordinators meet with patients prior to the transfer of care, support them as they negotiate the adult programs, and facilitate appointment keeping. Data assessing the impact of transition clinics suggest that the key to positive outcomes is helping patients develop a trusting relationship with the adult providers before fully transferring their care to the adult clinic. Similar conclusions can be drawn for transition programs, where it appears that the opportunity to discuss and plan transition with a pediatric provider over time and to meet with both the pediatric and adult providers simultaneously are beneficial for facilitating successful transfer to adult care. Although aspects of these care processes appear promising for improving transition success, this review identifies areas that need further study. We argue that studies are needed that examine individual patient and family-focused interventions as well as looking at other potential interventions in the health care system. [Pediatr Ann. 2017;46(5):e182-e187.].
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Mubanga N, Baumgardner DJ, Kram JJF. Health Care Transitions for Adolescents and Young Adults With Special Health Care Needs: Where Are We Now? J Patient Cent Res Rev 2017; 4:90-95. [PMID: 31413975 DOI: 10.17294/2330-0698.1406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Eventually, all adolescents must "graduate" from pediatric-oriented to adult-oriented health care. This transition, most often occurring during young adulthood, is especially important for adolescents with special health care needs and involves not only primary care physicians, but also both pediatric and adult subspecialists. Several studies support the benefit of transitional programs for adolescents and young adults with special health care needs. Additionally, the American Academy of Pediatrics named transitional care as one of its top priorities. However, transitional programs have yet to become an established norm among hospitals and providers, specifically outside of children's hospitals. This topic synopsis aims to draw attention to this important issue, review the rationale behind current recommendations and report the current status of transitional programs in North America. Moreover, the steps that individual clinicians, practices and health systems may take to plan for successful health care transitions are discussed.
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Affiliation(s)
- Nicole Mubanga
- Department of Family Medicine, Aurora University of Wisconsin Medical Group, Aurora Health Care, Milwaukee, WI
| | - Dennis J Baumgardner
- Department of Family Medicine, Aurora University of Wisconsin Medical Group, Aurora Health Care, Milwaukee, WI.,Center for Urban Population Health, Milwaukee, WI.,Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Jessica J F Kram
- Department of Family Medicine, Aurora University of Wisconsin Medical Group, Aurora Health Care, Milwaukee, WI.,Center for Urban Population Health, Milwaukee, WI
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62
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Al-Yateem N, Docherty C, Altawil H, Al-Tamimi M, Ahmad A. The quality of information received by parents of children with chronic ill health attending hospitals as indicated by measures of illness uncertainty. Scand J Caring Sci 2017; 31:839-849. [PMID: 28156023 DOI: 10.1111/scs.12405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 10/06/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND The effectiveness of communication can be defined in terms of one of its outcomes: the uncertainty that it eliminates. Clear unambiguous communication is important for the parents of children to help them understand problems, explore alternative solutions and help make decisions. Persistent uncertainty is known to produce anxiety, unpredictable responses, emotional distress and poor quality of life. The uncertainty experienced by parents is one indicator of quality in the healthcare system which could have diagnostic and predictive value. AIM To assess the uncertainty experienced by parents of children with chronic conditions in the United Arab Emirates (UAE). DESIGN An exploratory descriptive, cross-sectional design was chosen across different sites in the UAE. METHODS Data were collected from parents accompanying children receiving treatment either as an inpatient or outpatient, using the previously validated, culturally adapted 'Parent Perception of Uncertainty Scale' (PPUS). RESULTS Most study participants experienced moderate or high levels of uncertainty. Parents who did not speak the local language, whose child was less than 1 year old or who was acutely ill had significantly more uncertainty than others, as did those parents whose child was approaching adolescence and puberty. CONCLUSIONS As only 5% of all participants reported low levels of uncertainty this should be of major concern as both an indicator of the quality of communication between health professionals and parents, and of the adverse health effects and poor quality of life experienced by parents of patients with chronic illness.
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Affiliation(s)
- Nabeel Al-Yateem
- Department of Nursing, College of Health Sciences, Research Institute of Medical & Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Charles Docherty
- Department of Nursing, College of Health Sciences, Research Institute of Medical & Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Hanan Altawil
- Department of Nursing, College of Health Sciences, Research Institute of Medical & Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Muna Al-Tamimi
- Department of Nursing, College of Health Sciences, Research Institute of Medical & Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
| | - Alaa Ahmad
- Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
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Mitchell T, Gooding H, Mews C, Adams L, MacQuillan G, Garas G, Ravikumara M, Lopez A, Collins M, Jeffrey G. Transition to adult care for pediatric liver transplant recipients: the Western Australian experience. Pediatr Transplant 2017; 21. [PMID: 27762479 DOI: 10.1111/petr.12820] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2016] [Indexed: 01/25/2023]
Abstract
Transition to adult care is a vulnerable period for pediatric transplant recipients and is associated with reduced medication compliance, graft loss, and increased mortality. Psychosocial outcomes in young adults differ between pediatric transplant recipients and their healthy peers. We conducted a single-center, retrospective cohort study of all pediatric liver transplant recipients who were transitioned through our center. This study aimed to assess the outcomes of transitioned pediatric liver transplant recipients at an Australian center, including mortality, adherence, and psychosocial morbidity. The 1- and 5-year survival rates following transition were 100% and 92%, respectively. There were no episodes of late rejection. In total, 66.7% of patients were compliant with immunosuppression and 61.1% of patients were compliant with clinic attendance. There was a significant relationship between medication compliance and clinic attendance, as well as presence of psychological issues with clinic non-attendance. Psychosocial outcomes were in keeping with age-matched data from the general population. All patients were employed or studying following transition. This is the first study of its kind in the Australian population, and outcomes were superior to published international data. Despite the demonstrated good outcomes, transition programs may improve healthcare engagement in this cohort.
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Affiliation(s)
- Tim Mitchell
- Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Hannah Gooding
- Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Cathy Mews
- Department of Gastroenterology, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Leon Adams
- Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, WA, Australia.,School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | - Gerry MacQuillan
- Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, WA, Australia.,School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | - George Garas
- Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Madhur Ravikumara
- Department of Gastroenterology, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Ainslie Lopez
- Department of Gastroenterology, Princess Margaret Hospital for Children, Perth, WA, Australia
| | - Megan Collins
- Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Gary Jeffrey
- Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital, Perth, WA, Australia.,School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
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Annunziato RA, Duncan SE. Closer to fine: A transition success story. Pediatr Transplant 2017; 21. [PMID: 28127884 DOI: 10.1111/petr.12867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Rachel A Annunziato
- Department of Psychology, Fordham University, Bronx, NY, USA.,Department of Pediatrics, Icahn School of Medicine at Mount Sinai and Kravis Children's Hospital, New York, NY, USA
| | - Sarah E Duncan
- Department of Psychology, Fordham University, Bronx, NY, USA
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Coyne B, Hallowell SC, Thompson M. Measurable Outcomes After Transfer From Pediatric to Adult Providers in Youth With Chronic Illness. J Adolesc Health 2017; 60:3-16. [PMID: 27614592 DOI: 10.1016/j.jadohealth.2016.07.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 07/04/2016] [Accepted: 07/06/2016] [Indexed: 10/21/2022]
Abstract
Children with chronic medical conditions are requiring transition services to prepare for transfer of care. There has been little data on what qualifies as a successful transition or how to measure this goal. The purpose of this review was to identify measurable patient-level outcomes for transitioning youth with chronic illness from pediatric to adult health care. An integrative literature search was conducted using CINAHL and OVID Medline. Key words included transition to adult care and health transition. Research articles published between 2002 and 2015 and reported on measurable patient-level outcomes in youth with chronic illnesses were included. The initial search yielded 556 articles and 19 articles were selected. Most of the research reporting on outcomes after transfer is nonexperimental using secondary data. Additionally, there is inconsistency in the use of term transition. In the specific outcomes identified, there is little uniformity in measurement both in terms of timing and standardization of measurement. Further research is needed on outcomes after transfer that includes standardized measures and time intervals in order to evaluate successful transition services. This research is essential for health care providers who are instrumental in supporting young people during this high risk period.
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Affiliation(s)
- Bethany Coyne
- Department of Family, Community & Mental Health Systems, University of Virginia School of Nursing, Charlottesville, Virginia.
| | | | - Mary Thompson
- School of Nursing, MGH Institute of Health Professions, Boston, Massachusetts
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Oliveira RA, Turrini RNT, Poveda VDB. Adherence to immunosuppressive therapy following liver transplantation: an integrative review. Rev Lat Am Enfermagem 2016; 24:e2778. [PMID: 27579933 PMCID: PMC5016054 DOI: 10.1590/1518-8345.1072.2778] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 03/28/2016] [Indexed: 03/13/2023] Open
Abstract
OBJECTIVE to investigate the evidence available in the literature on non-adherence to immunosuppressive therapy among patients undergoing liver transplantation. METHOD integrative literature review, including research whose sample consisted of patients aged over 18 years undergoing liver transplantation. It excluded those containing patients undergoing multiple organ transplants. For the selection of articles, Medline / Pubmed, CINAHL, LILACS, Scopus and Embase were searched. The search period corresponded to the initial date of indexation of different bases, up to the deadline of February 10, 2015, using controlled and uncontrolled descriptors: liver transplantation, hepatic transplantation, liver orthotopic transplantation, medication adherence, medication non-adherence, medication compliance and patient compliance. RESULTS were located 191 investigations, 10 of which met the objectives of the study and were grouped into four categories, namely: educational process and non-adherence; non-adherence related to the number of daily doses of immunosuppressive medications; detection methods for non-adherence and side effects of therapy. CONCLUSION there were risk factors related to the health service, such as control and reduction of the number of doses; related to the individual, such as being male, divorced, alcohol or other substances user, exposed to low social support and being mentally ill.
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Affiliation(s)
- Ramon Antônio Oliveira
- Master's Student, Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brazil
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Abstract
Liver transplantation (LT) is an important component in the therapeutic armamentarium of managing end-stage liver disease. In North American children, biliary atresia remains the most common indication for LT compared to hepatitis C in adults, while hepatoblastoma is the most common liver tumor requiring LT, versus Hepatocellular carcinoma in adults. Rejection, lymphoproliferative disease, renal insufficiency, metabolic syndrome, recurrent disease, 'de novo' autoimmune hepatitis and malignancy require careful surveillance and prompt action in adults and children after LT. In children, specific attention to EBV viremia, growth, development, adherence and transition to the adult services is also required. Antibody mediated rejection and screening for donor specific antibodies is becoming important in managing liver graft dysfunction. Biomarkers to identify and predict tolerance are being developed. Machine perfusion and stem cells (iPS) to synthesize organs are generating interest and are a focus for research.
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Affiliation(s)
- Nanda Kerkar
- a Keck School of Medicine, Medical Director Liver/Intestinal and Hepatology Transplant Program, Children's Hospital of Los Angeles , University of Southern California , Los Angeles , CA , USA
| | - Arathi Lakhole
- b Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Los Angeles , University of Southern California , Los Angeles , CA , USA
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68
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Brown LW, Camfield P, Capers M, Cascino G, Ciccarelli M, de Gusmao CM, Downs SM, Majnemer A, Miller AB, SanInocencio C, Schultz R, Tilton A, Winokur A, Zupanc M. The neurologist's role in supporting transition to adult health care: A consensus statement. Neurology 2016; 87:835-40. [PMID: 27466477 DOI: 10.1212/wnl.0000000000002965] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 05/17/2016] [Indexed: 11/15/2022] Open
Abstract
The child neurologist has a critical role in planning and coordinating the successful transition from the pediatric to adult health care system for youth with neurologic conditions. Leadership in appropriately planning a youth's transition and in care coordination among health care, educational, vocational, and community services providers may assist in preventing gaps in care, delayed entry into the adult care system, and/or health crises for their adolescent patients. Youth whose neurologic conditions result in cognitive or physical disability and their families may need additional support during this transition, given the legal and financial considerations that may be required. Eight common principles that define the child neurologist's role in a successful transition process have been outlined by a multidisciplinary panel convened by the Child Neurology Foundation are introduced and described. The authors of this consensus statement recognize the current paucity of evidence for successful transition models and outline areas for future consideration.
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Affiliation(s)
- Lawrence W Brown
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.).
| | - Peter Camfield
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
| | - Melissa Capers
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
| | - Greg Cascino
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
| | - Mary Ciccarelli
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
| | - Claudio M de Gusmao
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
| | - Stephen M Downs
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
| | - Annette Majnemer
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
| | - Amy Brin Miller
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
| | - Christina SanInocencio
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
| | - Rebecca Schultz
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
| | - Anne Tilton
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
| | - Annick Winokur
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
| | - Mary Zupanc
- From The Children's Hospital of Philadelphia (L.W.B.); Dalhousie University (P.C.); independent medical writer (M. Capers); Mayo Clinic (G.C.); Indiana University School of Medicine (M. Ciccarelli, S.M.D.); Brigham and Women's Hospital (C.M.d.G.); McGill University (A.M.); Child Neurology Foundation (A.B.M.); Lennox Gastaut Syndrome Foundation (C.S.); Texas Children's Hospital (R.S.); Louisiana State University Health Sciences (A.T.); patient advocate (A.W.); and Children's Hospital of Orange County (M.Z.)
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Fredericks EM, Magee JC, Eder SJ, Sevecke JR, Dore-Stites D, Shieck V, Lopez MJ. Quality Improvement Targeting Adherence During the Transition from a Pediatric to Adult Liver Transplant Clinic. J Clin Psychol Med Settings 2016; 22:150-9. [PMID: 26231289 DOI: 10.1007/s10880-015-9427-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The transition from pediatric to adult transplant care is a high risk period for non-adherence and poor health outcomes. This article describes a quality improvement initiative integrated into a pediatric liver transplant program that focused on improving outcomes following the transfer from pediatric to adult liver transplant care. Using improvement science methodology, we evaluated the impact of our center's transition readiness skills (TRS) program by conducting a chart review of 45 pediatric liver transplant recipients who transferred to adult transplant care. Medication adherence, clinic attendance, and health status variables were examined for the year pre-transfer and first year post-transfer. 19 recipients transferred without participating in the TRS program (control group) and 26 recipients participated in the program prior to transferring to the adult clinic (TRS group). The TRS group was significantly older at the time of transfer, more adherent with medications, and more likely to attend their first adult clinic visit compared to the control group. Among the TRS group, better adolescent and parent regimen knowledge were associated with greater adherence to post-transfer clinic appointments. Transition planning should focus on the gradual shift in responsibility for health management tasks, including clinic attendance, from parent to adolescent. There may be support for extending transition support for at least 1 year post-transfer to promote adherence.
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Affiliation(s)
- Emily M Fredericks
- University of Michigan Medical School and C.S. Mott Children's Hospital, Ann Arbor, MI, 48109, USA.
| | - John C Magee
- University of Michigan Medical School and C.S. Mott Children's Hospital, Ann Arbor, MI, 48109, USA
| | - Sally J Eder
- University of Michigan Medical School and C.S. Mott Children's Hospital, Ann Arbor, MI, 48109, USA
| | - Jessica R Sevecke
- University of Michigan Medical School and C.S. Mott Children's Hospital, Ann Arbor, MI, 48109, USA
| | - Dawn Dore-Stites
- University of Michigan Medical School and C.S. Mott Children's Hospital, Ann Arbor, MI, 48109, USA
| | - Victoria Shieck
- University of Michigan Medical School and C.S. Mott Children's Hospital, Ann Arbor, MI, 48109, USA
| | - M James Lopez
- University of Michigan Medical School and C.S. Mott Children's Hospital, Ann Arbor, MI, 48109, USA
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Betz CL, Smith KA, Van Speybroeck A, Hernandez FV, Jacobs RA. Movin' On Up: An Innovative Nurse-Led Interdisciplinary Health Care Transition Program. J Pediatr Health Care 2016; 30:323-38. [PMID: 26483330 DOI: 10.1016/j.pedhc.2015.08.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 08/26/2015] [Accepted: 08/31/2015] [Indexed: 10/22/2022]
Abstract
This article provides an overview of an innovative nurse-led interdisciplinary health care transition (HCT) model of care entitled Movin' On Up for adolescents and emerging adults (AEAs) with spina bifida (SB) that was originally implemented in 2011. The components of the HCT service model include an HCT nursing specialist, who is an advanced practice nurse; interdisciplinary health care transition plans based on the individualized needs of AEAs; an interdisciplinary HCT team that meets on a weekly basis; direct HCT services provided in the weekly SB clinic; and telephonic follow-up with AEAs, families, and providers. The characteristics of this nurse-led HCT program can be described as an integrated, interdisciplinary, and comprehensive model of care based on a life span approach. To date, a total of 210 AEAs with SB, ages 10 to 20 years, have been enrolled into the program. An important feature of this HCT service model is that it is self-supporting; it generates the revenue needed for sustainability and, unlike other HCT programs, is not reliant on extramural programmatic support. Other accomplishments of Movin' On Up include the development of a transfer protocol wherein 35 AEAs with SB have been supported in their transfer to adult care; implementation of a standardized process to ensure that service referrals to community-based services for postsecondary education, employment, training, and initiation of conservatorships are made; timely performance of evaluations; close tracking of needs and outcomes of self-management knowledge and skills instruction; and attention to equipment needs prior to transfer.
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71
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Betz CL, O'Kane LS, Nehring WM, Lobo ML. Systematic review: Health care transition practice service models. Nurs Outlook 2016; 64:229-43. [DOI: 10.1016/j.outlook.2015.12.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 12/29/2015] [Accepted: 12/30/2015] [Indexed: 10/22/2022]
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Al-Yateem N, Docherty C, Rossiter R. Determinants of Quality of Care for Adolescents and Young Adults With Chronic Illnesses: A Mixed Methods Study. J Pediatr Nurs 2016; 31:255-66. [PMID: 26783050 DOI: 10.1016/j.pedn.2015.12.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/12/2015] [Accepted: 12/12/2015] [Indexed: 11/19/2022]
Abstract
UNLABELLED Measuring the quality of service and user experience is an acknowledged priority for healthcare services; however it seems that healthcare systems have to work very hard to achieve this goal as evidenced by reports of gaps and disparities in the quality of care provided to clients, especially within pediatric and adolescent populations. OBJECTIVES To identify quality determinants for healthcare services for adolescents and young adults with chronic conditions based on the perceptions and the experiences of adolescents and young adults themselves. METHODOLOGY A sequential exploratory mixed method design guided this study. The initial qualitative phase employed semi-structured in-depth interviews to elicit the elements and determinants of quality of care as identified by adolescents and young adults living with chronic conditions. The second phase employed a questionnaire developed from the data gathered during the qualitative phase to survey the target population. This was distributed to a larger sample of adolescents and young adults with chronic conditions to determine and confirm the relevance of the identified care elements and quality determinants. RESULTS The study revealed 4 main determinants: the provision of adolescent friendly information relating to all aspects of living with chronic conditions, services that facilitate and encourage independence, services characterized by structure with the capacity to be both dynamic and responsive, and finally health care professionals knowledgeable and skilled in relation to adolescent specific issues.
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Affiliation(s)
- Nabeel Al-Yateem
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.
| | - Charles Docherty
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Rachel Rossiter
- Visiting academic, University of Sharjah, UAE, Faculty of Science, Charles Sturt University, Australia
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Transition of Inflammatory Bowel Disease Care: Assessment of Transition Readiness Factors and Disease Outcomes in a Young Adult Population. Inflamm Bowel Dis 2016; 22:702-8. [PMID: 26841222 DOI: 10.1097/mib.0000000000000633] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Limited data exist on what factors impact transition readiness and how readiness impacts short-term disease outcomes. METHODS Patients between the ages of 18 and 25 with an established inflammatory bowel disease diagnosis completed questionnaires at the time of an outpatient visit in the pediatric or adult setting, which included the Transition Readiness Assessment Questionnaire (TRAQ). After 6 months, electronic medical records were reviewed. RESULTS A total of 95 patients were enrolled, 46 in the adult care setting and 49 in the pediatric care setting. Patients in the adult setting had a significantly higher overall TRAQ score compared with the pediatric setting (median: 4.42 [IQR: 3.9-4.6] versus 4.06 [IQR: 3.4-4.4], P < 0.001). Logistic regression analysis demonstrated that age was independently associated with higher TRAQ scores (odds ratio: 1.49; 95 confidence interval%, 1.1-2.02). Nonadherent patients scored lower on the Managing Medications subscale (median: 4.25 [IQR: 3.3-4.8] versus 4.75 [IQR: 4.3-5.0], P < 0.01). Logistic regression showed that patients who scored <4.75 on the Medication Management subscale were 3.8 times more likely to be nonadherent than patients who scored ≥4.75 (95% confidence interval, 1.4-10.3). This remained significant after adjusting for gender and age. During the 6-month follow-up period, 9/95 patients (10%) had hospitalizations or ED visits related to inflammatory bowel disease. There were no associations between TRAQ scores and hospitalizations/ED visits. CONCLUSIONS Age is the primary factor that drives transition readiness. Our findings suggest that administering the medication management portion of the TRAQ can be used to identify patients at risk for nonadherence. Follow-up studies are needed to determine how readiness impacts long-term disease outcomes.
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Levy-Shraga Y, Elisha N, Ben-Ami M, Boyko V, Lerner-Geva L, Ziv T, Konvalina N, Cohen O, Pinhas-Hamiel O. Glycemic control and clinic attendance of emerging adults with type 1 diabetes at a transition care clinic. Acta Diabetol 2016; 53:27-33. [PMID: 25794880 DOI: 10.1007/s00592-015-0734-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 03/05/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Emerging adulthood is a challenging period for diabetes management. Our aim was to determine whether a dedicated transition clinic for emerging adults with type 1 diabetes can improve glycemic control and visit attendance. METHODS An observational study of 53 emerging adults (30 males) treated during 2010-2014 in a newly established transition clinic. The clinic was operated jointly by pediatric and adult endocrinologists and included a transition coordinator. Data collected included the source of referral, HbA1c levels, frequency of visit attendance, and acute complications. For 27 patients who had attended the pediatric clinic at the same medical center, data from up to 2 years preceding the transition were also collected. Patients filled the Diabetes Quality of Life-Youth questionnaire at the transition and 1 year later. RESULTS Mean ± SD age at the transfer to the transition clinic was 22.1 ± 2.7 years; mean disease duration was 8.4 ± 5.0 years. Follow-up duration at the transition clinic was 1.2 ± 1.1 years. Mean HbA1c levels decreased from 67 mmol/mol (95 % CI 63-72) [8.3 % (95 % CI 7.9-8.7)] at transfer to 57 mmol/mol (95 % CI 52-63) [7.4 % (95 % CI 6.9-7.9)] after 1 year (p < 0.001). Thirty-six patients (68 %) attended three or more visits during their first year in the transition clinic. The impact of diabetes on quality of life, disease-related worries, and life satisfaction did not change significantly during 1-year attendance in the transition clinic. CONCLUSIONS A dedicated transition clinic for emerging adults, with tailored support according to the developmental needs of emerging adulthood, showed improved glycemic control and visit attendance.
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Affiliation(s)
- Y Levy-Shraga
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 52621, Tel Hashomer, Israel.
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - N Elisha
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 52621, Tel Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - M Ben-Ami
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 52621, Tel Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - V Boyko
- The Women and Children's Health Research Unit, Gertner Institute, Tel Hashomer, Israel
| | - L Lerner-Geva
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- The Women and Children's Health Research Unit, Gertner Institute, Tel Hashomer, Israel
| | - T Ziv
- Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Israel
| | - N Konvalina
- Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Israel
| | - O Cohen
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Israel
| | - O Pinhas-Hamiel
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 52621, Tel Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Lieber SR, Helcer J, Shemesh E. Monitoring drug adherence. Transplant Rev (Orlando) 2016; 29:73-7. [PMID: 25432088 DOI: 10.1016/j.trre.2014.10.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 10/23/2014] [Indexed: 11/19/2022]
Abstract
TOPIC Medication nonadherence is prevalent in transplant recipients and is a major reason for graft loss. The present review discusses the measurement of adherence in transplant recipients and strategies to improve adherence. SOURCES REVIEWED: Since adherence research is not confined to transplant recipients, our literature review included studies relevant to transplant recipients as well as adherence to medical recommendations more generally. We reviewed manuscripts in the English language indexed in PubMed Central, as well as ancillary sources of information such as textbook chapters that are not indexed. CONCLUSION There is no consensus in the literature about an optimal way to monitor adherence, nor is there agreement about a preferred management strategy. Until definitive studies demonstrate the effectiveness of intervention strategies, knowledge of the monitoring as well as intervention methods that are described in this review is expected to give practitioners the initial tools to deal with nonadherence as an important aspect of patient care.
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Gray WN, Monaghan MC, Marchak JG, Driscoll KA, Hilliard ME. Psychologists and the Transition From Pediatrics to Adult Health Care. J Adolesc Health 2015; 57:468-74. [PMID: 26499856 PMCID: PMC4621780 DOI: 10.1016/j.jadohealth.2015.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 06/29/2015] [Accepted: 07/20/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Guidelines for optimal transition call for multidisciplinary teams, including psychologists, to address youth and young adults' multifactorial needs. This study aimed to characterize psychologists' roles in and barriers to involvement in transition from pediatric to adult health care. METHODS Psychologists were invited via professional listservs to complete an online survey about practice settings, roles in transition programming, barriers to involvement, and funding sources. Participants also responded to open-ended questions about their experiences in transition programs. RESULTS One hundred participants responded to the survey. Involvement in transition was reported at multiple levels from individual patient care to institutional transition programming, and 65% reported more than one level of involvement. Direct clinical care (88%), transition-related research (50%), and/or leadership (44%) involvement were reported, with 59% reporting more than one role. Respondents often described advocating for their involvement on transition teams. Various sources of funding were reported, yet, 23% reported no funding for their work. Barriers to work in transition were common and included health care systems issues such as poor coordination among providers or lack of a clear transition plan within the clinic/institution. CONCLUSIONS Psychologists assume numerous roles in the transition of adolescents from pediatric to adult health care. With training in health care transition-related issues, psychologists are ideally positioned to partner with other health professionals to develop and implement transition programs in multidisciplinary settings, provided health care system barriers can be overcome.
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Affiliation(s)
- Wendy N. Gray
- Auburn University, Department of Psychology. Thach 226, Auburn, AL, USA 36849
| | - Maureen C. Monaghan
- Children’s National Health System, Center for Translational Science, 111 Michigan Avenue, Washington, DC 20010
| | - Jordan Gilleland Marchak
- Emory University School of Medicine, Department of Pediatrics, 2015 Uppergate Dr NE- 416D, Atlanta, GA USA 30322
| | - Kimberly A. Driscoll
- Florida State University College of Medicine, Department of Behavioral Sciences and Social Medicine. 1115 W. Call Street, Tallahassee, FL, USA 32306-4100
| | - Marisa E. Hilliard
- Baylor College of Medicine, Department of Pediatrics. 1102 Bates Avenue, Suite 940, Houston, TX, USA 77030
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Michihata N, Matsui H, Fushimi K, Yasunaga H. Clinical Features of Adult Patients Admitted to Pediatric Wards in Japan. J Adolesc Health 2015; 57:421-4. [PMID: 26403841 DOI: 10.1016/j.jadohealth.2015.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 06/16/2015] [Accepted: 07/08/2015] [Indexed: 01/18/2023]
Abstract
PURPOSE Pediatricians generally need to treat adult patients who require long-term care for pediatric diseases. However, little is known about the characteristics of adult patients in pediatric wards. Using a national inpatient database, the aim of this study was to determine the clinical details of adult patients admitted to pediatric wards in Japanese acute-care hospitals. METHODS We extracted all inpatients aged ≥19 years who were admitted to pediatric departments in Japan from April 2012 to March 2013. We examined the patients' main diagnoses and the use of life-supporting home medical devices. RESULTS Of 417,352 patients admitted to pediatric wards during the study period, we identified 4,729 (1.1%) adult patients. The major diagnoses of the adult patients were malignancy, congenital heart disease, epilepsy, and cerebral palsy. More than 35% of the patients with cerebral palsy had a tracheostomy tube, gastrostomy tube, home central venous alimentation, or home respirator. More than 20% of patients aged ≥40 years in pediatric wards had adult diseases, including ischemic heart diseases, cerebrovascular diseases, and adult malignancy. CONCLUSIONS Many adult patients in pediatric wards had adult diseases. It is essential to establish a disease-oriented support system for adults with chronic conditions that originated in their childhood.
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Affiliation(s)
- Nobuaki Michihata
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Merrick H, McConachie H, Le Couteur A, Mann K, Parr JR, Pearce MS, Colver A. Characteristics of young people with long term conditions close to transfer to adult health services. BMC Health Serv Res 2015; 15:435. [PMID: 26424085 PMCID: PMC4589084 DOI: 10.1186/s12913-015-1095-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 09/22/2015] [Indexed: 11/12/2022] Open
Abstract
Background For many young people with long term conditions (LTC), transferring from paediatric to adult health services can be difficult and outcomes are often reported to be poor. We report the characteristics and representativeness of three groups of young people with LTCs as they approach transfer to adult services: those with autism spectrum disorder with additional mental health problems (ASD); cerebral palsy (CP); or diabetes. Methods Young people aged 14 years-18 years 11 months with ASD, or those with diabetes were identified from children’s services and those with CP from population databases. Questionnaires, completed by the young person and a parent, included the ‘Mind the Gap’ Scale, the Rotterdam Transition Profile, and the Warwick and Edinburgh Mental Wellbeing Scale. Results Three hundred seventy four young people joined the study; 118 with ASD, 106 with CP, and 150 with diabetes. Participants had a significant (p < 0.001) but not substantial difference in socio-economic status (less deprived) compared to those who declined to take part or did not respond. Condition-specific severity of participants was similar to that of population data. Satisfaction with services was good as the ‘gap’ scores (the difference between their ideal and current care) reported by parents and young people were small. Parents’ satisfaction was significantly lower than their children’s (p < 0.001). On every domain of the Rotterdam Transition Profile, except for education and employment, significant differences were found between the three groups. A larger proportion of young people with diabetes were in a more independent phase of participation than those with ASD or CP. The wellbeing scores of those with diabetes (median = 53, IQR: 47–58) and CP (median = 53, IQR: 48–60) were similar, and significantly higher than for those with ASD (median = 47, IQR: 41–52; p < 0.001). Conclusions Having established that our sample of young people with one of three LTCs recruited close to transfer to adult services was representative, we have described aspects of their satisfaction with services, participation and wellbeing, noting similarities and differences by LTC. This information about levels of current functioning is important for subsequent evaluation of the impact of service features on the health and wellbeing of young people with LTCs following transfer from child services to adult services.
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Affiliation(s)
- Hannah Merrick
- Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK.
| | - Helen McConachie
- Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK.
| | - Ann Le Couteur
- Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK.
| | - Kay Mann
- Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK.
| | - Jeremy R Parr
- Institute of Neuroscience, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK.
| | - Mark S Pearce
- Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK.
| | - Allan Colver
- Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK.
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Annunziato RA, Parbhakar M, Kapoor K, Matloff R, Casey N, Benchimol C, Hotchkiss H, Nair V, Saland J. Can Transition to Adult Care for Transplant Recipients Be Improved by Intensified Services While Patients are Still in Pediatrics? Prog Transplant 2015; 25:236-42. [DOI: 10.7182/pit2015599] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Context— Transferring out of pediatrics is a vulnerable time for transplant recipients. Use of a transition coordinator before and after transfer improves outcomes, although it is unclear whether placing a transition coordinator in pediatrics alone is beneficial. Objective— To determine if incorporating a transition coordinator in pediatrics only is associated with stable outcomes for kidney transplant recipients. Design— A retrospective chart review was conducted on outcomes for kidney transplant recipients who shifted service location between 2008 and 2012. Setting— A pediatric and adult transplant unit. Patients— Twenty-two patients transferred during the study period. Intervention— Twelve patients received more intensified preparation from the team's social worker, whose role was aligned with a transition coordinator position; 10 patients received standard care. Main Outcome Measures— The primary outcome was medication adherence, using a validated measure, standard deviations of tacrolimus blood levels. A standard deviation greater than 2.5 has been established as a threshold associated with poor outcomes such as rejection. Standard deviation of tacrolimus levels was compared for 1 year before and 1 year after transfer. Results— Medication adherence worsened from 1 year before (2.03 [SD, 0.75]) to 1 year after transfer (2.95 [SD, 1.38]; t = −3.07, P = .007). A repeated-measures analysis of variance indicated that this pattern was the same for patients who did and patients who did not receive intensified services in pediatrics ( F1,16 = 1.07, P = .32).
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Affiliation(s)
- Rachel A. Annunziato
- Fordham University, Bronx, New York (RAA, MP, NC), Icahn School of Medicine at Mount Sinai, New York, (RAA, KK, CB, HH, VN, JS), Westchester Medical Center and New York Medical College, Valhalla, New York (RM)
| | - Meera Parbhakar
- Fordham University, Bronx, New York (RAA, MP, NC), Icahn School of Medicine at Mount Sinai, New York, (RAA, KK, CB, HH, VN, JS), Westchester Medical Center and New York Medical College, Valhalla, New York (RM)
| | - Kathryn Kapoor
- Fordham University, Bronx, New York (RAA, MP, NC), Icahn School of Medicine at Mount Sinai, New York, (RAA, KK, CB, HH, VN, JS), Westchester Medical Center and New York Medical College, Valhalla, New York (RM)
| | - Robyn Matloff
- Fordham University, Bronx, New York (RAA, MP, NC), Icahn School of Medicine at Mount Sinai, New York, (RAA, KK, CB, HH, VN, JS), Westchester Medical Center and New York Medical College, Valhalla, New York (RM)
| | - Nicole Casey
- Fordham University, Bronx, New York (RAA, MP, NC), Icahn School of Medicine at Mount Sinai, New York, (RAA, KK, CB, HH, VN, JS), Westchester Medical Center and New York Medical College, Valhalla, New York (RM)
| | - Corinne Benchimol
- Fordham University, Bronx, New York (RAA, MP, NC), Icahn School of Medicine at Mount Sinai, New York, (RAA, KK, CB, HH, VN, JS), Westchester Medical Center and New York Medical College, Valhalla, New York (RM)
| | - Hilary Hotchkiss
- Fordham University, Bronx, New York (RAA, MP, NC), Icahn School of Medicine at Mount Sinai, New York, (RAA, KK, CB, HH, VN, JS), Westchester Medical Center and New York Medical College, Valhalla, New York (RM)
| | - Vinay Nair
- Fordham University, Bronx, New York (RAA, MP, NC), Icahn School of Medicine at Mount Sinai, New York, (RAA, KK, CB, HH, VN, JS), Westchester Medical Center and New York Medical College, Valhalla, New York (RM)
| | - Jeffrey Saland
- Fordham University, Bronx, New York (RAA, MP, NC), Icahn School of Medicine at Mount Sinai, New York, (RAA, KK, CB, HH, VN, JS), Westchester Medical Center and New York Medical College, Valhalla, New York (RM)
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Annunziato RA, Kim SK. Assessment in transition: Options, challenges, and future directions. Pediatr Transplant 2015; 19:446-8. [PMID: 26111617 DOI: 10.1111/petr.12521] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Rachel A Annunziato
- Department of Psychology, Fordham University, Bronx, NY, USA. .,Department of Pediatrics, Icahn School of Medicine at Mount Sinai and Kravis Children's Hospital, New York, NY, USA.
| | - Se-Kang Kim
- Department of Psychology, Fordham University, Bronx, NY, USA
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81
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Bashore L, Bender J. Evaluation of the Utility of a Transition Workbook in Preparing Adolescent and Young Adult Cancer Survivors for Transition to Adult Services. J Pediatr Oncol Nurs 2015. [DOI: 10.1177/1043454215590102] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Transition to adult care for adolescent and young adult survivors is challenging and is inclusive of several factors like knowledge and developmental, emotional, and social status of survivors and parents. This pilot study addressed the feasibility of a transition workbook, a method of preparing adolescent and young adults to transition to adult care. Using a mixed methods design, investigators also measured transition worry and readiness in 30 survivors. Support was provided throughout a 6-month period as survivors and parents completed the workbook. The workbook included sections about the treatment history of survivors, when and who to call for worrisome symptoms, prescriptions and insurance, educational goals for health practices and how to get there, and independent living. Twenty survivors completed the study and reported greater worry about leaving pediatric oncology but indicated the need to make changes to transition to adult care. Ambiguity and intimidation about transitioning to adult providers and comfort in pediatric setting were themes expressed by survivors. Results indicate the need for adult/pediatric collaborative transition programs using various standardized methods of addressing transition readiness and evaluation.
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Affiliation(s)
- Lisa Bashore
- Cook Children’s Medical Center, Fort Worth, TX, USA
- Texas Christian University, Fort Worth, TX, USA
| | - Joyce Bender
- Cook Children’s Medical Center, Fort Worth, TX, USA
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82
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White M, O'Connell MA, Cameron FJ. Transition to adult endocrine services: What is achievable? The diabetes perspective. Best Pract Res Clin Endocrinol Metab 2015; 29:497-504. [PMID: 26051305 DOI: 10.1016/j.beem.2015.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Transition is defined as the 'purposeful, planned movement of adolescents and young adults with chronic physical and medical conditions from child-centred to adult-oriented health care systems' by Blum RW, (2002). The primary goal of transition is to ensure an uninterrupted process in healthcare delivery between the paediatric and adult settings; however, losses to follow up and decreased engagement with specialist services are common during this time. The current transition literature specifically pertaining to type 1 diabetes mellitus (T1DM) is often limited by incomplete data, the absence of control data and lack of follow up data spanning both the paediatric and adult years. This paper serves to review the current transition literature base, highlighting areas which warrant further study.
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Affiliation(s)
- Mary White
- Department of Endocrinology & Diabetes, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia.
| | - Michele A O'Connell
- Department of Endocrinology & Diabetes, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia.
| | - Fergus J Cameron
- Department of Endocrinology & Diabetes, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia.
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83
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Jensen PT, Karnes J, Jones K, Lehman A, Rennebohm R, Higgins GC, Spencer CH, Ardoin SP. Quantitative evaluation of a pediatric rheumatology transition program. Pediatr Rheumatol Online J 2015; 13:17. [PMID: 26003474 PMCID: PMC4453213 DOI: 10.1186/s12969-015-0013-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 05/01/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transition from pediatric to adult care can be a challenging process which leaves young people vulnerable to interruptions of care and worsening disease status. Efforts to improve transition processes and outcomes have included development of individualized transition plans, creation of transition clinics, and utilization of transition coordinators. Few interventions have assessed transition outcomes quantitatively. METHODS We assessed transition outcome and satisfaction of a social worker-centered transition program in a pediatric rheumatology clinic. The social worker met with patients who were 16 years or older and their families, provided transition education materials, assisted patients in developing an individualized transition plan, assisted in making appointments with an adult rheumatologist at time of transfer of care, and followed up with patients to assess transition outcomes. Patients were contacted 6-8 months after initial appointment with the adult rheumatologist to assess whether they remained in the care of the adult provider. Participants then completed a questionnaire to rate their satisfaction with the transition program. RESULTS 210 adolescents and young adults participated in the transition program. Twenty-six similarly aged patients were eligible for transition services but did not participate in the program and were used as controls. Of the patients who participated in the program, 42% were considered to have transitioned successfully to adult care compared to 23% of controls (p-value = 0.002) of all patients. In the survey of satisfaction, 81% of participants said that they were satisfied with the transition process. CONCLUSIONS This study shows that a social worker transition coordinator can significantly improve the rate of pediatric rheumatology patients who successfully transition to adult care. Furthermore, patients are largely satisfied with this process.
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Affiliation(s)
- Paul T. Jensen
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue Third Floor, Columbus, OH 43210 USA ,Department of Pediatrics, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205 USA
| | - Jill Karnes
- Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Karla Jones
- Department of Pediatrics, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Amy Lehman
- Center for Biostatistics, The Ohio State University Wexner Medical Center, 2012 Kenny Road, Columbus, OH, 43221, USA.
| | - Robert Rennebohm
- Department of Pediatrics, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| | - Gloria C. Higgins
- Department of Pediatrics, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205 USA
| | - Charles H. Spencer
- Department of Pediatrics, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205 USA
| | - Stacy P. Ardoin
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue Third Floor, Columbus, OH 43210 USA ,Department of Pediatrics, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205 USA
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Abstract
Pediatric solid organ transplantation has become an accepted modality of treatment in the last few decades. The number of childhood recipients of solid organ transplantation surviving to adulthood is correspondingly rising. This review examines the epidemiology of pediatric solid organ transplant recipients, and the challenges faced during transition to adult services, with suggestions for improvement in collaborative and coordinated care. Transition to adulthood has been established as a vulnerable period for recipients of a solid organ transplant. Assessment of readiness for transfer, allowing sufficient time for preparation before the actual transfer, involvement of all stakeholders, and inclusion of a transition coordinator are some of the components that can facilitate successful transition to the adult transplant program. This programmatic approach improves both quality of life and long-term graft and patient survival. Moreover, the economic benefits associated with avoiding frequent hospitalizations for graft dysfunction and preventing re-transplantation more than compensate for the costs related to establishing and maintaining a robust transition program.
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Affiliation(s)
- Nanda Kerkar
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Los Angeles, University of Southern California, 4650 Sunset Blvd, #147, Los Angeles, California 90027.
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85
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Muise ED, Cowles RA. Transition of care in pediatric surgical patients with complex gastrointestinal disease. Semin Pediatr Surg 2015; 24:65-8. [PMID: 25770365 DOI: 10.1053/j.sempedsurg.2015.01.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Pediatric surgeons provide care for infants and children with a wide variety of conditions throughout the body. Many of these conditions are congenital or occur very early in life, and for this reason, providing continuity of care for these patients into adulthood is an emerging challenge. In the gastrointestinal tract, congenital and acquired conditions are now associated with excellent long-term prognosis; however, little guidance on long-term care exists. The aim of this article is to discuss aspects that are important to transitioning care of pediatric surgical patients with complex gastrointestinal disorders from pediatric to adult practitioners. Transitional care of patients with short bowel syndrome, Hirschsprung Disease, and anorectal malformations will be the focus of this discussion, but the concepts introduced here may translate to other diagnoses as well.
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Affiliation(s)
- Eleanor D Muise
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Robert A Cowles
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
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Rogers K, Zeni MB. Systematic review of medical home models to promote transitions to primary adult health care for adolescents living with autism spectrum disorder. Worldviews Evid Based Nurs 2015; 12:98-107. [PMID: 25774018 DOI: 10.1111/wvn.12085] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is a growing number of children diagnosed and living with autism spectrum disorders (ASDs) in the United States. This increasing incidence and prevalence of ASDs require care coordination within a medical home model, which needs to continue into adulthood. AIM This paper is an evidence review of medical home models for transitioning adolescents living with ASDs from pediatric primary healthcare practices to adult primary care practices. METHOD Databases were reviewed and articles selected based on inclusion and exclusion criteria. RESULTS Nine articles were reviewed and four met criteria. None of the articles addressed medical home models to transition adolescents living with ASDs into adult primary healthcare services. LINKING EVIDENCE TO ACTION There is a need for nursing to work within an interdisciplinary framework to educate adult healthcare providers on the needs of adolescents living with ASDs and to evaluate medical home transition models for this vulnerable population.
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Affiliation(s)
- Kathleen Rogers
- Assistant Professor, Department of Nursing, Ursuline College, Pepper Pike, OH, USA
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87
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Annunziato RA. Lost as we are translating? Informing transitional interventions with data from the adult side. Liver Transpl 2015; 21:143-4. [PMID: 25530076 DOI: 10.1002/lt.24065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 12/04/2014] [Indexed: 02/07/2023]
Affiliation(s)
- Rachel A Annunziato
- Fordham University, Department of Psychology, Bronx, NY; and Icahn School of Medicine, Department of Pediatrics at Mount Sinai, New York, NY
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88
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Annunziato RA, Arrato N, Rubes M, Arnon R. The importance of mental health monitoring during transfer to adult care settings as examined among paediatric transplant recipients. J Paediatr Child Health 2015; 51:220-2. [PMID: 25407852 DOI: 10.1111/jpc.12765] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2014] [Indexed: 11/28/2022]
Abstract
AIM Although the transfer out of paediatrics is established as a dangerous time for transplant recipients, the reasons for this are not well understood. One possible explanation is that in general, young adulthood is a period of vulnerability to psychological distress, which could impact self-management. The purpose of the present study was to investigate whether psychological distress is associated with medication non-adherence after transfer. METHODS Twenty paediatric liver transplant recipients (mean age = 22.42, standard deviation (SD) = 1.64) have been followed prospectively at our site for a year after they transferred from paediatrics. At their last visit in paediatrics, they completed the Symptom Checklist-90, a measure of psychological distress. Additionally, patients' medication adherence was tracked 1 year after transfer, using a validated measure, SDs of tacrolimus blood levels. RESULTS Psychological distress and medication non-adherence after transfer were significantly correlated, r = 0.50, P = 0.04. Furthermore, there was a significant interaction between adherence status and changes in mental health after transfer. CONCLUSION Psychological distress may be one factor behind deteriorating medical outcomes when transplant recipients transfer out of paediatric settings. It is important to consider mental health screening as a part of the transition process. Further research is needed to determine if identified patients may require services in addition to transitional interventions.
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Affiliation(s)
- Rachel A Annunziato
- Department of Psychology, Fordham University, Bronx, New York, United States; Department of Pediatrics, Kravis Children's Hospital & Recanati/Miller Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States
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Heldman MR, Sohn MW, Gordon EJ, Butt Z, Mohammed S, Alonso EM, Levitsky J. National survey of adult transplant hepatologists on the pediatric-to-adult care transition after liver transplantation. Liver Transpl 2015; 21:213-23. [PMID: 25378291 DOI: 10.1002/lt.24044] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 10/19/2014] [Accepted: 10/20/2014] [Indexed: 02/07/2023]
Abstract
Adult transplant hepatologists face challenges in providing care to young adults who received liver transplants during childhood. Because prior studies have focused mainly on pediatric providers, understanding these issues from the perspective of the adult hepatologist may provide novel insights and identify key barriers to care in this population. We conducted a national survey of adult transplant hepatologists to assess factors that may affect the transition of recipients from pediatric care to adult care. More than half of transplant hepatologists from all United Network for Organ Sharing regions (236/408 or 57.8%) completed the survey, and they reported that only 46.1% of patients arrived at their first adult clinic with both adequate knowledge of their condition and a parent/guardian. Moreover, 32.4% reported having no transition strategy, and only 15.5% reported having a formal transition program. The respondents reported that the greatest barriers to optimal care were patients' poor adherence and their limited knowledge and management of their condition. Those who reported participating in a formal transition program were less likely to report an inability of patients to discuss the impact of their condition on their overall daily life, fitness, and sexuality as a barrier to transition (odds ratio = 0.40, 95% confidence interval = 0.16-1.00). Our survey suggests that a formalized transition process is uncommon in adult transplant hepatology clinics and that improving patient knowledge, understanding specific components of effective transition programs, and incorporating input from adult providers in designing such programs may improve this process.
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Affiliation(s)
- Madeleine R Heldman
- Northwestern University Transplant Outcomes Research Collaborative, Comprehensive Transplant Center
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Annunziato RA, Freiberger D, Martin K, Helcer J, Fitzgerald C, Lefkowitz DS. An empirically based practice perspective on the transition to adulthood for solid organ transplant recipients. Pediatr Transplant 2014; 18:794-802. [PMID: 25224273 DOI: 10.1111/petr.12359] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2014] [Indexed: 11/26/2022]
Abstract
Preparing patients for transitioning to self-managed care and subsequently transferring to the adult healthcare system has become a critical process for clinicians working with pediatric transplant recipients. This paper reviews several barriers to a successful transition. These include patient barriers, caregiver barriers, and considerations within pediatric and adult centers. To date, few approaches for improving the transition process have been empirically tested. This review details studies that have examined possible models including usage of a transition coordinator and transition clinics. Recommendations are offered to promote an optimal transition including the importance and content of preparation, assessing and addressing transition readiness, insuring the involvement of all stakeholders, and finally, at minimum providing services during the transfer period. Future directions are offered aiming to advance this important area of investigation.
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92
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Prior M, McManus M, White P, Davidson L. Measuring the "triple aim" in transition care: a systematic review. Pediatrics 2014; 134:e1648-61. [PMID: 25422015 DOI: 10.1542/peds.2014-1704] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Without adequate support, adolescents transitioning from the pediatric to the adult health care system are at increased risk for poor health outcomes. Numerous interventions attempt to improve this transition, yet few comprehensively evaluate efficacy. To advance evaluation methods and ultimately the quality of transition services, it is necessary to understand the current state of health care transition measurement. This study examines and categorizes transition measures by using the "Triple Aim" framework of experience of care, population health, and cost of care. METHODS Ovid Medline and the Cumulative Index to Nursing and Allied Health Literature were searched for articles published between 1995 and 2013. Two reviewers independently screened studies and included those that evaluated the impact of a health care transition intervention. Measures were subsequently classified according to population health, experience of care, and costs of care. RESULTS Of the 2282 studies initially identified, 33 met inclusion criteria. Population health measures were used in 27 studies, with disease-specific measures collected most frequently. Fifteen studies measured cost, most often service utilization. Eight studies measured experience of care, with satisfaction assessed most commonly. Only 3 studies examined all 3 domains of the "Triple Aim." Transition interventions described in the gray literature were not reviewed. CONCLUSIONS Transition programs are inconsistently evaluated in terms of their impact on population health, patient experience, and cost. To demonstrate improvement in the transition from pediatric to adult health care, a more robust and consistent set of measures is needed.
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Affiliation(s)
- Megan Prior
- The National Alliance to Advance Adolescent Health, Washington, District of Columbia; and Georgetown University School of Medicine, Washington District of Columbia
| | - Margaret McManus
- The National Alliance to Advance Adolescent Health, Washington, District of Columbia; and
| | - Patience White
- The National Alliance to Advance Adolescent Health, Washington, District of Columbia; and
| | - Laurie Davidson
- Georgetown University School of Medicine, Washington District of Columbia
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93
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Davis AM, Brown RF, Taylor JL, Epstein RA, McPheeters ML. Transition care for children with special health care needs. Pediatrics 2014; 134:900-8. [PMID: 25287460 PMCID: PMC4533283 DOI: 10.1542/peds.2014-1909] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Approximately 750,000 children in the United States with special health care needs will transition from pediatric to adult care annually. Fewer than half receive adequate transition care. METHODS We had conversations with key informants representing clinicians who provide transition care, pediatric and adult providers of services for individuals with special health care needs, policy experts, and researchers; searched online sources for information about currently available programs and resources; and conducted a literature search to identify research on the effectiveness of transition programs. RESULTS We identified 25 studies evaluating transition care programs. Most (n = 8) were conducted in populations with diabetes, with a smaller literature (n = 5) on transplant patients. We identified an additional 12 studies on a range of conditions, with no more than 2 studies on the same condition. Common components of care included use of a transition coordinator, a special clinic for young adults in transition, and provision of educational materials. CONCLUSIONS The issue of how to provide transition care for children with special health care needs warrants further attention. Research needs are wide ranging, including both substantive and methodologic concerns. Although there is widespread agreement on the need for adequate transition programs, there is no accepted way to measure transition success. It will be essential to establish consistent goals to build an adequate body of literature to affect practice.
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Affiliation(s)
- Alaina M. Davis
- Division of General Pediatrics, and,Evidence-Based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee; and
| | - Rebekah F. Brown
- Division of Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics;,Evidence-Based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee; and
| | - Julie Lounds Taylor
- Division of General Pediatrics, and,Evidence-Based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee; and,Vanderbilt University Kennedy Center for Research on Education and Human Development, Nashville, Tennessee
| | - Richard A. Epstein
- Division of Child and Adolescent Psychiatry, Department of Psychiatry; and,Evidence-Based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee; and
| | - Melissa L. McPheeters
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee;,Evidence-Based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee; and
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94
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Annunziato RA, Rubes M, Davis C, Rose S, Arnon R. An Empirically Supported Framework for Addressing Pediatric Nonalcoholic Fatty Liver Disease in Outpatient Care. COGNITIVE AND BEHAVIORAL PRACTICE 2014. [DOI: 10.1016/j.cbpra.2014.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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95
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Venick RS. What is the future of pediatric liver transplantation? Optimal management of long-term recipients. Liver Transpl 2014; 20 Suppl 2:S19-21. [PMID: 25212753 DOI: 10.1002/lt.23994] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 09/08/2014] [Indexed: 02/07/2023]
Affiliation(s)
- Robert S Venick
- Department of Pediatrics and Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
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96
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Supelana C, Annunziato R, Schiano T, Anand R, Vaidya S, Chuang K, Zack Y, Florman S, Shneider BL, Shemesh E. Medication level variability index predicts rejection, possibly due to nonadherence, in adult liver transplant recipients. Liver Transpl 2014; 20:1168-77. [PMID: 24931127 PMCID: PMC4177441 DOI: 10.1002/lt.23930] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 06/08/2014] [Indexed: 12/12/2022]
Abstract
Nonadherence to immunosuppressants may play a role in late rejection in liver transplant recipients. In children, emerging data suggest that adherence can be measured through the computation of the standard deviation (SD) of consecutive blood levels of tacrolimus, which results in a number that reflects the degree of variability between individual measures: the medication level variability index (MLVI). A higher MLVI value means erratic immunosuppression, likely due to less adherence. Data on this method are limited for adults. We obtained data from the medical charts of 150 randomly selected adult recipients. The MLVI was significantly higher for patients who had biopsy-confirmed rejection (mean MLVI = 3.8, SD = 3.2) versus the rest of the cohort (mean MLVI = 2.3, SD = 1.5, P = 0.003), and it was significantly higher for patients who suffered rejection versus patients whose biopsy sample was not read as rejection (mean MLVI = 2.6, SD = 1.6, P = 0.008). The MLVI was associated with rejection and predicted its occurrence. A threshold MLVI of 2.0 resulted in 77% sensitivity and 60% specificity in predicting rejection; a threshold of 1.8 resulted in a sensitivity of 92% and a specificity of 48%. The area under the curve in a receiver operating characteristic curve analysis was 0.71 (95% CI = 0.61-0.81). In conclusion, the MLVI is associated with and can predict rejection, possibly related to nonadherence, in adult liver transplant recipients.
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Affiliation(s)
- Christina Supelana
- Department of Pediatrics and Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York, NY,Department of Psychology, Fordham University, Bronx, NY
| | - Rachel Annunziato
- Department of Pediatrics and Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York, NY,Department of Psychology, Fordham University, Bronx, NY,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Thomas Schiano
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Swapna Vaidya
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kelley Chuang
- Department of Pediatrics and Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York, NY,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yelena Zack
- Department of Pediatrics and Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York, NY,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sander Florman
- Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Benjamin L. Shneider
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Eyal Shemesh
- Department of Pediatrics and Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York, NY,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
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Provider awareness alone does not improve transition readiness skills in adolescent patients with inflammatory bowel disease. J Pediatr Gastroenterol Nutr 2014; 59:221-4. [PMID: 24762453 PMCID: PMC4162294 DOI: 10.1097/mpg.0000000000000405] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Adolescent patients with chronic health conditions must gradually assume responsibility for their health. Self-management skills are needed for a successful transfer from adolescent to adult health care, but the development of these skills could be resource intensive. Pediatric providers are already instrumental in teaching patients about their health and may improve these skills. The aim of the study was to evaluate whether informal education of pediatric providers regarding transition improves inflammatory bowel disease (IBD) patient self-management skills. METHODS Consecutive patients with IBD older than 10 years who presented to the outpatient setting were administered a survey regarding self-management behaviors in 2008 and 2011. During this time, several conferences on transition were presented to the providers. RESULTS In 2008, 294 patients completed the survey (82%) compared with 121 patients (89%) in 2011. The patient groups were comparable with respect to sex (boys 50% vs 42%), mean age (16.7 vs 16.2 years), and type of IBD (Crohn 68% vs 66%). The 13- to 15-year-olds reported calling in refills (11%, 8%, respectively), scheduling clinic appointment (0, 1%), preparing questions (13%, 5%), and taking the main role in talking during clinic visits (15%, 24%). The 16- to 18-year-olds reported calling in refills (13%, 27%), scheduling clinic appointments (9%, 6%), preparing questions (9%, 16%), and taking the main role in talking in clinic visits (36%, 45%). Responsibility for behaviors gradually increases with age, but did not differ significantly between 2008 and 2011. CONCLUSIONS Increasing awareness around transition readiness for pediatric providers had an insignificant effect on the self-management skills of patients with IBD. A more formal or structured approach is likely required to improve transition skills in adolescent patients.
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