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Malik FS, Senturia KD, Lind CD, Chalmers KD, Yi-Frazier JP, Shah SK, Pihoker C, Wright DR. Adolescent and parent perspectives on the acceptability of financial incentives to promote self-care in adolescents with type 1 diabetes. Pediatr Diabetes 2020; 21:533-551. [PMID: 31863541 PMCID: PMC7663046 DOI: 10.1111/pedi.12970] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 10/02/2019] [Accepted: 11/25/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND An understanding of acceptability among potential intervention participants is critical to the design of successful real-world financial incentive (FI) programs. The purpose of this qualitative study was to explore adolescent and parent perspectives on the acceptability of using FI to promote engagement in diabetes self-care in adolescents with type 1 diabetes (T1D). METHODS Focus groups with 46 adolescents with T1D (12-17 years old) and 39 parents of adolescents with T1D were conducted in the Seattle metropolitan area. Semistructured questions addressed participants' current use of incentives to promote change in diabetes self-care and receptivity to a theoretical incentive program administered by a third-party. Qualitative data were analyzed and emergent themes identified. RESULTS Three thematic categories informed participant views about the acceptability of FI programs: (a) the extent to which using FIs in the context of diabetes management fit comfortably into a family's value system, (b) the perceived effectiveness for FIs to promote improved diabetes self-care, and (c) the urgent need for improved self-care due to the threat of diabetes-related health complications. These factors together led most parents and adolescents to be open to FI program participation. CONCLUSIONS The results from this qualitative study suggest that well-designed FI programs to support diabetes management are acceptable to families with adolescents with T1D. Additionally, the use of FIs may have the potential to support adolescents with T1D in developing strong self-care habits and ease the often-turbulent transition to independent self-care.
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Affiliation(s)
- Faisal S. Malik
- Department of Pediatrics, University of Washington, 1959 NE Pacific St, Seattle, WA, USA,Seattle Children’s Research Institute, 2001 8th Ave #400, Seattle, WA, USA
| | | | - Cara D. Lind
- Seattle Children’s Research Institute, 2001 8th Ave #400, Seattle, WA, USA
| | | | | | - Seema K. Shah
- Northwestern University, 680 N Lake Shore Drive, Chicago, IL, USA
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington, 1959 NE Pacific St, Seattle, WA, USA,Seattle Children’s Research Institute, 2001 8th Ave #400, Seattle, WA, USA
| | - Davene R. Wright
- Department of Pediatrics, University of Washington, 1959 NE Pacific St, Seattle, WA, USA,Seattle Children’s Research Institute, 2001 8th Ave #400, Seattle, WA, USA
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Davis S, MacKay L. Moving Beyond the Rhetoric of Shared Decision-Making: Designing Personal Health Record Technology With Young Adults With Type 1 Diabetes. Can J Diabetes 2020; 44:434-441. [PMID: 32616277 DOI: 10.1016/j.jcjd.2020.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 03/17/2020] [Accepted: 03/17/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Engaging young adults with type 1 diabetes (T1D) in the self-management of daily tasks and decision-making provides opportunities for positive health outcomes. However, emerging adulthood and care transitions are associated with decreased clinic attendance and diabetes complications. Shared decision-making (SDM) is an optimal approach for health decisions; however, it has been difficult to implement in practice. Personal health record (PHR) technology is a promising approach for overcoming such barriers. Still, today, PHRs have yet to root themselves into care and present an opportunity for improvement in SDM and engagement in self-management decision-making. The objective of this study was to confirm a functional model of an integrated shared decision-making-personal health record system (e-PHR) by young adults with T1D and care providers. METHODS User-centred design approach whereby young adults with T1D, 18 to 24 years of age, and care providers matched PHR functions for the SDM process to confirm an e-PHR functional model. RESULTS An e-PHR functional model justified by young adults (n=7) and providers (n=15) was confirmed. The conceptual design was architected within an interconnected digital health ecosystem and integrated 23 PHR functionalities for SDM with a moderate level of agreement between patients and providers (Cohen kappa 0.60 to 0.74). CONCLUSIONS The establishment of an e-PHR functional model is a precursor to system design requirements. Results highlight the conceivable value of integrating SDM into PHRs for engagement of young adults with T1D in self-management decision-making. Design implications highlight key challenges for future research and system development, including information exchange across disparate systems, usability considerations and system intelligence for information personalization and decision-support tools.
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Affiliation(s)
- Selena Davis
- School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada.
| | - Lee MacKay
- Kootenay Lake Hospital Diabetes Clinic and Kootenay Boundary Division of Family Practice, Nelson, British Columbia, Canada
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Allende-Richter S, Ramirez M, Khoury Z, Bourgeois F, Epee-Bounya A, O'Hare K. Assessment of: self-management skills towards transition readiness and patient portal use among Hispanic adolescent and young adult patients. BMJ Paediatr Open 2020; 4:e000658. [PMID: 32399506 PMCID: PMC7204810 DOI: 10.1136/bmjpo-2020-000658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 03/30/2020] [Indexed: 11/16/2022] Open
Abstract
We conducted a 15-item self-answered survey to assess self-management skills and explore interest in a patient portal among publicly insured Hispanic youths ages 12-25. Out of 61 participants, 33% did not know how to schedule an appointment, 50% how to refill prescriptions, 58% how to access their personal health information, 84% were unaware of the portal and 92% never used it. Referring to the portal as an online application increased participants interest by 39%. Although study participants exhibit low self-management skills and awareness of a patient portal, most welcome using it to manage their health. Further research is needed to validate whether a patient portal can promote self-management skills towards transition readiness among Hispanic youths.
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Affiliation(s)
- Sophie Allende-Richter
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Melanie Ramirez
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.,Tufts University, Department of Community Health, Boston, Massachusetts, USA
| | - Zana Khoury
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Fabienne Bourgeois
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexandra Epee-Bounya
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Kitty O'Hare
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,WakeMed Children's Hospital, Raleigh, North Carolina, USA
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54
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Bray L, Appleton V, Sharpe A. 'If I knew what was going to happen, it wouldn't worry me so much': Children's, parents' and health professionals' perspectives on information for children undergoing a procedure. J Child Health Care 2019; 23:626-638. [PMID: 31431048 DOI: 10.1177/1367493519870654] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Children undergoing procedures such as blood tests and X-rays experience less anxiety and upset if they are well prepared and informed. Currently the provision of information about procedures can be ad hoc and there are barriers to children understanding this information. This study explored the perspectives of 32 children undergoing procedures (aged between 8 and 12 years), 27 parents and 19 health professionals on the provision of preparatory information to children. Qualitative interviews, prompted by visual images, were thematically analysed. The three themes, 'accessing information', 'understanding information' and 'using information', resonated with the central tenets of health literacy. Children reported mainly accessing information second-hand through their parents and demonstrated misconceptions about their procedure. Children identified that procedural information would help them to know what was going to happen and enable them to feel less worried and scared about their procedure. This study highlights that children can have low levels of health literacy in relation to a planned procedure. Their health literacy in this context is heavily influenced by the adults (parents and health professionals) around them. There needs to be further work conducted, informed directly by children, to improve the health literacy of children attending hospital for planned procedures.
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Affiliation(s)
- Lucy Bray
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Victoria Appleton
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Ashley Sharpe
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
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Mok E, Henderson M, Dasgupta K, Rahme E, Hajizadeh M, Bell L, Prevost M, Frei J, Nakhla M. Group education for adolescents with type 1 diabetes during transition from paediatric to adult care: study protocol for a multisite, randomised controlled, superiority trial (GET-IT-T1D). BMJ Open 2019; 9:e033806. [PMID: 31719096 PMCID: PMC6859409 DOI: 10.1136/bmjopen-2019-033806] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Transition from paediatric to adult care is challenging for adolescents and emerging adults (ages 18 to 30 years) with type 1 diabetes (T1D). This transition is characterised by a deterioration in glycaemic control (haemoglobin A1c (HbA1c)), decreased clinical attendance, poor self-management and increased acute T1D-related complications. However, evidence to guide delivery of transition care is lacking. Given the effectiveness of group education in adult diabetes glycaemic control and improvements in qualitative measures in paediatric diabetes, group education is a potentially feasible and cost-effective alternative for the delivery of transition care. In emerging adults with T1D, we aim to assess the effectiveness of group education visits compared with usual care on HbA1c, T1D-related complications, psychosocial measures and cost-effectiveness after the transfer to adult care. METHODS AND ANALYSIS In a multisite, assessor-blinded, randomised, two-arm, parallel-group, superiority trial, 212 adolescents with T1D (ages 17 years) are randomised to 12 months group education versus usual T1D care before transfer to adult care. Visits in the active arm consist of group education sessions followed by usual T1D care visits every 3 months. Primary outcome is change in HbA1c measured at 24 months. Secondary outcomes are delays in establishing adult diabetes care, T1D-related hospitalisations and emergency department visits, severe hypoglycaemia, stigma, self-efficacy, diabetes knowledge, transition readiness, diabetes distress, quality of life and cost-effectiveness at 12 and 24 months follow-up. Analysis will be by intention-to-treat. Change in HbA1c will be calculated and compared between arms using differences (95% CI), along with cost-effectiveness analysis. A similar approach will be conducted to examine between-arm differences in secondary outcomes. ETHICS AND DISSEMINATION The study was approved by McGill University Health Centre Research Ethics Board (GET-IT/MP-37-2019-4434, version 'Final 1.0 from November 2018). Study results will be disseminated through peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT03703440.
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Affiliation(s)
- Elise Mok
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Melanie Henderson
- Centre de Recherche du Centre Hospitalier Universitaire Sainte-Justine, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Québec, Canada
| | - Kaberi Dasgupta
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Elham Rahme
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Mohammad Hajizadeh
- School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lorraine Bell
- Pediatrics, Nephrology, McGill University Health Centre, Montréal, Québec, Canada
| | - Melinda Prevost
- Pediatrics, Endocrinology, McGill University Health Centre, Montreal, Québec, Canada
| | - Jennifer Frei
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Meranda Nakhla
- Pediatrics, Endocrinology, McGill University Health Centre, Montreal, Québec, Canada
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Brown M, Macarthur J, Higgins A, Chouliara Z. Transitions from child to adult health care for young people with intellectual disabilities: A systematic review. J Adv Nurs 2019; 75:2418-2434. [PMID: 30816570 DOI: 10.1111/jan.13985] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/18/2018] [Accepted: 01/08/2019] [Indexed: 12/31/2022]
Abstract
AIMS To examine the experiences of health transitions for young people with intellectual disabilities and their carers and identify the implications for nursing practice. DESIGN A systematic review and critical appraisal of qualitative, quantitative, and mixed methods studies. DATA SOURCES A search of the relevant literature published 2007-2017 was carried out in AMED, ASSIA, CINAHL, MEDLINE, PsycINFO, PubMed, and Science Direct Sociological Abstracts databases. REVIEW METHODS A total of 12 of 637 papers identified in the search met the inclusion criteria for this review. A narrative review of the papers was undertaken by synthesizing the key findings and grouping them into concepts and emergent themes. RESULTS Four main themes were identified: (a) becoming an adult; (b) fragmented transition process and care; (c) parents as advocates in emotional turmoil; and (d) making transitions happen. CONCLUSION The range of issues that have an impact on the transition from child to adult health services for young people with intellectual disabilities and their carers raise important implications for policy development, nursing practice, and education.
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Affiliation(s)
- Michael Brown
- School of Nursing & Midwifery, Queen's University, Belfast, UK
| | | | - Anna Higgins
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Zoë Chouliara
- Division in Mental Health & Counselling, Abertay University, Dundee, UK
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Brown M, Higgins A, MacArthur J. Transition from child to adult health services: A qualitative study of the views and experiences of families of young adults with intellectual disabilities. J Clin Nurs 2019; 29:195-207. [DOI: 10.1111/jocn.15077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/05/2019] [Accepted: 09/24/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Michael Brown
- School of Nursing & Midwifery Queen's University Belfast UK
| | - Anna Higgins
- School of Health & Social Care Edinburgh Napier University Edinburgh UK
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58
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Baker AC, Wiebe DJ, Kelly CS, Munion A, Butner JE, Swinyard MT, Murray M, Berg CA. Structural model of patient-centered communication and diabetes management in early emerging adults at the transfer to adult care. J Behav Med 2019; 42:831-841. [PMID: 30680592 PMCID: PMC6656634 DOI: 10.1007/s10865-019-00012-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 01/14/2019] [Indexed: 12/26/2022]
Abstract
Early emerging adulthood (ages 18-25) is a time of risk for type 1 diabetes (T1D) when relationships with parents and providers are changing. We examined whether individuals' high-quality relationships with mothers are associated with greater perceptions of patient-centered communication (PCC) with their doctor and whether PCC is associated with better adherence and glycemic control through diabetes-related self-efficacy. Additionally, we tested whether associations of PCC with self-efficacy and diabetes outcomes are stronger among those who had transferred to adult care. One-year post-high school, 217 individuals with T1D (60% women, 53% in adult care) reported perceptions of maternal relationship quality, PCC, self-efficacy, and adherence. Glycemic control was measured via HbA1c assay kits. Structural equation modeling indicated good model fit and revealed indirect paths linking higher maternal relationship quality to better adherence through higher PCC, and higher PCC to better HbA1c through adherence. Transfer status moderated the link between PCC and self-efficacy, suggesting PCC may be especially important when emerging adults transfer to adult care.
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Affiliation(s)
- Ashley C Baker
- Psychological Sciences and Health Sciences Research Institute, University of California, Merced, 5200 N. Lake Rd SSM, Merced, CA, 95343, USA.
| | - Deborah J Wiebe
- Psychological Sciences and Health Sciences Research Institute, University of California, Merced, 5200 N. Lake Rd SSM, Merced, CA, 95343, USA
| | - Caitlin S Kelly
- Department of Psychology, University of Utah, Salt Lake City, USA
| | - Ascher Munion
- Department of Psychology, University of Utah, Salt Lake City, USA
| | | | - Michael T Swinyard
- Mountain Vista Medicine, University of Utah School of Medicine, Salt Lake City, USA
| | - Mary Murray
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, USA
| | - Cynthia A Berg
- Department of Psychology, University of Utah, Salt Lake City, USA
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Hart LC, Patel-Nguyen SV, Merkley MG, Jonas DE. An Evidence Map for Interventions Addressing Transition from Pediatric to Adult Care: A Systematic Review of Systematic Reviews. J Pediatr Nurs 2019; 48:18-34. [PMID: 31220801 DOI: 10.1016/j.pedn.2019.05.015] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/20/2019] [Accepted: 05/22/2019] [Indexed: 11/28/2022]
Abstract
PROBLEM Adolescents and young adults with chronic illnesses continue to face barriers as they transition from pediatric to adult care. An evidence map can help to identify gaps in the transition literature to determine targets for future research. ELIGIBILITY CRITERIA We searched PubMed, CINAHL, PsycInfo, and Cochrane for systematic reviews published through February 2018. Eligible reviews included at least one comparative study testing a youth-focused intervention for improving transition with at least one quantitative health-related outcome reported. SAMPLE We identified 431 unique reviews in our search, and 37 reviews (containing 71 eligible primary studies) met inclusion criteria. RESULTS Most reviews (20 of 37) summarized some aspect of transition across diagnoses. Type 1 diabetes was the most common diagnosis studied (7 of 37 reviews and 24 of 71 primary studies). Only 14 of 71 primary studies focused on care after transfer to adult care. CONCLUSIONS The literature on interventions to improve transition to adult care has focused on a limited number of diagnoses, most commonly Type 1 diabetes. Common pediatric conditions, such as asthma, have not been studied with regard to transition. Efforts have been mainly targeted on transition preparation, with less focus on transition needs after transfer to adult care. IMPLICATIONS There is a need for transition research focused on common pediatric conditions and transition needs after transfer to adult care.
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Affiliation(s)
- Laura C Hart
- Nationwide Children's Hospital, Columbus, OH, United States of America; The Ohio State University College of Medicine, Departments of Pediatrics and Medicine, United States of America; The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, United States of America.
| | | | | | - Daniel E Jonas
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, United States of America; University of North Carolina at Chapel Hill, Department of Medicine, United States of America.
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Coyne I, Sheehan A, Heery E, While AE. Healthcare transition for adolescents and young adults with long-term conditions: Qualitative study of patients, parents and healthcare professionals' experiences. J Clin Nurs 2019; 28:4062-4076. [PMID: 31327174 DOI: 10.1111/jocn.15006] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 06/20/2019] [Accepted: 07/09/2019] [Indexed: 01/26/2023]
Abstract
AIM AND OBJECTIVES To examine the needs and perspectives regarding healthcare transition for adolescents and young adults (AYAs) with the following long-term conditions: diabetes, cystic fibrosis and congenital heart disease. BACKGROUND Transition of AYAs within healthcare services has become increasingly important as more children are surviving into adulthood with long-term conditions. Yet, limited empirical evidence exists regarding transition experiences. DESIGN Qualitative study fulfilling the completed consolidated criteria for reporting qualitative studies criteria (see Appendix S1). METHODS Semi-structured interviews with AYAs aged 14-25 years (n = 47), parents (n = 37) and health professionals (n = 32), which was part of a larger mixed-methods study. Sample was recruited from two children's hospitals and four general hospitals in Ireland. RESULTS Transfer occurred between the ages of 16-early 20s years depending on the service. None of the hospitals had a transition policy, and transition practices varied considerably. Adolescents worried about facing the unknown, communicating and trusting new staff and self-management. The transition process was smooth for some young adults, while others experienced a very abrupt transfer. Parents desired greater involvement in the transition process with some perceiving a lack of recognition of the importance of their role. In paediatric services, nurses reported following-up adolescents who struggled with treatment adherence and clinic attendance, whereas after transfer, little effort was made to engage young adults if there were lapses in care, as this was generally considered the young adults' prerogative. CONCLUSIONS The amount of preparation and the degree to which the shift in responsibility had occurred prior to transition appeared to influence successful transition for AYAs and their parents. RELEVANCE TO CLINICAL PRACTICE Nurses in collaboration with the multidisciplinary team can help AYAs develop their self-management skills and guide parents on how to relinquish responsibility gradually prior to transition.
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Affiliation(s)
- Imelda Coyne
- School of Nursing & Midwifery, Trinity College Dublin, Dublin 2, Ireland
| | - Aisling Sheehan
- School of Nursing & Midwifery, Trinity College Dublin, Dublin 2, Ireland
| | - Emily Heery
- School of Nursing & Midwifery, Trinity College Dublin, Dublin 2, Ireland
| | - Alison E While
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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Allemang B, Allan K, Johnson C, Cheong M, Cheung P, Odame I, Ward R, Williams S, Mukerji G, Kuo KHM. Impact of a transition program with navigator on loss to follow-up, medication adherence, and appointment attendance in hemoglobinopathies. Pediatr Blood Cancer 2019; 66:e27781. [PMID: 31045326 DOI: 10.1002/pbc.27781] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 04/03/2019] [Accepted: 04/05/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Transition from pediatric to adult care is a period of high risk for loss to follow-up, morbidity, and mortality in adolescents and young adults (AYA) with hemoglobinopathies. The purpose of this study was to determine whether a transition program with transition navigator (TN) reduced loss to follow-up and hospitalizations and improved medication adherence and appointment attendance compared with an unstructured transfer. PROCEDURE A retrospective observational study compared all AYA with hemoglobinopathies who turned 18 one year prior to (n = 51) and one year after (n = 61) the initiation of the transition program. Data from one year prior to last pediatric appointment and one year following first adult appointment were collected from each patient. RESULTS The transition program with TN reduced loss to follow-up from 29% to 7% (P = 0.034). A greater proportion of patients in the transition cohort maintained or improved adherence to hydroxyurea or iron chelation to ≥4 days/week; exposure to the program was independently associated with such improvement (P = 0.047). A trend toward improvement or maintenance of ≥90% attendance to appointments was observed (P = 0.096). Frequency of hospitalization was not significantly different between the two cohorts (P = 0.985). CONCLUSIONS A transition program with TN significantly reduced loss to follow-up, and significantly improved and maintained fair to good medication adherence. Further analysis of economic benefit and patient satisfaction will be conducted.
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Affiliation(s)
- Brooke Allemang
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Medical Oncology and Hematology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Kate Allan
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Colleen Johnson
- Division of Medical Oncology and Hematology, Department of Medicine, University Health Network, Toronto, Ontario, Canada.,Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Melina Cheong
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Patrina Cheung
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Isaac Odame
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Richard Ward
- Division of Medical Oncology and Hematology, Department of Medicine, University Health Network, Toronto, Ontario, Canada.,Division of Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Suzan Williams
- Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Geetha Mukerji
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Women's College Hospital, Toronto, Ontario, Canada
| | - Kevin H M Kuo
- Division of Medical Oncology and Hematology, Department of Medicine, University Health Network, Toronto, Ontario, Canada.,Division of Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Culen C, Herle M, König M, Hemberger SH, Seferagic S, Talaska C, Ertl DA, Wagner G, Straub C, Johnson K, Wood DL, Häusler G. Be on TRAQ – Cross-cultural adaptation of the Transition Readiness Assessment Questionnaire (TRAQ 5.0) and pilot testing of the German Version (TRAQ-GV-15). JOURNAL OF TRANSITION MEDICINE 2019. [DOI: 10.1515/jtm-2018-0005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractObjectiveTransfer from pediatric care into the adult health care system is known to be a vulnerable phase in the lives of youth with special health care needs (YSHCN). Recommendations from the literature favor assessment of transition readiness rather than simply pass over YSHCN from pediatric to adult-centered care by the age of 18. Nevertheless, no validated and disease neutral assessment instrument in German exists to date. Hence, our aim was to cross-culturally adapt and to pilot-test a German version of the Transition Readiness Assessment Questionnaire (TRAQ 5.0). We wanted to provide a tool that can be applied broadly during the health care transition (HCT) process of YSHCN.MethodsThe development included translating and adapting TRAQ 5.0 to German and conducting a pilot-study with 172 YSHCN between the ages of 14 and 23.ResultsCross-cultural adaptation resulted in the TRAQ-GV-15. Exploratory factor analysis led to a 3 factor-structure. Internal consistency for the overall score was good with a Cronbach’s alpha of 0.82. Age, in contrast to sex, had a significant effect on the TRAQ scoring. The administration of the TRAQ-GV-15 was well received and demonstrated good feasibility.ConclusionThe TRAQ-GV-15 is an easily applicable and clinically usable instrument for assessing transition readiness in German speaking YSHCN prior to HCT.
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Affiliation(s)
- Caroline Culen
- Medical University of Vienna, University Department of Pediatric and Adolescent Medicine (UKKJ), Division of Pediatric Pulmonology, Allergology and Endocrinology, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Marion Herle
- Medical University of Vienna, University Department of Pediatric and Adolescent Medicine (UKKJ), Division of Pediatric Pulmonology, Allergology and Endocrinology, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Marianne König
- Medical University of Vienna, University Department of Pediatric and Adolescent Medicine (UKKJ), Division of Pediatric Pulmonology, Allergology and Endocrinology, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Sophie-Helene Hemberger
- Medical University of Vienna, University Department of Pediatric and Adolescent Medicine (UKKJ), Division of Pediatric Nephrology and Gastroenterology, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Sanja Seferagic
- Medical University of Vienna, University Department of Pediatric and Adolescent Medicine (UKKJ), Division of Pediatric Nephrology and Gastroenterology, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Carolin Talaska
- Medical University of Vienna, University Department of Pediatric and Adolescent Medicine (UKKJ), Division of Pediatric Pulmonology, Allergology and Endocrinology, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Diana-Alexandra Ertl
- Medical University of Vienna, University Department of Pediatric and Adolescent Medicine (UKKJ), Division of Pediatric Pulmonology, Allergology and Endocrinology, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Gudrun Wagner
- Medical University of Vienna, Department of Child and Adolescent Psychiatry, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Christine Straub
- University of Freiburg, Medical Center, Medical Faculty, Center for Pediatrics, Department of General Pediatrics, Adolescent Medicine And Neonatology, Freiburg, Germany
| | - Kiana Johnson
- East Tennessee State University, Quillen College of Medicine, Department of Pediatrics, Johnson City, TN, USA
| | - David L. Wood
- East Tennessee State University, Quillen College of Medicine, Department of Pediatrics, Johnson City, TN, USA
| | - Gabriele Häusler
- Medical University of Vienna, University Department of Pediatric and Adolescent Medicine (UKKJ), Division of Pediatric Pulmonology, Allergology and Endocrinology, Waehringer Guertel 18-20, 1090 Vienna, Austria, Phone: +43 1 40 400 40160
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Low JK, Manias E. Use of Technology-Based Tools to Support Adolescents and Young Adults With Chronic Disease: Systematic Review and Meta-Analysis. JMIR Mhealth Uhealth 2019; 7:e12042. [PMID: 31322129 PMCID: PMC6670279 DOI: 10.2196/12042] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 04/30/2019] [Accepted: 06/10/2019] [Indexed: 01/15/2023] Open
Abstract
Background With the large amount of material that is readily available on the internet, there are endless opportunities for electronic health–literate patients to obtain and learn new information. Although novel, a Web- or mobile-based program can be a powerful way to engage adolescents and young adults (AYAs). The ongoing engagement of AYAs with chronic disease is vital not only to empower them but also to ensure a smooth transition from pediatric to adult health care. Objective This study aimed to evaluate the current evidence on Web- or mobile-based interventions designed for AYAs. Methods This review was registered with PROSPERO: CRD42018096487. A systematic search of MEDLINE Complete, EMBASE, and CINAHL Complete was conducted on April 10, 2019, for studies that examined the perspectives of transition-age patients about technology-based interventions, the process involved in intervention development, or the evaluation of intervention efficacy. For each study, the comprehensiveness of reporting was appraised. The Downs and Black checklist was used for intervention efficacy trials, the Standards for Reporting Qualitative Research checklist was used for qualitative work, and a 16-item tool developed by Tong et al was used for questionnaire research. Results The search uncovered 29 relevant studies, which included qualitative studies (n=14), intervention efficacy studies (n=7), questionnaire studies (n=4), mixed qualitative and questionnaire studies (n=2), and a mixed qualitative and pilot randomized controlled trial study (n=1). The reporting comprehensiveness score of questionnaires was rated considerably lower (n=6, 13%-57% [2/16-8/14]) than the scores of intervention efficacy trials (n=8, 48%-85% [13/27-23/27]) and qualitative research (n=17, 40%-93% [8.5/21-19.5/21]). AYAs were receptive to obtaining information via a website or mobile app. An intervention was more likely to be perceived as useful by AYAs when there was a concerted effort to involve AYAs and subject matter experts in the process of intervention design, as opposed to relying solely on the AYAs or the experts alone. The preferred medium of intervention delivery varied greatly for AYAs, ranging from static text to audiovisual materials. However, AYAs considered being concise was the most important aspect. Across different conditions, AYAs were interested in receiving information on diverse topics, such as anxiety and stress management, dealing with insurance, and having social relationships. Patients also requested for disease-specific information, such as weather forecasts and pollen levels for patients with asthma and information related to the pretransplant period for organ transplant recipients. Meta-analyses showed no significant group differences across time on quality of life, self-efficacy, and self-management. Conclusions Owing to the lack of intervention efficacy trials, no conclusion can be drawn if an intervention delivered via a mobile app is better than that delivered via a website. However, through this systematic review, it is confirmed that AYAs were receptive to receiving medical information electronically.
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Affiliation(s)
- Jac Kee Low
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Burwood, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Burwood, Australia
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Markowitz B, Pritlove C, Mukerji G, Lavery JV, Parsons JA, Advani A. The 3i Conceptual Framework for Recognizing Patient Perspectives of Type 1 Diabetes During Emerging Adulthood. JAMA Netw Open 2019; 2:e196944. [PMID: 31298715 PMCID: PMC6628591 DOI: 10.1001/jamanetworkopen.2019.6944] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
IMPORTANCE Early emerging adulthood, the developmental life stage roughly spanning between the ages of 18 and 24 years, can be a challenging time for individuals living with type 1 diabetes, being associated with an increased risk of acute complications, loss to follow-up, and the emergence of long-term diabetes complications. Few evidence-based interventions exist, and practice guidelines instead emphasize the importance of delivering individualized, developmentally appropriate care. OBJECTIVE To inform the provision of tailored care and education by illuminating the individual lived experiences of emerging adults with type 1 diabetes. DESIGN, SETTING, AND PARTICIPANTS This qualitative study used in-depth interviews conducted with 33 emerging adults living with type 1 diabetes between October 14, 2016, and May 16, 2017. Participants were recruited from 2 urban Young Adult Diabetes Clinics in the city of Toronto, Ontario, Canada, using a convenience sampling approach. Narrative analysis of participants' accounts was conducted inductively to define story typology. MAIN OUTCOMES AND MEASURES Participant accounts of type 1 diabetes during childhood, adolescence, and emerging adulthood. RESULTS Interviews were conducted with 33 participants aged 18 to 24 years (mean [SD] age at interview, 20.6 [1.7] years); 17 (51%) were women. Duration of diabetes ranged from 3 to 20 years (mean [SD] duration, 12.0 [4.8] years). Narrative analysis identified 3 distinct story types, or lenses, termed ingrained (n = 14), intrusive (n = 12), and inconspicuous (n = 7). Ingrained narratives portrayed an active integration of diabetes self-management into daily life. Intrusive narratives were characterized by stories of struggles for acceptance and striving for control. Inconspicuous narratives were differentiated by descriptions of a willingness to ignore diabetes and its attendant daily tasks with the goals of preserving normalcy and limiting distress. Mean levels of hemoglobin A1c were higher in participants conveying an intrusive lens narrative (mean [SD], 9.3% [1.6%]) than those conveying an ingrained lens (mean [SD], 7.4% [0.7%]) (difference between intrusive and ingrained, 1.9%; 95% CI, 0.8%-2.9%; P = .007) or an inconspicuous lens (mean [SD], 8.6% [1.5%]). CONCLUSIONS AND RELEVANCE Although every person is unique, there are commonalities in how emerging adults perceive and depict their experiences living with type 1 diabetes. Among the emerging adults interviewed in the present study, the 3i conceptual framework of ingrained, intrusive, and inconspicuous lenses encapsulated these commonalities. Recognition of the different psychosocial contexts surrounding type 1 diabetes during emerging adulthood may help health care professionals individualize their care accordingly.
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Affiliation(s)
- Benjamin Markowitz
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
| | - Cheryl Pritlove
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Geetha Mukerji
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Toronto, Ontario, Canada
- University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto, Ontario, Canada
| | - James V. Lavery
- Hubert Department of Global Health, Rollins School of Public Health and Center for Ethics, Emory University, Atlanta, Georgia
| | - Janet A. Parsons
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
- Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
| | - Andrew Advani
- Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St Michael’s Hospital, Toronto, Ontario, Canada
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Yassaee A, Hale D, Armitage A, Viner R. The Impact of Age of Transfer on Outcomes in the Transition From Pediatric to Adult Health Systems: A Systematic Review of Reviews. J Adolesc Health 2019; 64:709-720. [PMID: 30833120 DOI: 10.1016/j.jadohealth.2018.11.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 11/30/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE International guidance on health-care transition has existed for over a decade; however, many unanswered questions remain. This systematic review of reviews aimed to answer the question: is a later age of transfer from pediatric to adult health care associated with improved health and health service outcomes? METHODS We included systematic reviews which considered at least one long-term condition and provided outcome data from adult services. Methodology of primary studies was not an exclusion criterion. We searched multiple databases and conducted an initial search in May 2015 which was repeated in May 2017. All reviews were assessed for quality using the Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) tool. Reviews that scored less than 22 were excluded. RESULTS Initial searches identified 6,149 papers. Forty-three reviews met exclusion and inclusion criteria, and 15 reviews also met quality criteria. With one exception, primary studies from reviews which only considered quantitative evidence found that a delayed age of transfer resulted in improved outcomes. Qualitative and mixed-methods evidence supported the view that age 18 was an appropriate time of transfer. CONCLUSION We found moderate evidence that models of transition which transfer young people in late adolescence or early adulthood can improve transition outcomes and patient satisfaction.
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Affiliation(s)
- Arrash Yassaee
- General Adolescent Pediatrics Unit, Institute of Child Health, UCL, London, United Kingdom.
| | - Daniel Hale
- General Adolescent Pediatrics Unit, Institute of Child Health, UCL, London, United Kingdom
| | - Alice Armitage
- General Adolescent Pediatrics Unit, Institute of Child Health, UCL, London, United Kingdom
| | - Russell Viner
- General Adolescent Pediatrics Unit, Institute of Child Health, UCL, London, United Kingdom
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Ersig AL. An Exploratory Study: Transition to Adulthood for College Students with Type 1 Diabetes and Their Parents. J Pediatr Nurs 2019; 46:12-17. [PMID: 30811974 DOI: 10.1016/j.pedn.2019.01.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/13/2019] [Accepted: 01/13/2019] [Indexed: 12/23/2022]
Abstract
PURPOSE The transition to college and adulthood can be challenging for young adults with chronic health conditions and their parents. Few studies have simultaneously explored the experiences of college students and their parents during the transition to college. The purpose of this study was to explore the transition to adulthood for college students with type 1 diabetes (T1D) and their parents. DESIGN AND METHODS A descriptive exploratory study was conducted with college students with T1D and their parents. Data were collected online using quantitative surveys and open-ended questions. Descriptive statistics were generated for quantitative measures. Analysis of responses to open-ended questions used qualitative description. RESULTS College students (18-24 years) and parents described challenges with life-stage stress, diabetes management worries, and concern about T1D-related long-term complications. Respondents also described the critical role of the college peer network for support and help in case of crisis situations. Students reported stress related to uncertainty in diabetes management, while parents described constant worry about their child's diabetes. CONCLUSIONS Findings support the importance of assessing anticipated and current stressors of college students with T1D and other chronic health conditions and their parents during and after transition to college. PRACTICE IMPLICATIONS Nurses can support students and parents by providing anticipatory guidance about the transition to college. Assistance identifying established sources of support on college campuses, as well as planning for potential crisis situations, may help reduce stress experienced by students and parents.
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Affiliation(s)
- Anne L Ersig
- The University of Wisconsin-Madison, School of Nursing, Madison, WI, United States of America..
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Higginson A, Forgeron P, Harrison D, Finley GA, Dick BD. Moving on: Transition experiences of young adults with chronic pain. CANADIAN JOURNAL OF PAIN-REVUE CANADIENNE DE LA DOULEUR 2019; 3:85-97. [PMID: 35005397 PMCID: PMC8730586 DOI: 10.1080/24740527.2019.1587707] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Purpose: The purpose of this study was to explore the transition experience of young adults with chronic pain in Canada from the pediatric health care setting to the adult health care setting. Materials and Methods: A qualitative descriptive approach using semistructured interviews was used to capture the transition experiences of young people with chronic pain who have recently transferred from the pediatric setting to the adult health care setting. Participants were recruited from west, central, and the east coast of Canada to situate the findings within the context of Canada. Interviews were transcribed and analyzed using qualitative inductive content analysis. Results: Nine participants were interviewed, three from each part of Canada (west, central, and east). Five common categories were determined to describe the transition experience of young adults with chronic pain which include (1) independence (I can do it, maybe?), (2) pain trajectory (stress and pain along for the ride), (3) social support networks (need a shoulder to lean on), (4) parental support (obviously they are there), and (5) collaborative systems (the bridge). Conclusion: Young people with chronic pain experience unique challenges when faced with transitioning to the adult health care setting. Supporting the young person and his or her family in preparation and readiness and collaboration between the pediatric and adult health care settings are essential to ensure a smooth transition and avoid negative transition outcomes. Further research is needed to determine the best ways to prepare young people for transition and the care activities required in both pediatric and adult health care settings to improve pain-related outcomes posttransition.
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Affiliation(s)
- Andrea Higginson
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Paula Forgeron
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Department of Anaesthesia, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Denise Harrison
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - G. Allen Finley
- Department of Anesthesia & Psychology, Dalhousie University, Halifax, Nova Scotia, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Canada
| | - Bruce D. Dick
- Depts. of Anesthesiology and Pain Medicine, Psychiatry & Pediatrics, Faculties of Medicine and Dentistry & Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
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White PH, Cooley WC, Boudreau ADA, Cyr M, Davis BE, Dreyfus DE, Forlenza E, Friedland A, Greenlee C, Mann M, McManus M, Meleis AI, Pickler L. Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home. Pediatrics 2018; 142:peds.2018-2587. [PMID: 30348754 DOI: 10.1542/peds.2018-2587] [Citation(s) in RCA: 421] [Impact Index Per Article: 70.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Risk and vulnerability encompass many dimensions of the transition from adolescence to adulthood. Transition from pediatric, parent-supervised health care to more independent, patient-centered adult health care is no exception. The tenets and algorithm of the original 2011 clinical report, "Supporting the Health Care Transition from Adolescence to Adulthood in the Medical Home," are unchanged. This updated clinical report provides more practice-based quality improvement guidance on key elements of transition planning, transfer, and integration into adult care for all youth and young adults. It also includes new and updated sections on definition and guiding principles, the status of health care transition preparation among youth, barriers, outcome evidence, recommended health care transition processes and implementation strategies using quality improvement methods, special populations, education and training in pediatric onset conditions, and payment options. The clinical report also includes new recommendations pertaining to infrastructure, education and training, payment, and research.
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Affiliation(s)
- Patience H. White
- Got Transition/The National Alliance to Advance Adolescent Health and Department of Medicine and Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia; and
| | - W. Carl Cooley
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
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Essaddam L, Kallali W, Jemel M, Kandara H, Kammoun I, Hsairi M, Ben Salem L, Ben Becher S. Implementation of effective transition from pediatric to adult diabetes care: epidemiological and clinical characteristics-a pioneering experience in North Africa. Acta Diabetol 2018; 55:1163-1169. [PMID: 30074090 DOI: 10.1007/s00592-018-1196-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 07/18/2018] [Indexed: 12/13/2022]
Abstract
AIMS Type 1 diabetes is increasing in children leading more T1D young adults to adult healthcare settings. This change is experienced as a tear and results in a disengagement from specialist services. This study reports on an implementation of an effective and pioneering program of transition in North Africa. METHODS A total of 65 teenagers with T1D were recruited for a structured program of transition. They attend transitional meetings involving both pediatric and adult team and were, when ready, welcomed in specialized consultations for adolescents with a special « passport ». Here we study their characteristics before and after structured transition and the benefit of this program. RESULTS 9 transition meetings took place (September 2012-December 2017). Mean age was 16.5 years. Mean age at onset of T1D was 7.5 years with average pediatric follow-up of 9 years.72% of young adults felt satisfied. After the transition meeting, 74% of patients wished to join directly adult unit. They were followed there for 28.4 ± 16.2 months. The glycaemic control improved significantly with a decrease in HbA1C of 0.93 ± 1.69% the first year of follow-up and the number of young adults achieving a HbA1C < 7.5% increased by 8%. CONCLUSION This program was beneficial for 75% of patients who demonstrated an improvement in their metabolic control the year following transition to adult care service. To our knowledge, this study is the first one in North Africa to report on the outcome of a structured transition program from pediatric to adult diabetes care.
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Affiliation(s)
- Leïla Essaddam
- Faculté de Médecine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia.
- Children Hospital Béchir Hamza de Tunis, Jebbari, 1007, Tunis, Tunisia.
- , Tunis, Tunisia.
| | - Wafa Kallali
- Faculté de Médecine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
- Children Hospital Béchir Hamza de Tunis, Jebbari, 1007, Tunis, Tunisia
| | - Manel Jemel
- Faculté de Médecine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
- Unit of Endocrinology, Diabetology and Metabolic diseases, Institut National de Nutrition de Tunis, 1007, Tunis, Tunisia
| | - Hager Kandara
- Faculté de Médecine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
- Unit of Endocrinology, Diabetology and Metabolic diseases, Institut National de Nutrition de Tunis, 1007, Tunis, Tunisia
| | - Inès Kammoun
- Faculté de Médecine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
- Unit of Endocrinology, Diabetology and Metabolic diseases, Institut National de Nutrition de Tunis, 1007, Tunis, Tunisia
| | - Mohamed Hsairi
- Faculté de Médecine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
- Department of Epidemiology, Salah Azaiez Institute of Tunis, 1007, Tunis, Tunisia
| | - Leïla Ben Salem
- Faculté de Médecine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
- Unit of Endocrinology, Diabetology and Metabolic diseases, Institut National de Nutrition de Tunis, 1007, Tunis, Tunisia
| | - Saayda Ben Becher
- Faculté de Médecine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
- Children Hospital Béchir Hamza de Tunis, Jebbari, 1007, Tunis, Tunisia
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Iversen HH, Helland Y, Bjertnaes O, Skrivarhaug T. Parent experiences of diabetes care questionnaire (PEQ-DC): reliability and validity following a national survey in Norway. BMC Health Serv Res 2018; 18:774. [PMID: 30314486 PMCID: PMC6186125 DOI: 10.1186/s12913-018-3591-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 10/01/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Patient experiences are acknowledged as an important aspect of health care quality but no validated instruments have been identified for the measurement of either parent or patient experiences with outpatient paediatric diabetes care. The aim of the current study was to assess the psychometric properties of a new instrument developed to measure parent experiences of paediatric diabetes care at hospital outpatient departments in Norway. METHODS The development of the questionnaire was based on a literature review of existing questionnaires, qualitative interviews with both parents and children/adolescents, expert-group consultations, pretesting of the questionnaire and a pilot study. The national pilot study included parents of 2606 children/adolescents aged 0-17 years with Type 1 Diabetes registered in The Norwegian Childhood Diabetes Registry, a nationwide, population-based registry. Levels of missing data, ceiling effects, factor structure, internal consistency, item discriminant validity and construct validity were assessed. RESULTS A total of 2606 patients were included in the survey, but 80 were excluded due to incorrect addresses. 1399 (55%) parents responded to the questionnaire. Low levels of missing or "not applicable" responses were found for 31 of the 35 items (< 10%), and 27 of 35 items were below the ceiling-effect criterion. Psychometric testing and theoretical considerations identified six scales: Consultation (six items), organisation (five items), equipment (three items), nurse contact (four items), doctor contact (four items) and outcome (five items). All six scales met the 0.7 criterion for Cronbach's alpha (range: 0.71-0.90). As expected, each item had a higher correlation with its hypothesised scale than with any of the other five scales. The construct validity of the Parent Experiences of Diabetes Care Questionnaire (PEQ-DC) was supported by 17 out of 18 associations with variables expected to be related to parent experiences. CONCLUSION The psychometric testing of the PEQ-DC showed good evidence for data quality, internal consistency and construct validity. The instrument includes important aspects of diabetes care at paediatric outpatient departments from the perspective of the parent. The content validity of the PEQ-DC was secured by a rigorous development process, and the instrument was tested following a national survey in Norway, securing generalisability across Norway.
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Affiliation(s)
| | - Ylva Helland
- Norwegian Directorate of Health, PO Box 7000, N-0130 Oslo, Norway
| | - Oyvind Bjertnaes
- Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403 Oslo, Norway
| | - Torild Skrivarhaug
- Division of Paediatric and Adolescent Medicine, The Norwegian Childhood Diabetes Registry, Oslo University Hospital, PO Box 4956, Nydalen, N-0424 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, N-0318 Oslo, Norway
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Hyperglycemia in Young Adults With Types 1 and 2 Diabetes Seen in the Emergency Department: A Health Records Review. Can J Diabetes 2018; 42:296-301.e5. [DOI: 10.1016/j.jcjd.2017.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/13/2017] [Accepted: 06/29/2017] [Indexed: 11/22/2022]
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Gray S, Cheetham T, McConachie H, Mann KD, Parr JR, Pearce MS, Colver A. A longitudinal, observational study examining the relationships of patient satisfaction with services and mental well-being to their clinical course in young people with Type 1 diabetes mellitus during transition from child to adult health services. Diabet Med 2018; 35:1216-1222. [PMID: 29852520 PMCID: PMC6099219 DOI: 10.1111/dme.13698] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/29/2018] [Indexed: 12/25/2022]
Abstract
AIM We hypothesized that participant well-being and satisfaction with services would be positively associated with a satisfactory clinical course during transition from child to adult health care. METHODS Some 150 young people with Type 1 diabetes mellitus from five diabetes units in England were recruited to a longitudinal study of transition. Each young person was visited at home four times by a research assistant; each visit was 1 year apart. Satisfaction with services (Mind the Gap; MTG) and mental well-being (Warwick-Edinburgh Mental Well-being Scale; WEMWBS) were captured. Change in HbA1c , episodes of ketoacidosis, clinic and retinal screening attendance were used to assess clinical course. In total, 108 of 150 (72%) young people had sufficient data for analysis at visit 4. RESULTS Mean age at entry was 16 years. By visit 4, 81.5% had left paediatric healthcare services. Median HbA1c increased significantly (P = 0.01) from 69 mmol/mol (8.5%) at baseline to 75 mmol/mol (9.0%) at visit 4. WEMWBS scores were comparable with those in the general population at baseline and were stable over the study period. MTG scores were also stable. By visit 4, some 32 individuals had a 'satisfactory' and 76 a 'suboptimal' clinical course. There were no significant differences in average WEMWBS and MTG scores between the clinical course groups (P = 0.96, 0.52 respectively); nor was there a significant difference in transfer status between the clinical course groups. CONCLUSIONS The well-being of young people with diabetes and their satisfaction with transition services are not closely related to their clinical course. Investigating whether innovative psycho-educational interventions can improve the clinical course is a research priority.
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Affiliation(s)
- S. Gray
- Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - T. Cheetham
- Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
- Institute of Genetic MedicineNewcastle upon TyneUK
| | - H. McConachie
- Institute of Health and SocietyNewcastle upon TyneUK
| | - K. D. Mann
- Institute of Health and SocietyNewcastle upon TyneUK
| | - J. R. Parr
- Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
- Institute of NeuroscienceNewcastle UniversityNewcastle upon TyneUK
| | - M. S. Pearce
- Institute of Health and SocietyNewcastle upon TyneUK
| | - A. Colver
- Institute of Health and SocietyNewcastle upon TyneUK
- Northumbria Healthcare NHS Foundation TrustNorth ShieldsUK
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Descriptive Analysis and Profile of Health Care Transition Services Provided to Adolescents and Emerging Adults in the Movin' On Up Health Care Transition Program. J Pediatr Health Care 2018; 32:273-284. [PMID: 29398163 DOI: 10.1016/j.pedhc.2017.11.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 11/29/2017] [Accepted: 11/30/2017] [Indexed: 11/23/2022]
Abstract
Global efforts are underway to develop, implement and test health care transition (HCT) models of care. Most studies have focused on the transfer of care models. In contrast, the nurse-led interdisciplinary HCT model, Movin' On Up, provides comprehensive HCT services beginning in early adolescence. A retrospective analysis was conducted of data extracted from HCT records of 146 adolescents and emerging adults with spina bifida (with a mean age of 13.91 years) who were provided services in the Movin' On Up HCT program. Data were categorized based on the Health Care Transition Research Consortium HCT model and the Omaha System framework and as to type of direct HCT services provided by the HCT Specialist and nurse-led interdisciplinary team conferences conducted. Findings revealed that the scope of services provided represented the scope of comprehensive needs beyond those associated with the transfer of care.
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Nordin K, Brorsson AL, Ekbom K. Adolescents' experiences of obesity surgery: a qualitative study. Surg Obes Relat Dis 2018; 14:1157-1162. [PMID: 29903687 DOI: 10.1016/j.soard.2018.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/01/2018] [Accepted: 04/05/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND The positive effects of behavioural treatment and weight management in adolescents with severe obesity are modest. Obesity surgery can be an option for adolescents, but is not the first-hand choice of treatment. The knowledge about adolescents' own experiences of having undergone surgery and their thoughts and feelings of the follow-up period are limited. OBJECTIVES To describe adolescents' decision to go through obesity surgery as teenager and their experiences of the follow-up period. SETTING National Childhood Obesity Centre at Karolinska University Hospital in Stockholm, Sweden. METHODS Phone interviews with 20 young adults that went through obesity surgery as teenagers. Interviews were analysed with qualitative systematic text condensation. RESULTS "Lost in the healthcare system" and "A rough but well worth journey to a healthier life" were the categories that appeared in our analysis. The participant had a feeling of uncertainty about contacts with the healthcare system and the transition to primary care was confusing. Most of the participants were happy with the decision to go through obesity surgery as teenager, despite it had been a difficult time. CONCLUSIONS Our results show implications for improving the clinical care of adolescents undergoing obesity surgery, which should be offered as a last choice. Information and individualized supports should be offered more often during first year postsurgery and should be given by a multidisciplinary team. This multifaceted population should be given priority for a successful transition.
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Affiliation(s)
- Karin Nordin
- Division of Paediatrics, Department for Clinical Science Intervention and Technology, Karolinska Institute, Stockholm, Sweden; Division of Endocrinology, Diabetes and Metabolism, National Childhood Obesity Centre, Karolinska University Hospital, Stockholm, Sweden
| | - Anna-Lena Brorsson
- Schools of Education, Health and Social Studies, Högskolan Dalarna, Falun, Sweden
| | - Kerstin Ekbom
- Division of Paediatrics, Department for Clinical Science Intervention and Technology, Karolinska Institute, Stockholm, Sweden; Division of Endocrinology, Diabetes and Metabolism, National Childhood Obesity Centre, Karolinska University Hospital, Stockholm, Sweden.
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Kapellen TM, Müther S, Schwandt A, Grulich-Henn J, Schenk B, Schwab KO, Marg W, Holl RW. Transition to adult diabetes care in Germany-High risk for acute complications and declining metabolic control during the transition phase. Pediatr Diabetes 2018; 19:1094-1099. [PMID: 29691964 DOI: 10.1111/pedi.12687] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 04/12/2018] [Accepted: 04/16/2018] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE There is evidence that transition from pediatric to adult health care is frequently associated with deterioration of health in youths with type 1 diabetes (T1D). The aim of this study was to compare metabolic control, acute complications and microvascular complications in adolescents and young adults before and after transfer to an adult treatment center with respect to the time between first visit in the adult center and last visit in pediatric treatment. METHODS All data were collected during routine care and retrieved from the German/Austrian DPV database. We analyzed data as of March 2017. RESULTS We found 1283 young adults with available data of the last pediatric treatment year and the first year after transition to adult care. HbA1c increased significantly from 8.95% (74 mmol/mol) before to 9.20% (77 mmol/mol) in the first year after transition. Frequency of DKA with hospitalization (0.10-0.191 per annum, P < .0001) and severe hypoglycemia (0.23-0.46 per annum, P = .013) doubled during transition. Microvascular complications increased dramatically depending on the time between first visit in adult treatment and last visit in pediatric care. We could not find a significant correlation of this rise of microvascular complications to the duration of transition (short or long). CONCLUSION This phase of life bears a high risk for detrimental outcome in young adults with T1D. Structured transition programs with case management are therefore needed to improve the transition process and outcomes.
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Affiliation(s)
- T M Kapellen
- Department of Women and Child Health, University of Leipzig, Leipzig, Germany
| | - S Müther
- Department of Pediatrics, DRK Kliniken Berlin, Berlin, Germany
| | - A Schwandt
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Center for Diabetes Research, DZD, Munich, Germany
| | - J Grulich-Henn
- Department of Pediatrics, University of Heidelberg, Heidelberg, Germany
| | - B Schenk
- Department of Pediatrics, Helios Kliniken Schwerin, Schwerin, Germany
| | - K O Schwab
- Department of Pediatrics, University of Freiburg, Freiburg, Germany
| | - W Marg
- Childrens Hospital Bremen, Bremen, Germany
| | - R W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Center for Diabetes Research, DZD, Munich, Germany
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76
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Wherrett DK, Ho J, Huot C, Legault L, Nakhla M, Rosolowsky E. Type 1 Diabetes in Children and Adolescents. Can J Diabetes 2018; 42 Suppl 1:S234-S246. [DOI: 10.1016/j.jcjd.2017.10.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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77
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Walsh DMJ, Hynes L, O'Hara MC, Mc Sharry J, Dinneen SF, Byrne M. Embedding a user-centred approach in the development of complex behaviour change intervention to improve outcomes for young adults living with type 1 diabetes: The D1 Now Study. HRB Open Res 2018. [PMID: 32002502 DOI: 10.12688/hrbopenres.12803.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Type 1 diabetes (T1D) is an auto-immune condition which requires intensive self-management. Diabetes self-management is challenging, especially during young adulthood. Effective interventions to improve outcomes for young adults with T1D are needed. This paper describes the development of the D1 Now intervention, employing a user-centred approach to engage with stakeholders in parallel with the application of theory. Methods: Intervention development consisted of 4 phases: 1) the formation of a public and patient involvement (PPI) Young Adult Panel (YAP); 2) a systematic review to synthesise evidence regarding the effectiveness of interventions aimed at improving outcomes for young adults with T1D; 3) understand young adults' diabetes self-management behaviour through engagement with key stakeholders; and 4) an expert consensus meeting to discuss self-management strategies identified in Phase 1 and 3 that would form the core components of the D1 Now intervention. Results: The YAP resulted in meaningful involvement between young adults, researchers and service providers. The systematic review highlighted a lack of quality intervention studies. Qualitative findings highlighted how young adult self-management is driven by complex interactions between external resources, which influence capability, and motivation. The expert panel in Phase 4 highlighted focus areas to improve outcomes for young adults and implementation strategies. Subsequent to these 4 phases, 3 intervention components have been identified: 1) a key worker to liaise with the young adult; 2) an online portal to facilitate relationship building between staff and young adults; and 3) an agenda setting tool to facilitate joint decision-making. Conclusions: This study described the systematic development of an intervention underpinned by theoretical frameworks and PPI, and has identified components for the D1 Now intervention. The resulting intervention content will now be subject to an intervention optimisation process.
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Affiliation(s)
- Deirdre M J Walsh
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, H91 EV56, Ireland.,School of Medicine, National University of Ireland, Galway, Galway, H91 V4AY, Ireland
| | - Lisa Hynes
- SPLAT (Pediatric Lab for Adherence and Transition), West Virginia University, Morgantown, WV, 26506, USA
| | - Mary Clare O'Hara
- Research and Development, Strategic Planning and Transformation, Health Service Executive, Dublin 8, D08 W2A8, Ireland
| | - Jenny Mc Sharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, H91 EV56, Ireland
| | | | - Séan F Dinneen
- School of Medicine, National University of Ireland, Galway, Galway, H91 V4AY, Ireland.,Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, H91 YR71, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, H91 EV56, Ireland
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Walsh DMJ, Hynes L, O'Hara MC, Mc Sharry J, Dinneen SF, Byrne M. Embedding a user-centred approach in the development of complex behaviour change intervention to improve outcomes for young adults living with type 1 diabetes: The D1 Now Study. HRB Open Res 2018; 1:8. [PMID: 32002502 PMCID: PMC6973524 DOI: 10.12688/hrbopenres.12803.2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Type 1 diabetes (T1D) is an auto-immune condition which requires intensive self-management. Diabetes self-management is challenging, especially during young adulthood. Effective interventions to improve outcomes for young adults with T1D are needed. This paper describes the development of the D1 Now intervention, employing a user-centred approach to engage with stakeholders in parallel with the application of theory. Methods: Intervention development consisted of 4 phases: 1) the formation of a public and patient involvement (PPI) Young Adult Panel (YAP); 2) a systematic review to synthesise evidence regarding the effectiveness of interventions aimed at improving outcomes for young adults with T1D; 3) understand young adults' diabetes self-management behaviour through engagement with key stakeholders; and 4) an expert consensus meeting to discuss self-management strategies identified in Phase 1 and 3 that would form the core components of the D1 Now intervention. Results: The YAP resulted in meaningful involvement between young adults, researchers and service providers. The systematic review highlighted a lack of quality intervention studies. Qualitative findings highlighted how young adult self-management is driven by complex interactions between external resources, which influence capability, and motivation. The expert panel in Phase 4 highlighted focus areas to improve outcomes for young adults and implementation strategies. Subsequent to these 4 phases, 3 intervention components have been identified: 1) a key worker to liaise with the young adult; 2) an online portal to facilitate relationship building between staff and young adults; and 3) an agenda setting tool to facilitate joint decision-making. Conclusions: This study described the systematic development of an intervention underpinned by theoretical frameworks and PPI, and has identified components for the D1 Now intervention. The resulting intervention content will now be subject to an intervention optimisation process.
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Affiliation(s)
- Deirdre M J Walsh
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, H91 EV56, Ireland.,School of Medicine, National University of Ireland, Galway, Galway, H91 V4AY, Ireland
| | - Lisa Hynes
- SPLAT (Pediatric Lab for Adherence and Transition), West Virginia University, Morgantown, WV, 26506, USA
| | - Mary Clare O'Hara
- Research and Development, Strategic Planning and Transformation, Health Service Executive, Dublin 8, D08 W2A8, Ireland
| | - Jenny Mc Sharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, H91 EV56, Ireland
| | | | - Séan F Dinneen
- School of Medicine, National University of Ireland, Galway, Galway, H91 V4AY, Ireland.,Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, H91 YR71, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, H91 EV56, Ireland
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79
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Vallis M, Willaing I, Holt RIG. Emerging adulthood and Type 1 diabetes: insights from the DAWN2 Study. Diabet Med 2018; 35:203-213. [PMID: 29171084 DOI: 10.1111/dme.13554] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2017] [Indexed: 12/20/2022]
Abstract
AIMS To compare clinical, psychological, education and social variables in emerging adults (aged 18-30 years) with Type 1 diabetes with their adult counterparts aged >30 years. METHODS A single assessment multinational sample was surveyed as part of the larger second Diabetes Attitudes, Wishes and Needs (DAWN2) study. Participants completed a series of surveys incorporating demographic as well as clinical questions (comorbidities, hypoglycaemia) and validated self-report scales concerning psychosocial (health impact, quality of life, beliefs and attitudes, self-management behaviours, healthcare experience and family support) and diabetes education factors. RESULTS Emerging adults differed from adults aged >30 years with regard to a number of psychosocial variables. Emerging adults reported better overall quality of life, social support and support from their healthcare team compared with adults aged >30 years of age; however, emerging adults experienced greater diabetes-specific distress and were less engaged in self-management. Diabetes education was related to a number of indicators, while experience of discrimination was harmful, but these impacts did not differ between emerging adults and adults aged >30 years. An analysis of geographical regions suggested that emerging adults in North America and Europe had better well-being than older adults, while the opposite was observed in Asia. CONCLUSIONS Emerging adults, particularly those in the later phase (ages 25-30 years) are especially at risk in terms of diabetes-specific distress. There is a need for novel interventions to meet the needs of these vulnerable emerging adults more effectively.
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Affiliation(s)
- M Vallis
- Behaviour Change Institute, Nova Scotia Health Authority and Dalhousie University, Halifax, Nova Scotia, Canada
| | - I Willaing
- Diabetes Management Research, Health Promotion Research, Steno Diabetes Centre, Copenhagen, Denmark
| | - R I G Holt
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
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80
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Fisher E, Lazar L, Shalitin S, Yackobovitch-Gavan M, de Vries L, Oron T, Tenenbaum A, Phillip M, Lebenthal Y. Association between Glycemic Control and Clinic Attendance in Emerging Adults with Type 1 Diabetes: A Tertiary Center Experience. J Diabetes Res 2018; 2018:9572817. [PMID: 30116747 PMCID: PMC6079433 DOI: 10.1155/2018/9572817] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/21/2018] [Accepted: 06/19/2018] [Indexed: 11/17/2022] Open
Abstract
AIMS The transition of emerging adults with type 1 diabetes (T1D) from pediatric diabetes clinics to adult clinics between 18 and 21 years of age could result in decreased clinic attendance and thus worsen glycemic control. Our institutional policy offering surveillance till age 30 enabled us to evaluate clinic attendance without the confounding effect of transition. Our aim was to determine the association between glycemic control (HbA1c) and attendance rate. METHODS The medical records of 261 (54% males) young adult T1D patients (median age 22.9 years) were reviewed. Patients were stratified according to the attainment/nonattainment of glycemic targets (HbA1c ≤ 7% versus HbA1c > 7% (53 mmol/mol)). The attendance rate was calculated as the number of clinic visits/number of scheduled appointments. RESULTS Median annual number of scheduled visits was 3 (3, 4); attendance rate was 75% (53.6%, 100%). Seventy-four (28.4%) patients attained glycemic targets (median HbA1c 6.5% (48 mmol/mol) (6.3%, 6.8% (45.51 mmol/mol)); 187 (71.6%) patients had a median HbA1c of 7.8% (62 mmol/mol) (7.4%, 8.4% (57.68 mmol/mol)). The attainment of the treatment target was more prevalent in older patients (P = 0.006), in male patients (P = 0.007), and in patients with higher education (P = 0.017). Higher attendance rate (β (2.483), P < 0.001) and male gender (β (0.746), P = 0.015) were associated with better metabolic control. CONCLUSIONS In emerging adults with T1D during the ongoing stable phase of diabetes management, higher attendance rate, rather than absolute number of clinic visits, was associated with the attainment of glycemic targets.
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Affiliation(s)
- Eldad Fisher
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Liora Lazar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva 49202, Israel
| | - Shlomit Shalitin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva 49202, Israel
| | - Michal Yackobovitch-Gavan
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva 49202, Israel
| | - Liat de Vries
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva 49202, Israel
| | - Tal Oron
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva 49202, Israel
| | - Ariel Tenenbaum
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva 49202, Israel
| | - Moshe Phillip
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva 49202, Israel
| | - Yael Lebenthal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva 49202, Israel
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81
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Byrne M, O’Connell A, Egan AM, Dinneen SF, Hynes L, O’Hara MC, Holt RIG, Willaing I, Vallis M, Hendrieckx C, Coyne I. A core outcomes set for clinical trials of interventions for young adults with type 1 diabetes: an international, multi-perspective Delphi consensus study. Trials 2017; 18:602. [PMID: 29258565 PMCID: PMC5735534 DOI: 10.1186/s13063-017-2364-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 11/29/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Achieving consensus from a range of relevant stakeholders about an agreed set of core outcomes to be measured and reported as a minimum in clinical trials has the potential to enhance evidence synthesis and make findings more relevant and applicable. Intervention research to improve outcomes for young adults with type 1 diabetes (T1DM) is hampered by inconsistent use of outcome measures. This population frequently struggles to manage their condition and reports suboptimal clinical outcomes. Our aim was to conduct an international, e-Delphi consensus study to identify a core outcome set (COS) that key stakeholders (young adults with T1DM, diabetes health professionals, diabetes researchers and diabetes policy makers) consider as essential outcomes for future intervention research. METHODS Using a list of 87 outcomes generated from a published systematic review, we administered two online surveys to a sample of international key stakeholders. Participants in the first survey (survey 1; n = 132) and the second survey (survey 2; n = 81) rated the importance of the outcomes. Survey 2 participants received information on total mean rating for each outcome and a reminder of their personal outcome ratings from Survey 1. Survey 2 results were discussed at a consensus meeting and participants (n = 12: three young adults with T1DM, four diabetes health professionals, four diabetes researchers and one diabetes policy maker) voted on outcomes. Final core outcomes were included provided that 70% of consensus group participants voted for their inclusion. RESULTS Eight core outcomes were agreed for inclusion in the final COS: measures of diabetes-related stress; diabetes-related quality of life; number of severe hypoglycaemic events; self-management behaviour; number of instances of diabetic ketoacidosis (DKA); objectively measured glycated haemoglobin (HbA1C); level of clinic engagement; and perceived level of control over diabetes. CONCLUSIONS This study is the first to identify a COS for inclusion in future intervention trials to improve outcomes for young adults with T1DM. Use of this COS will improve the quality of future research and increase opportunities for evidence synthesis. Future research is necessary to identify the most robust outcome measure instruments.
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Affiliation(s)
- Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
| | - Anthony O’Connell
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
| | - Aoife M. Egan
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Sean F. Dinneen
- School of Medicine, National University of Ireland, Galway, Ireland
- Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland
| | - Lisa Hynes
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
| | - Mary Clare O’Hara
- School of Medicine, National University of Ireland, Galway, Ireland
- Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland
| | - Richard I. G. Holt
- Human Development and Health Academic Unit, University of Southampton Faculty of Medicine, Southampton, UK
| | - Ingrid Willaing
- Health Promotion Research, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Michael Vallis
- Department of Family Medicine, Dalhousie University, Halifax, NS Canada
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, VIC Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC Australia
| | - Imelda Coyne
- Trinity College Dublin, School of Nursing and Midwifery, Dublin, Ireland
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O’Hara MC, Hynes L, O’Donnell M, Keighron C, Allen G, Caulfield A, Duffy C, Long M, Mallon M, Mullins M, Tonra G, Byrne M, Dinneen SF. Strength in Numbers: an international consensus conference to develop a novel approach to care delivery for young adults with type 1 diabetes, the D1 Now Study. RESEARCH INVOLVEMENT AND ENGAGEMENT 2017; 3:25. [PMID: 29214056 PMCID: PMC5713095 DOI: 10.1186/s40900-017-0076-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 10/27/2017] [Indexed: 06/07/2023]
Abstract
PLAIN ENGLISH SUMMARY Many young adults with type 1 diabetes struggle with the day-to-day management of their condition. They often find it difficult to find the time to attend their clinic appointments and to meet with their diabetes healthcare team. Young adults living with type 1 diabetes are not routinely involved in research that may help improve health services other than being invited to take part in studies as research participants. A 3-day international conference was held in Galway in June 2016 called "Strength In Numbers: Teaming up to improve the health of young adults with type 1 diabetes". It aimed to bring together people from a broad variety of backgrounds with an interest in young adults with type 1 diabetes. Young people with type 1 diabetes came together with healthcare professionals, researchers, software developers and policy makers to come up with and agree on a new approach for engaging young adults with type 1 diabetes with their health services and to improve how they manage their diabetes.The people involved in the conference aimed to reach agreement (consensus) on a fixed set of outcome measures called a core outcome set (COS) that the group would recommend future studies involving young adults with type 1 diabetes to use, to suggest a new approach (intervention) for providing health services to young adults with type 1 diabetes, and to come up with health technology ideas that could help deliver the new intervention. Over the 3 days, this diverse international group of people that included young adults living with type 1 diabetes, agreed on a COS, 3 key parts of a new intervention and 1 possible health technology idea that could help with how the overall intervention could be delivered.Involving young adults living with type 1 diabetes in a 3-day conference along with other key groups is an effective method for coming up with a new approach to improve health services for young adults with type 1 diabetes and better support their self-management. ABSTRACT Background A 3-day international consensus meeting was hosted by the D1 Now study team in Galway on June 22-24, 2016 called "Strength In Numbers: Teaming up to improve the health of young adults with type 1 diabetes". The aim of the meeting was to bring together young adults with type 1 diabetes, healthcare providers, policy makers and researchers to reach a consensus on strategies to improve engagement, self-management and ultimately outcomes for young adults living with type 1 diabetes. Methods This diverse stakeholder group participated in the meeting to reach consensus on (i) a core outcome set (COS) to be used in future intervention studies involving young adults with type 1 diabetes, (ii) new strategies for delivering health services to young adults and (iii) potential digital health solutions that could be incorporated into a future intervention. Results A COS of 8 outcomes and 3 key intervention components that aim to improve engagement between young adults with type 1 diabetes and service providers were identified. A digital health solution that could potentially compliment the intervention components was proposed. Conclusion The outputs from the 3-day consensus conference, that held patient and public involvement at its core, will help the research team further develop and test the D1 Now intervention for young adults with type 1 diabetes in a pilot and feasibility study and ultimately in a definitive trial. The conference represents a good example of knowledge exchange among different stakeholders for health research and service improvement.
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Affiliation(s)
- M. C. O’Hara
- School of Medicine, National University of Ireland, Galway, Galway, Ireland
- Health and Wellbeing Division, Health Service Executive, Merlin Park University Hospital, 2nd Floor, Block A H91 N973, Galway, Ireland
| | - L. Hynes
- SPLAT (Pediatric Lab for Adherence and Transition), West Virginia University, Morgantown, USA
| | - M. O’Donnell
- School of Medicine, National University of Ireland, Galway, Galway, Ireland
| | - C. Keighron
- Member of the D1 Now Young Adult Panel, Galway, Ireland
| | - G. Allen
- Member of the D1 Now Young Adult Panel, Galway, Ireland
| | - A. Caulfield
- Member of the D1 Now Young Adult Panel, Galway, Ireland
| | - C. Duffy
- Member of the D1 Now Young Adult Panel, Galway, Ireland
| | - M. Long
- Member of the D1 Now Young Adult Panel, Galway, Ireland
| | - M. Mallon
- Member of the D1 Now Young Adult Panel, Galway, Ireland
| | - M. Mullins
- Member of the D1 Now Young Adult Panel, Galway, Ireland
| | - G. Tonra
- Member of the D1 Now Young Adult Panel, Galway, Ireland
| | - M. Byrne
- School of Psychology, National University of Ireland, Galway, Galway, Ireland
| | - S. F. Dinneen
- School of Medicine, National University of Ireland, Galway, Galway, Ireland
- Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
| | - with the D1 Now Type 1 Diabetes Young Adult Study Group
- School of Medicine, National University of Ireland, Galway, Galway, Ireland
- Health and Wellbeing Division, Health Service Executive, Merlin Park University Hospital, 2nd Floor, Block A H91 N973, Galway, Ireland
- SPLAT (Pediatric Lab for Adherence and Transition), West Virginia University, Morgantown, USA
- Member of the D1 Now Young Adult Panel, Galway, Ireland
- School of Psychology, National University of Ireland, Galway, Galway, Ireland
- Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
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83
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Simms M, Baumann K, Monaghan M. Health Communication Experiences of Emerging Adults with Type 1 Diabetes. CLINICAL PRACTICE IN PEDIATRIC PSYCHOLOGY 2017; 5:415-425. [PMID: 29456906 DOI: 10.1037/cpp0000211] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objective In an effort to refine a model of clinical care identifying effective communication with health care providers (HCPs) as a key skill for successful transition to adult medical care, this study explored the perspectives of emerging adults with type 1 diabetes (T1D) about factors that impact the quality and content of communication with their HCPs. Methods Twenty emerging adults with T1D were interviewed about health communication experiences with their pediatric HCP and readiness for transition to adult diabetes care. Interviews were recorded and transcribed; three raters coded transcripts using conventional content analysis for broad themes. Results Five themes emerged from the data capturing factors that influence emerging adult-HCP communication: HCP interaction style, HCP consistency, HCP support for autonomy, parental involvement in medical care, and emerging adult comfort with disclosure. Most emerging adults had not discussed transition to adult diabetes care with their HCP; some expressed confidence in their ability to transition while others expressed anxiety about the transition process. Conclusions Findings support the conceptual model of communication and inform clinical implications for working with emerging adults with T1D. Continuity of care should be prioritized with transition-age patients. Additionally, HCPs should initiate conversations about engagement in risky behaviors and transition to adult medical care and ensure emerging adults have time without parents to discuss these sensitive topics. Psychologists can enhance the transition process by facilitating effective patient-HCP communication and coaching both patients and HCPs to ask questions about risky behaviors and transition to adult medical care.
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Affiliation(s)
| | | | - Maureen Monaghan
- Children's National Health System, Washington, DC.,George Washington University School of Medicine, Washington, DC
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84
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Wong CA, Miller VA, Murphy K, Small D, Ford CA, Willi SM, Feingold J, Morris A, Ha YP, Zhu J, Wang W, Patel MS. Effect of Financial Incentives on Glucose Monitoring Adherence and Glycemic Control Among Adolescents and Young Adults With Type 1 Diabetes: A Randomized Clinical Trial. JAMA Pediatr 2017; 171:1176-1183. [PMID: 29059263 PMCID: PMC6583649 DOI: 10.1001/jamapediatrics.2017.3233] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
IMPORTANCE Glycemic control often deteriorates during adolescence and the transition to young adulthood for patients with type 1 diabetes. The inability to manage type 1 diabetes effectively during these years is associated with poor glycemic control and complications from diabetes in adult life. OBJECTIVE To determine the effect of daily financial incentives on glucose monitoring adherence and glycemic control in adolescents and young adults with type 1 diabetes. DESIGN, SETTING, AND PARTICIPANTS The Behavioral Economic Incentives to Improve Glycemic Control Among Adolescents and Young Adults With Type 1 Diabetes (BE IN CONTROL) study was an investigator-blinded, 6-month, 2-arm randomized clinical trial conducted between January 22 and November 2, 2016, with 3-month intervention and follow-up periods. Ninety participants (aged 14-20) with suboptimally controlled type 1 diabetes (hemoglobin A1c [HbA1c] >8.0%) were recruited from the Diabetes Center for Children at the Children's Hospital of Philadelphia. INTERVENTIONS All participants were given daily blood glucose monitoring goals of 4 or more checks per day with 1 or more level within the goal range (70-180 mg/dL) collected with a wireless glucometer. The 3-month intervention consisted of a $60 monthly incentive in a virtual account, from which $2 was subtracted for every day of nonadherence to the monitoring goals. During a 3-month follow-up period, the intervention was discontinued. MAIN OUTCOMES AND MEASURES The primary outcome was change in HbA1c levels at 3 months. Secondary outcomes included adherence to glucose monitoring and change in HbA1c levels at 6 months. All analyses were by intention to treat. RESULTS Of the 181 participants screened, 90 (52 [57.8%] girls) were randomized to the intervention (n = 45) or control (n = 45) arms. The mean (SD) age was 16.3 (1.9) years. The intervention group had significantly greater adherence to glucose monitoring goals in the incentive period (50.0% vs 18.9%; adjusted difference, 27.2%; 95% CI, 9.5% to 45.0%; P = .003) but not in the follow-up period (15.3% vs 8.7%; adjusted difference, 3.9%; 95% CI, -2.0% to 9.9%; P = .20). The change in HbA1c levels from baseline did not differ significantly between groups at 3 months (adjusted difference, -0.08%; 95% CI, -0.69% to 0.54%; P = .80) or 6 months (adjusted difference, 0.03%; 95% CI, -0.55% to 0.60%; P = .93). CONCLUSIONS AND RELEVANCE Among adolescents and young adults with type 1 diabetes, daily financial incentives improved glucose monitoring adherence during the incentive period but did not significantly improve glycemic control. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02568501.
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Affiliation(s)
- Charlene A. Wong
- Department of Pediatrics, Duke Clinical Research Institute, Duke-Margolis Center for Health Policy, Duke University, Durham, North Carolina,Leonard Davis Institute of Health Economics, Center for Health Incentives and Behavioral Economics at the University of Pennsylvania, Philadelphia
| | - Victoria A. Miller
- Division of Adolescent Medicine, The Children’s Hospital of Philadelphia, Perelman School of Medicine and University of Pennsylvania, Philadelphia
| | - Kathryn Murphy
- Division of Pediatric Endocrinology, The Children’s Hospital of Philadelphia, Philadelphia
| | - Dylan Small
- Leonard Davis Institute of Health Economics, Center for Health Incentives and Behavioral Economics at the University of Pennsylvania, Philadelphia,Department of Statistics, The Wharton School, University of Pennsylvania, Philadelphia
| | - Carol A. Ford
- Division of Adolescent Medicine, The Children’s Hospital of Philadelphia, Perelman School of Medicine and University of Pennsylvania, Philadelphia
| | - Steven M. Willi
- Division of Pediatric Endocrinology, The Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia
| | - Jordyn Feingold
- medical student, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alexander Morris
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Yoonhee P. Ha
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Jingsan Zhu
- Leonard Davis Institute of Health Economics, Center for Health Incentives and Behavioral Economics at the University of Pennsylvania, Philadelphia,Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Wenli Wang
- Leonard Davis Institute of Health Economics, Center for Health Incentives and Behavioral Economics at the University of Pennsylvania, Philadelphia,Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Mitesh S. Patel
- Leonard Davis Institute of Health Economics, Center for Health Incentives and Behavioral Economics at the University of Pennsylvania, Philadelphia,Perelman School of Medicine at the University of Pennsylvania, Philadelphia,Department of Medicine, Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania,Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia
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85
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Horný M, Glover W, Gupte G, Saraswat A, Vimalananda V, Rosenzweig J. Patient navigation to improve diabetes outpatient care at a safety-net hospital: a retrospective cohort study. BMC Health Serv Res 2017; 17:759. [PMID: 29162073 PMCID: PMC5699176 DOI: 10.1186/s12913-017-2700-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 11/07/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Recent emphasis on value based care and population management, such as Accountable Care Organizations in the United States, promote patient navigation to improve the quality of care and reduce costs. Evidence supporting the efficacy of patient navigation for chronic disease care is limited. The objective of this study was to evaluate the effect of a patient navigation program on medical and administrative outcomes among patients with diabetes in an urban, safety-net hospital clinic setting. METHODS A retrospective cohort study with pre- and post-intervention periods was conducted. Eligible patients were those with A1C ≥ 8.5% and at least one appointment no-show in the previous 12 months. The intervention and reference groups were balanced on observed characteristics and baseline outcome levels using propensity score matching. The effect of patient navigation was isolated using the difference-in-differences approach. Primary outcomes were A1C, low-density lipoprotein cholesterol, triglycerides, random urine microalbumin, the number of scheduled appointments, clinic visits, emergency visits, and inpatient stays, and the percentage of arrivals, cancellations, and no-shows to scheduled appointments. RESULTS Of 797 eligible patients, 328 entered the navigation program. Matching reduced the sample size to 392 individuals (196 in each group). Patient navigation resulted in improved A1C (-1.1 percentage points; p < .001), more scheduled appointments (+ 5.3 per year; p < .001), more clinic visits (+6.4 per year; p < .001), more arrivals to scheduled appointments (+7.4 percentage points; p = .009) and fewer no-shows (-9.8 percentage points; p < .001). CONCLUSIONS Navigation was associated with improved glycemic control and better clinic engagement among patients with diabetes. Further research is important to identify what features of navigation in diabetes care are critical to achieving success and to understand navigators' role in other settings.
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Affiliation(s)
- Michal Horný
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Woodruff Memorial Research Building, Room 1215A, 101 Woodruff Circle, Atlanta, GA 30322 USA
- Department of Health Policy and Management, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322 USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany St, Boston, MA 02118 USA
| | - Wiljeana Glover
- Department of Technology, Operations, and Information Management, Babson College, 231 Forest Street, Babson Park, MA 02457 USA
| | - Gouri Gupte
- Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany St, Boston, MA 02118 USA
- Cambridge Health Alliance, 1035 Cambridge Street, Cambridge, MA 02139 USA
| | - Aruna Saraswat
- Tufts Medical Center, 800 Washington Street, Boston, MA 02111 USA
| | - Varsha Vimalananda
- Department of Medicine, Boston University School of Medicine, 715 Albany St, Boston, MA 02118 USA
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Affairs Medical Center, 200 Springs Road, Bedford, MA 01730 USA
| | - James Rosenzweig
- Department of Medicine, Boston University School of Medicine, 715 Albany St, Boston, MA 02118 USA
- Hebrew Rehabilitation Hospital, 1200 Centre Street, Boston, MA 02131 USA
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86
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Kızıler E, Yıldız D, Eren Fidancı B. Validation of Transition Readiness Assessment Questionaire in Turkish Adolescents with Diabetes. Balkan Med J 2017; 35:93-100. [PMID: 29039345 PMCID: PMC5820454 DOI: 10.4274/balkanmedj.2016.1415] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Today, more than 90% of adolescents with chronic conditions survive into adulthood and move from pediatric care to adult care for the management of their chronic illness. It is important to grant autonomy and ensure that adolescents/young adults are ready to use the adult health care system prior to the transfer of care. However, the lack of a transition readiness assessment tool that is validated, patient-centered, and appropriate to developmental differences in pediatric care is a major obstacle for the transition of care from pediatric services to adult services. AIMS This study examined the validity and reliability of the Turkish version of the Transition Readiness Assessment Questionnaire, which assesses the readiness for transition from pediatric to adult health care for adolescents/young adults with diabetes mellitus. STUDY DESIGN Methodological study. METHODS Participants were 109 adolescents/young adults with type 1 diabetes mellitus aged 14-21 years. After permission was obtained to adapt the Transition Readiness Assessment Questionnaire, the Turkish Transition Readiness Assessment Questionnaire and self-care scale were administered to participants through face-to-face interviews at two pediatric endocrinology clinics. Validity was evaluated by exploratory and confirmatory factor analysis and content-scope validity assessment; reliability was evaluated by item-total score correlation and continuity methods. Internal reliability was assessed by Cronbach's alpha coefficient and criterion validity assessment. RESULTS The item analysis, exploratory factor analysis, and confirmatory factor analysis identified five basic dimensions, with high internal consistency (0.89-0.75). The ratio χ2/df and other conformity indices were a good fit to the data. The correlation coefficient in the analyses of test-retest scores was 0.86 for the total scale (p<0.05), and the Cronbach's alpha coefficient was 0.88 for overall scale. CONCLUSION The Turkish Transition Readiness Assessment Questionnaire is a valid and reliable measure of the transition readiness of adolescents/young adults with diabetes mellitus in Turkey. The Transition Readiness Assessment Questionnaire assesses the self-management abilities and health care transition knowledge of adolescents/young adults with diabetes mellitus who need special health care. It can also serve as a guide for health care professionals in detecting the educational fields that are necessary for acquiring self-management and self-care abilities.
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Affiliation(s)
- Evrim Kızıler
- Clinic of Pediatrics, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
| | - Dilek Yıldız
- Department of Pediatric Nursing, University of Health Sciences, Gülhane School of Nursing, Ankara, Turkey
| | - Berna Eren Fidancı
- Department of Pediatric Nursing, University of Health Sciences, Gülhane School of Nursing, Ankara, Turkey
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87
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Departure from Pediatric Care: Transitioning of Adolescents with Chronic Pain to Adult Care. Pain Manag Nurs 2017; 18:273-277. [DOI: 10.1016/j.pmn.2017.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 02/09/2017] [Accepted: 05/15/2017] [Indexed: 11/18/2022]
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88
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Kelly CS, Berg CA, Ramsey MA, Baker AC, Donaldson DL, Swinyard MT, Lindsay R, Murray M, Wiebe DJ. Relationships and the development of transition readiness skills into early emerging adulthood for individuals with type 1 diabetes. CHILDRENS HEALTH CARE 2017; 47:308-325. [PMID: 30906104 PMCID: PMC6426132 DOI: 10.1080/02739615.2017.1354294] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The study examined how 'transition readiness' skills develop from relationship processes with parents, friends, and healthcare providers. During their senior year of high school and one year later, participants (N = 217) with type 1 diabetes completed measures of transition readiness skills (Self-Management; Self-Advocacy), adherence, HbA1c, and relationships with providers (patient-centered communication), parents (monitoring/knowledge), and friends (knowledge/helpfulness) surrounding diabetes. Self-Management skills increased across time. Higher friend knowledge/helpfulness during emerging adulthood was associated with increased Self-Management skills. Adherence improved when relationships with providers and friends matched transition readiness skills, indicating that these relationships may facilitate transition skills in early emerging adulthood.
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Affiliation(s)
- Caitlin S. Kelly
- Department of Psychology, University of Utah, Salt Lake City, UT
| | - Cynthia A. Berg
- Department of Psychology, University of Utah, Salt Lake City, UT
| | - Meagan A. Ramsey
- Department of Psychology, University of Utah, Salt Lake City, UT
| | - Ashley C. Baker
- Psychological Sciences and Health Sciences Research Institute, University of California, Merced, Merced, CA
| | - David L. Donaldson
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | | | - Rob Lindsay
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - Mary Murray
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - Deborah J. Wiebe
- Psychological Sciences and Health Sciences Research Institute, University of California, Merced, Merced, CA
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89
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Coyne I, Sheehan AM, Heery E, While AE. Improving transition to adult healthcare for young people with cystic fibrosis: A systematic review. J Child Health Care 2017; 21:312-330. [PMID: 29119815 DOI: 10.1177/1367493517712479] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
As survival increases worldwide, large numbers of young people will need to transition from child to adult cystic fibrosis (CF) services. Little is known about the best method for transitioning patients with CF and which transition programmes yield better outcomes. This paper provides a systematic review of the empirical literature on the outcomes and experiences of transition for young people with CF. Outcomes data were subject to a narrative synthesis and a thematic synthesis of experiences data. Structured transition programmes were associated with increased satisfaction, discussions about transition, self-care and self-advocacy skills, more independence, lower anxiety, and increased self-management and parent management of physiotherapy and nutritional supplementation. Young people's concerns included leaving behind previous caregivers, differences in care provision and infection risks. Lack of preparation was a consistent theme. The two most useful aspects of transition programmes were meeting the adult doctors/CF specialist nurse/team and visiting the adult centre. Young people want education about the differences between services, implications of their condition and self-care management. Structured transition programmes appear to impact positively on experiences but the contribution of the different components of transition programmes is unclear. The absence of high-quality studies indicates the need for more well-designed research.
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Affiliation(s)
| | | | | | - Alison E While
- 2 Florence Nightingale School of Nursing & Midwifery, King's College London, London, UK
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90
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Chaplin S. The impact of transition on NHS diabetes service delivery: key audit results spanning 2003-2014. PRACTICAL DIABETES 2017. [DOI: 10.1002/pdi.2131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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91
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Interventions to improve treatment, retention and survival outcomes for adolescents with perinatal HIV-1 transitioning to adult care: moving on up. Curr Opin HIV AIDS 2017; 11:477-486. [PMID: 27272537 DOI: 10.1097/coh.0000000000000302] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW There is an increasing number of deaths among adult survivors of perinatal HIV. Multiple and complex factors drive this mortality, including problems with retention in care and adherence during adolescence, coupled with the critical period of transition from paediatric to adult care, increasing their risk of treatment failure and severe immunosuppression. We reviewed studies that evaluated the impact of service delivery interventions to improve the health of perinatally infected adolescents living with HIV (P-ALHIV) to gain insight into what might help them survive the vulnerable period of adolescence. RECENT FINDINGS Youth-focused health services and individual-level interventions may improve P-ALHIV adherence and retention in care. However, there have been few studies, many with small sample sizes and with short durations of follow-up that end before the transition period. Studies from other childhood-onset chronic diseases are similarly limited. SUMMARY Further studies are urgently needed to identify optimal intervention strategies to reduce mortality and poor outcomes as the adolescent population expands and ages into adult care. Until we have a more robust evidence base, programmes can develop transition plans based on best practice recommendations to optimize the health and longevity of ALHIV in adulthood.
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92
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O'Hara MC, Hynes L, O'Donnell M, Nery N, Byrne M, Heller SR, Dinneen SF. A systematic review of interventions to improve outcomes for young adults with Type 1 diabetes. Diabet Med 2017; 34:753-769. [PMID: 27761951 PMCID: PMC5484309 DOI: 10.1111/dme.13276] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Many young adults with Type 1 diabetes experience poor outcomes. The aim of this systematic review was to synthesize the evidence regarding the effectiveness of interventions aimed at improving clinical, behavioural or psychosocial outcomes for young adults with Type 1 diabetes. METHODS Electronic databases were searched. Any intervention studies related to education, support, behaviour change or health service organizational change for young adults aged between 15-30 years with Type 1 diabetes were included. A narrative synthesis of all studies was undertaken due to the large degree of heterogeneity between studies. RESULTS Eighteen studies (of a possible 1700) were selected and categorized: Health Services Delivery (n = 4), Group Education and Peer Support (n = 6), Digital Platforms (n = 4) and Diabetes Devices (n = 4). Study designs included one randomized controlled trial, three retrospective studies, seven feasibility/acceptability studies and eight studies with a pre/post design. Continuity, support, education and tailoring of interventions to young adults were the most common themes across studies. HbA1c was the most frequently measured outcome, but only 5 of 12 studies that measured it showed a significant improvement. CONCLUSION Based on the heterogeneity among the studies, the effectiveness of interventions on clinical, behavioural and psychosocial outcomes among young adults is inconclusive. This review has highlighted a lack of high-quality, well-designed interventions, aimed at improving health outcomes for young adults with Type 1 diabetes.
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Affiliation(s)
- M. C. O'Hara
- School of MedicineNUI GalwayGalwayIreland
- Endocrinology and Diabetes CentreGalway University HospitalsGalwayIreland
| | - L. Hynes
- School of PsychologyNUI GalwayGalwayIreland
| | | | - N. Nery
- School of MedicineNUI GalwayGalwayIreland
| | - M. Byrne
- School of PsychologyNUI GalwayGalwayIreland
| | - S. R. Heller
- Department of Human MetabolismAcademic Unit of DiabetesEndocrinology and MetabolismUniversity of SheffieldSheffieldUK
| | - S. F. Dinneen
- School of MedicineNUI GalwayGalwayIreland
- Endocrinology and Diabetes CentreGalway University HospitalsGalwayIreland
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Castensøe-Seidenfaden P, Jensen AK, Smedegaard H, Hommel E, Husted GR, Pedersen-Bjergaard U, Teilmann G. Clinical, behavioural and social indicators for poor glycaemic control around the time of transfer to adult care: a longitudinal study of 126 young people with diabetes. Diabet Med 2017; 34:667-675. [PMID: 28099760 DOI: 10.1111/dme.13318] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2017] [Indexed: 01/09/2023]
Abstract
AIMS To describe and compare changes in glycaemic control in young people with Type 1 diabetes over time between the last 2 years in paediatric care and the first 2 years in adult care and to identify risk factors for poor glycaemic control. METHODS Our retrospective cohort study followed participants aged 14-22 years from 2 years before to 2 years after transfer from paediatric to adult care. Changes in glycaemic control were calculated using repeated measurements. We adjusted for gender, age at diabetes onset, age at transfer, duration of diabetes at transfer, gap (amount of time) between last paediatric and first adult visit, comorbidity, learning disability and/or mental health conditions and family structure. We examined associations between acute hospital admissions, low visit attendance rate, loss to follow-up and baseline HbA1c level. RESULTS Among 126 participants, the mean HbA1c level was 80 mmol/mol (9.4%) pre-transfer but decreased by an average of 3 mmol/mol (0.3%) each year post-transfer (P = 0.005). Young people with a learning disability and/or a mental health condition had worse glycaemic control (P = 0.041) and the mean HbA1c of those with divorced parents was 14 mmol/mol (1.2%) higher (P = 0.014). Almost one-third of participants were admitted to the hospital for acute diabetes care. Low visit attendance rate, high baseline HbA1c level, learning disability and/or mental health conditions and divorced parents predicted acute hospital admissions. CONCLUSIONS Glycaemic control improved significantly after transfer to adult care, but the mean HbA1c level remained high. Future interventions should focus on young people with divorced parents, those with a learning disability and/or mental health condition and those who do not attend clinical visits to improve HbA1c levels and thereby reduce hospitalization rates.
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Affiliation(s)
| | - A K Jensen
- Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Research, Nordsjaellands Hospital, Hillerød, Denmark
| | - H Smedegaard
- Paediatric and Adolescent Department, Nordsjaellands Hospital, Hillerød, Denmark
| | - E Hommel
- Steno Diabetes Centre, Gentofte, Denmark
| | - G R Husted
- Steno Diabetes Centre, Gentofte, Denmark
| | - U Pedersen-Bjergaard
- Department of Cardiology, Nephrology and Endocrinology, Nordsjaellands Hospital, Hillerød, Denmark
| | - G Teilmann
- Paediatric and Adolescent Department, Nordsjaellands Hospital, Hillerød, Denmark
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94
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An investigation of the foot ankle joint mobility, muscle strength, and foot structure in adolescent with type 1 diabetes. Int J Diabetes Dev Ctries 2017. [DOI: 10.1007/s13410-017-0556-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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95
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Mauri A, Schmidt S, Sosero V, Sambataro M, Nollino L, Fabris F, Corò A, Scantamburlo A, Marcon ML, Cazziola-Merlotto M, Ciani T, Tessarin M, Paccagnella A. A structured therapeutic education program for children and adolescents with type 1 diabetes: an analysis of the efficacy of the "Pediatric Education for Diabetes" project. Minerva Pediatr (Torino) 2017; 73:159-166. [PMID: 28176508 DOI: 10.23736/s2724-5276.17.04634-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Therapeutic education for Type 1 Diabetes involves the process of transmitting knowledge and developing the skills and behavior required to treat the disease. guidelines agree on stressing the importance of therapeutic educational intervention in teaching self-management skills to children and adolescents with Type 1 Diabetes (T1D). This study presents the results of the "Pediatric Education for Type 1 Diabetes (T1D)" (PED) project, specifically designed for children and adolescents aged 6 to 16, and structured on guidelines indications, as part of a broader clinical-educational intervention for Type 1 diabetes. METHODS Twenty-four patients with Type 1 diabetes (mean age: 12,13 y; SD=1.48 y; range 9-14) were studied in a 12-month PED structured project followed by an educational summer camp. All the activities were designed and organized by a multidisciplinary team (dietitian, pediatric diabetologist, nurse, psychologist and adult diabetologist). Glycated hemoglobin (HbA1C), knowledge about Type 1 Diabetes (T1D) (self-monitoring and nutrition), self-management (self-monitoring, nutrition and flexibility of medical treatment), and wellbeing were used as outcome measures. RESULTS Data suggest that the PED had a positive impact on all the targeted levels indicated for recommended care. CONCLUSIONS The results of this study seem to confirm the effectiveness in altering the three levels of "knowing," "know-how" and "wellbeing" required to optimize the quality of life of young patients with Type 1 diabetes. In addition, the proposed model, where a pediatric diabetologist always cooperates with an adult diabetologist, seems to be a permanent solution to the transitional gap widely discussed in the literature.
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Affiliation(s)
- Alessandra Mauri
- Department of Psychiatry, Psychological Consulting Service, Local Health Authority (ULSS 9), Treviso, Italy
| | - Susanna Schmidt
- Department of Psychology, University of Turin, Turin, Italy -
| | - Valentina Sosero
- Department of Psychiatry, Psychological Consulting Service, Local Health Authority (ULSS 9), Treviso, Italy
| | - Maria Sambataro
- Unit of Metabolic and Nutritional Diseases, Department of Specialist Diseases and Endocrinology, Local Health Authority (ULSS 9), Ca' Foncello Hospital, Treviso, Italy
| | - Laura Nollino
- Unit of Metabolic and Nutritional Diseases, Department of Specialist Diseases and Endocrinology, Local Health Authority (ULSS 9), Ca' Foncello Hospital, Treviso, Italy
| | - Francesco Fabris
- Unit of Pediatrics, Department of Pediatrics, Local Health Authority (ULSS 9), Treviso, Italy
| | - Anna Corò
- Unit of Pediatrics, Department of Pediatrics, Local Health Authority (ULSS 9), Treviso, Italy
| | - Antonella Scantamburlo
- Unit of Metabolic and Nutritional Diseases, Department of Specialist Diseases and Endocrinology, Local Health Authority (ULSS 9), Ca' Foncello Hospital, Treviso, Italy
| | - Maria L Marcon
- Unit of Metabolic and Nutritional Diseases, Department of Specialist Diseases and Endocrinology, Local Health Authority (ULSS 9), Ca' Foncello Hospital, Treviso, Italy
| | - Michela Cazziola-Merlotto
- Unit of Metabolic and Nutritional Diseases, Department of Specialist Diseases and Endocrinology, Local Health Authority (ULSS 9), Ca' Foncello Hospital, Treviso, Italy
| | - Tania Ciani
- Unit of Metabolic and Nutritional Diseases, Department of Specialist Diseases and Endocrinology, Local Health Authority (ULSS 9), Ca' Foncello Hospital, Treviso, Italy
| | - Michele Tessarin
- General Management and Health, Local Health Authority (ULSS 9), Treviso, Italy
| | - Agostino Paccagnella
- Unit of Metabolic and Nutritional Diseases, Department of Specialist Diseases and Endocrinology, Local Health Authority (ULSS 9), Ca' Foncello Hospital, Treviso, Italy
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Schultz AT, Smaldone A. Components of Interventions That Improve Transitions to Adult Care for Adolescents With Type 1 Diabetes. J Adolesc Health 2017; 60:133-146. [PMID: 27939878 DOI: 10.1016/j.jadohealth.2016.10.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/15/2016] [Accepted: 10/06/2016] [Indexed: 12/11/2022]
Abstract
Adolescents with type 1 diabetes struggle with glycemic control with decline further exacerbated by transfer from pediatric to adult care. The purpose of this systematic review/meta-analysis was to examine which components of transition programs are effective in improving outcomes following transfer. We searched six databases for studies that assessed the efficacy of a transition program on diabetes outcomes. Studies reporting hemoglobin A1c (HbA1c) or its change for the intervention versus control group pretransition and posttransition were pooled using a random effects meta-analysis model. Of 4,689 studies identified, 18 (1 randomized control trial, 6 quasi-experimental, 1 prospective, and 10 retrospective cohort) met inclusion criteria. Findings represent data from 3,382 youth with type 1 diabetes (52% male, age 16-23 years) undergoing transition. Programs varied and included transition coordinators (n = 7), transition clinics (n = 10), and group education meetings (n = 5). Average age of transfer was 17.7 years. All but one study reported improvement/maintenance of HbA1c posttransition. However, pooling data from four studies with a control group (418 youth), there were no differences in HbA1c at 12 months (-.11 [95% confidence interval: -.31, .08]). Of other outcomes studied (clinic attendance [n = 12], severe hypoglycemia [n = 8], and diabetic ketoacidosis [n = 7]), transition programs showed greatest consistency in reducing diabetic ketoacidosis episodes. Findings suggest that transition interventions may be effective in maintaining glycemic control and reducing diabetic ketoacidosis episodes posttransition. Further research is needed to determine which program types are most effective.
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Affiliation(s)
- Alan T Schultz
- Columbia University School of Nursing, New York, New York
| | - Arlene Smaldone
- Columbia University School of Nursing, New York, New York; College of Dental Medicine, Columbia University Medical Center, New York, New York.
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While AE, Heery E, Sheehan AM, Coyne I. Health-related quality of life of young people with long-term illnesses before and after transfer from child to adult healthcare. Child Care Health Dev 2017; 43:144-151. [PMID: 27678488 DOI: 10.1111/cch.12410] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 08/24/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND The numbers of children with long-term illnesses surviving into adulthood and transferring from child to adult services has increased dramatically in the last 30 years. This study aimed to examine health-related quality of life pre- and post-transfer from child to adult healthcare for young people with three long-term illnesses. METHODS A total of 217 young people with cystic fibrosis, congenital heart defects or diabetes attending child and adult hospital services in Dublin, Ireland completed a questionnaire survey. Multiple linear regression was used to identify predictors of five dimensions of health-related quality of life pre- and post-transfer. RESULTS Post-transfer young people with congenital heart disease and diabetes reported significantly lower physical well-being than their pre-transfer counterparts. Pre-transfer young people with cystic fibrosis reported significantly lower physical well-being than those with diabetes, but there was no significant difference post-transfer. Pre-transfer females reported lower scores than males on the Psychological Well-being and Autonomy and Parent Relation dimensions; however, these differences disappeared post-transfer. Higher maternal overprotection scores were associated with significantly lower scores on the Psychological Well-being, Autonomy and Parent Relation, and Social Support and Peers dimensions, regardless of transfer status. CONCLUSIONS Disease group, gender and maternal overprotection were predictors of health-related quality of life pre- and post-transfer from child to adult healthcare. Transition programmes should promote self-management and discourage parental overprotection.
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Affiliation(s)
- A E While
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - E Heery
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - A M Sheehan
- Centre for Effective Services, Dublin, Ireland
| | - I Coyne
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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98
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Osan JK, Punch JD, Watson M, Chan YX, Barrie P, Fegan PG, Yeap BB. Associations of demographic and behavioural factors with glycaemic control in young adults with type 1 diabetes mellitus. Intern Med J 2016; 46:332-8. [PMID: 26748888 DOI: 10.1111/imj.12991] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 11/23/2015] [Accepted: 12/23/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite recognised benefits of optimal glycaemic control in patients with type 1 diabetes mellitus (T1DM), good control is still difficult to achieve, particularly for adolescents and young adults. Recognition of factors that may assist early optimisation of glycaemic control is therefore important. AIMS We explored associations of demographic, social and behavioural factors with glycosylated haemoglobin (HbA1c) levels in participants with T1DM aged 18-25 years. METHODS A cross-sectional analysis was performed on young adults attending a dedicated multidisciplinary clinic at Fremantle Hospital, Western Australia from January to August 2014. RESULTS Data from 93 participants were analysed. Mean age was 21.4 ± 2.3 years, and 39.8% of the cohort were female. Longer duration of diabetes was associated with higher HbA1c (r = 0.25, P = 0.04). Men had lower HbA1c than women (8.2 ± 1.6 vs 9.2 ± 2.0%, P = 0.01). Increased frequency of clinic attendance was associated with lower HbA1c (r = -0.27, P = 0.02). Those engaged in work or study had better HbA1c compared with those who were not (8.9 ± 2.1 vs 10.5 ± 2.1%, P = 0.03). Socioeconomic disadvantage, risk-taking behaviour, insulin pump use and distance travelled to clinic were not associated with differences in HbA1c. CONCLUSION In young adults with T1DM, geographical separation, socioeconomic disadvantage and risk-taking behaviours did not influence glycaemic control. Longer duration of diabetes identifies young adults at higher risk of poor control, while attendance at a multidisciplinary clinic and engagement in work or study was associated with better glycaemic control. Additional studies are warranted to clarify the role of behavioural interventions to improve diabetes management in young adults.
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Affiliation(s)
- J K Osan
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - J D Punch
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - M Watson
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - Y X Chan
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia.,Department of Endocrinology and Diabetes, Perth, Western Australia, Australia
| | - P Barrie
- Diabetes Education Unit, Fiona Stanley and Fremantle Hospitals, Perth, Western Australia, Australia
| | - P G Fegan
- Department of Endocrinology and Diabetes, Perth, Western Australia, Australia
| | - B B Yeap
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia.,Department of Endocrinology and Diabetes, Perth, Western Australia, Australia
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99
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Blake H, Quirk H, Leighton P, Randell T, Greening J, Guo B, Glazebrook C. Feasibility of an online intervention (STAK-D) to promote physical activity in children with type 1 diabetes: protocol for a randomised controlled trial. Trials 2016; 17:583. [PMID: 27931254 PMCID: PMC5146845 DOI: 10.1186/s13063-016-1719-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 11/22/2016] [Indexed: 01/02/2023] Open
Abstract
Background Regular physical activity has important health benefits for children with type 1 diabetes mellitus (T1DM), yet children and their parents face barriers to participation such as lack of self-efficacy or concerns around hypoglycaemia. Multimedia interventions are useful for educating children about their health and demonstrate potential to improve children’s health-related self-efficacy, but few paediatric clinics offer web-based resources as part of routine care. The Steps to Active Kids with Diabetes (STAK-D) programme is an online intervention grounded in psychological theory (social cognitive theory) and informed by extensive preliminary research. The aim of the programme is to encourage and support safe engagement with physical activity for children with T1DM. The aim of this research is to explore the feasibility of delivering the STAK-D programme to children aged 9–12 years with T1DM, and to assess the feasibility of further research to demonstrate its clinical and cost-effectiveness. Methods Up to 50 children aged 9–12 years with T1DM and their parents will be recruited from two paediatric diabetes clinics in the UK. Child-parent dyads randomised to the intervention group will have access to the intervention website (STAK-D) and a wrist-worn activity monitor for 6 months. The feasibility of intervention and further research will be assessed by rate of recruitment, adherence, retention, data completion and adverse events. Qualitative interviews will be undertaken with a subsample of children and parents (up to 25 dyads) and health care professionals (up to 10). Health outcomes and the feasibility of outcome measurement tools will be assessed. These include self-efficacy (CSAPPA), objective physical activity, self-reported physical activity (PAQ), fear of hypoglycaemia (CHFS; PHFS), glycaemic control (HbA1c), insulin dose, Body Mass Index (BMI), health-related quality of life (CHU9D; CHQ-PF28), health service use and patient-clinician communication. Assessments will be taken at baseline (T0), 8 weeks (T1) and at 6-month follow-up (T2). Discussion The goal of this feasibility trial is to assess the delivery of STAK-D to promote physical activity among children with T1DM, and to assess the potential for further, definitive research to demonstrate its effectiveness. Results will provide the information necessary to design a larger randomised controlled trial and maximise the recruitment rate, intervention delivery and trial retention. Trial registration ISRCTN, ISRCTN48994721. Registered on 28 October 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1719-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Holly Blake
- University of Nottingham School of Health Sciences, A Floor, Queen's Medical Centre, Nottingham, NG7 2HA, UK.
| | - Helen Quirk
- University of Nottingham School of Health Sciences, A Floor, Queen's Medical Centre, Nottingham, NG7 2HA, UK
| | - Paul Leighton
- University of Nottingham School of Medicine, C Floor, South Block, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Tabitha Randell
- Department of Paediatric Endocrinology and Diabetes, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - James Greening
- Children's Hospital, Leicester Royal Infirmary, Children's Diabetes and Endocrinology, Infirmary Square, Leicester, LE1 5WW, UK
| | - Boliang Guo
- Institute of Mental Health, Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
| | - Cris Glazebrook
- Institute of Mental Health, B Floor, Innovation Park, Triumph Road, Nottingham, NG7 2TU, UK
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100
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James S, Perry L, Gallagher R, Lowe J. Diabetes Educators' Intended and Reported Use of Common Diabetes-Related Technologies: Discrepancies and Dissonance. J Diabetes Sci Technol 2016; 10:1277-1286. [PMID: 27179011 PMCID: PMC5094322 DOI: 10.1177/1932296816646798] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Technology provides adjuvant and/or alternative approaches to care and may promote self-care, communication, and engagement with health care services. Common recent technologies for diabetes include continuous subcutaneous insulin infusions (insulin pumps), continuous glucose monitoring systems, smartphone and tablet applications, and telehealth (video conferencing). This study reports Australian diabetes educators' intentions and reported professional use of these technologies for people with type 1 diabetes, and factors predictive of this. METHODS An anonymous, web-based questionnaire based on the technology acceptance model was distributed to members of the Australian Diabetes Educators Association through their electronic newsletter. Exploratory factor analysis revealed a 5-factor solution comprising confidence and competence, improving clinical practice, preparation (intentions and training), ease of use, and subjective norms. Logistic regression analyses identified factors predicting intention and use of technology. RESULTS Respondents (n = 228) had high intentions to use technology. The majority reported using continuous subcutaneous insulin infusions, continuous glucose monitoring systems, and applications with patients, but usage was occasional. Confidence and competence independently predicted both intentions and use of all 4 technologies. Preparation (intentions and training) independently predicted use of each technology also. CONCLUSIONS Discrepancies and dissonance appear between diabetes educators' intentions and behavior (intentions to use and reported technology use). Intentions were higher than current use, which was relatively low and not likely to provide significant support to people with type 1 diabetes for disease management, communication, and engagement with health care services. Continuing education and experiential learning may be key in supporting diabetes educators to align their intentions with their practice.
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Affiliation(s)
- Steven James
- University of Technology Sydney, Ultimo, NSW, Australia
| | - Lin Perry
- University of Technology Sydney, Ultimo, NSW, Australia
| | | | - Julia Lowe
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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