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Betz CL, Smith KA, Van Speybroeck A, Hernandez FV, Jacobs RA. Movin' On Up: An Innovative Nurse-Led Interdisciplinary Health Care Transition Program. J Pediatr Health Care 2016; 30:323-38. [PMID: 26483330 DOI: 10.1016/j.pedhc.2015.08.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 08/26/2015] [Accepted: 08/31/2015] [Indexed: 10/22/2022]
Abstract
This article provides an overview of an innovative nurse-led interdisciplinary health care transition (HCT) model of care entitled Movin' On Up for adolescents and emerging adults (AEAs) with spina bifida (SB) that was originally implemented in 2011. The components of the HCT service model include an HCT nursing specialist, who is an advanced practice nurse; interdisciplinary health care transition plans based on the individualized needs of AEAs; an interdisciplinary HCT team that meets on a weekly basis; direct HCT services provided in the weekly SB clinic; and telephonic follow-up with AEAs, families, and providers. The characteristics of this nurse-led HCT program can be described as an integrated, interdisciplinary, and comprehensive model of care based on a life span approach. To date, a total of 210 AEAs with SB, ages 10 to 20 years, have been enrolled into the program. An important feature of this HCT service model is that it is self-supporting; it generates the revenue needed for sustainability and, unlike other HCT programs, is not reliant on extramural programmatic support. Other accomplishments of Movin' On Up include the development of a transfer protocol wherein 35 AEAs with SB have been supported in their transfer to adult care; implementation of a standardized process to ensure that service referrals to community-based services for postsecondary education, employment, training, and initiation of conservatorships are made; timely performance of evaluations; close tracking of needs and outcomes of self-management knowledge and skills instruction; and attention to equipment needs prior to transfer.
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102
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Crossen SS, Wilson DM, Saynina O, Sanders LM. Outpatient Care Preceding Hospitalization for Diabetic Ketoacidosis. Pediatrics 2016; 137:peds.2015-3497. [PMID: 27207491 PMCID: PMC4894257 DOI: 10.1542/peds.2015-3497] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To identify patterns of outpatient care associated with diabetic ketoacidosis (DKA) among pediatric patients with type 1 diabetes (T1D). METHODS Retrospective cohort study using Medicaid claims data from 2009 to 2012 for children with T1D enrolled ≥365 consecutive days in California Children's Services, a Title V program for low-income children with chronic disease. Outcome was DKA hospitalization >30 days after enrollment. Outpatient visits to primary care, endocrinology, pharmacies, and emergency departments (EDs) were assessed during the 6 months before an index date: either date of first DKA hospitalization or end of enrollment for those without DKA. Univariate and multivariate analysis was used to evaluate independent associations between DKA and outpatient care at clinically meaningful intervals preceding the index date. RESULTS Among 5263 children with T1D, 16.7% experienced DKA during the study period. Patients with DKA were more likely to have had an ED visit (adjusted odds ratio [aOR] 3.99, 95% confidence interval [CI]: 2.60-6.13) or a nonpreventive primary care visit (aOR 1.35, 95% CI: 1.01-1.79) within 14 days before the index date, and less likely to have visited an endocrinologist (aOR 0.76, 95% CI: 0.65-0.89) within the preceding 120 days. Preventive visits and pharmacy claims were not associated with DKA. CONCLUSIONS For children with T1D, recent ED visits and long intervals without subspecialty care are important signals of impending DKA. Combined with other known risk factors, these health-use indicators could be used to inform clinical and case management interventions that aim to prevent DKA hospitalizations.
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Affiliation(s)
| | | | - Olga Saynina
- Center for Primary Care and Outcomes Research, and
| | - Lee M. Sanders
- Center for Primary Care and Outcomes Research, and,General Pediatrics, Stanford University School of Medicine, Stanford, California
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103
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Betz CL, O'Kane LS, Nehring WM, Lobo ML. Systematic review: Health care transition practice service models. Nurs Outlook 2016; 64:229-43. [DOI: 10.1016/j.outlook.2015.12.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 12/29/2015] [Accepted: 12/30/2015] [Indexed: 10/22/2022]
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104
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Trivedi I, Holl JL, Hanauer S, Keefer L. Integrating Adolescents and Young Adults into Adult-Centered Care for IBD. Curr Gastroenterol Rep 2016; 18:21. [PMID: 27086002 DOI: 10.1007/s11894-016-0495-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Planned healthcare transition, initiated in pediatric care, is a gradual process aimed at fostering the adolescent patient's disease knowledge and skills with the ultimate objective of preparing patients and families for adult-centered care. The process is critical in inflammatory bowel diseases (IBD) where there is an increased risk of non-adherence, hospitalizations, and emergency department use as young adult patients graduate from pediatric to adult-centered care. While evidence for healthcare transition in IBD is mounting, important gaps remain in the understanding of this process from the perspective of the adult gastroenterologist. This paper summarizes what is known about healthcare transition in IBD and explores the unanswered questions-a conceptual and methodological framework for transition interventions, relevant outcomes that define successful transition, and key stakeholder perspectives. For the adult gastroenterologist managing the young adult patient population, this paper presents the paradigm of "care integration"-a process of ongoing, multi-modality support for the patient, initiated in the adult care setting, with the goal of improving self-management skills and active participation in medical decision-making.
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Affiliation(s)
- Itishree Trivedi
- Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, 676 N. St Clair, Suite 1400, Chicago, IL, 60611, USA.
- Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, 633 N. St. Clair Street (20th floor), Chicago, IL, 60611, USA.
| | - Jane L Holl
- Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, 633 N. St. Clair Street (20th floor), Chicago, IL, 60611, USA
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, 225 E. Chicago Avenue #86, Chicago, 60611, IL, USA
| | - Stephen Hanauer
- Division of Gastroenterology and Hepatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, 676 N. St Clair, Suite 1400, Chicago, IL, 60611, USA
| | - Laurie Keefer
- Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, 17 East 102nd Street - 5th Floor, New York, 10029, NY, USA
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105
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Los E, Ulrich J, Guttmann-Bauman I. Technology Use in Transition-Age Patients With Type 1 Diabetes: Reality and Promises. J Diabetes Sci Technol 2016; 10:662-8. [PMID: 26892506 PMCID: PMC5038542 DOI: 10.1177/1932296816632543] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Youth with chronic illnesses have the greatest risk for a decline in their health management during transition-age. Because of this demonstrated and well-known issue, research has focused on how to improve the transition of care process. Despite the increasing number of technological devices on the market and the advances in telemedicine modalities available to patients with type 1 diabetes (T1D), the utilization of technology is still suboptimal among patients of transition-age (ages 13-25). This article reviews the available resources, patterns of use in transition-age youth, and explores opportunities to advance technology use in transitioning patients with T1D from pediatric to adult care.
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Affiliation(s)
- Evan Los
- Oregon Health & Science University, Portland, OR, USA
| | - Jenae Ulrich
- Oregon Health & Science University, Portland, OR, USA
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106
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Monaghan M, Baumann K. Type 1 diabetes: addressing the transition from pediatric to adult-oriented health care. RESEARCH AND REPORTS IN ENDOCRINE DISORDERS 2016; 6:31-40. [PMID: 27812509 PMCID: PMC5087810 DOI: 10.2147/rred.s56609] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Adolescents and young adults with type 1 diabetes are at risk for poor health outcomes, including poor glycemic control, acute and chronic complications, and emergency department admissions. During this developmental period, adolescent and young adult patients also experience significant changes in living situation, education, and/or health care delivery, including transferring from pediatric to adult health care. In recent years, professional and advocacy organizations have proposed expert guidelines to improve the process of preparation for and transition to adult-oriented health care. However, challenges remain and evidence-based practices for preparing youth for adult health care are still emerging. Qualitative research suggests that adolescent and young adult patients rely on health care providers to guide them through the transition process and appreciate a gradual approach to preparing for adult-oriented health care, keeping parents in supportive roles into young adulthood. Patients also benefit from specific referrals and contact information for adult care providers. Promising models of transition care include provision of transition navigators, attendance at a young adult bridge clinic, or joint visits with pediatric and adult care providers. However, much of this research is in its early stages, and more rigorous trials need to be conducted to evaluate health outcomes during transition into adult health care. The purpose of this review is to provide an overview of the transition process, patient and health care provider perceptions of transition care, and emerging evidence of successful models of care for engagement in adult-oriented health care. Recommendations and resources for health care providers are also presented.
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Affiliation(s)
- Maureen Monaghan
- Center for Translational Science, Children's National Health System
- George Washington University School of Medicine, Washington, DC, USA
| | - Katherine Baumann
- George Washington University School of Medicine, Washington, DC, USA
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107
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Suleiman AK. A prospective study assessing the etiology of Diabetes mellitus among Jordanian patients. Diabetes Metab Syndr 2016; 10:S60-S63. [PMID: 26878988 DOI: 10.1016/j.dsx.2016.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 01/09/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Diabetes mellitus has considerable public health implications for communities, individuals, and health services. Increasing prevalence of diabetes all over the world intensifies the demand for health care services, and particularly for inpatient care. AIM The present study aims to assess the current prevalence of diabetes and its etiology among hospitalized Jordanian adults. METHODS This was a cross sectional study conducted at Specialist Hospital (SH) in the Jordanian capital of Amman, with data collection taking place between June and August 2015, and data was extracted manually from medical records. Patients were divided into three groups: (a) those with a medical history of diabetes, (b) those with unrecognized diabetes or new hyperglycemia, and (c) those with no diabetes. Data management and analysis were conducted using the SPSS program. Means ±SD were used to present all continuous variables, as well as the numbers and percentages for categorical variables, and we used analysis of variance (ANOVA) to compare between means. For differences between categorical variables, we used (x(2)). A P-value of less than 0.05 was considered significant. RESULTS A total of 392 patients (266 female, 126 male) were admitted during the 10-week study period. Of these, 204 fell into category (a), 45 into category (b), and 143 into category (c). Diabetes was the principal diagnosis in 52% of the hospitalizations. Patients who had diabetes or new hyperglycemia were considerably older than non-diabetic patients. The five most common reasons for hospitalization were congestive heart failure (25.0%), pneumonia (22.5%), DKA (22.0%), coronary atherosclerosis (16.20%), and septicemia (14.20%). CONCLUSION The common etiologies for hospitalization were congestive heart failure, pneumonia, DKA, coronary atherosclerosis, and septicemia. Keeping in view the results of this study it is recommend that regular screening should be performed for diabetic patients, as this will increase the chances that many diabetes complications will be prevented, particularly for elderly subjects.
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Affiliation(s)
- Amal K Suleiman
- Pharmaceutical Practices Department, Pharmacy College, Princess Noura bint Abdul Rahman University, Riyadh 11671, Saudi Arabia.
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108
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Hanghøj S, Boisen KA, Schmiegelow K, Hølge-Hazelton B. A Photo Elicitation Study on Chronically Ill Adolescents' Identity Constructions During Transition. Glob Qual Nurs Res 2016; 3:2333393616631678. [PMID: 28462329 PMCID: PMC5342639 DOI: 10.1177/2333393616631678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 12/29/2015] [Accepted: 12/30/2015] [Indexed: 01/18/2023] Open
Abstract
Adolescence is an important phase of life with increasing independence and identity development, and a vulnerable period of life for chronically ill adolescents with a high occurrence of insufficient treatment adherence. We conducted four photo elicitation focus group interviews with 14 adolescents (12-20 years) with juvenile idiopathic arthritis to investigate identity constructions during transition. Using a discourse analysis approach, six identity types were identified distributed on normal and marginal identities, which were lived either at home (home arena) or outside home with peers (out arena). Most participants positioned themselves as normal in the out arena and as ill in the home arena. Few participants positioned themselves as ill in an out arena, and they described how peers perceived this as a marginal and skewed behavior. This study contributes to a better understanding of why it can be extremely difficult to live with a chronic illness during adolescence.
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Affiliation(s)
- Signe Hanghøj
- Rigshospitalet and University of Copenhagen, Denmark
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109
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Helping Adolescents with Type 1 Diabetes "Figure It Out". J Pediatr Nurs 2016; 31:123-31. [PMID: 26586309 DOI: 10.1016/j.pedn.2015.10.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 09/11/2015] [Accepted: 10/12/2015] [Indexed: 01/08/2023]
Abstract
UNLABELLED The aim of this study was to gain an understanding of adolescent's experiences living with diabetes and build a theoretical paradigm for future interventions in adolescents with type 1 diabetes mellitus (T1DM). The adolescent's quest for independence, balancing blood sugars, and integrating diabetes led to increased conflict with parents which contributed to difficulty coping. One code in this study, "figuring it out", is the focus of this manuscript. METHODS Grounded theory with 15 in depth interviews were conducted with adolescents ages 11 to 15 with T1DM. RESULTS A theoretical model about the concept of "normalizing" was identified. Normalizing was defined as the ability to integrate diabetes into the background of one's daily life to make diabetes 'part of me'. The fifth phase of normalizing was "Figuring it out" which had 4 sub codes: (1) learning to accept diabetes, (2) believing it's possible to manage their diabetes, (3) showing responsibility, and (4) staying on track, and the normalizing task was "accepting the new normal". CONCLUSIONS Adolescents with T1DM develop the understanding that diabetes is their 'new normal'. The use of motivational interviewing, goal setting, and promotion of self-management may be important interventions in supporting adolescents with T1DM to normalize their life.
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110
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Vaks Y, Bensen R, Steidtmann D, Wang TD, Platchek TS, Zulman DM, Malcolm E, Milstein A. Better health, less spending: Redesigning the transition from pediatric to adult healthcare for youth with chronic illness. HEALTHCARE (AMSTERDAM, NETHERLANDS) 2016; 4:57-68. [PMID: 27001100 PMCID: PMC4805882 DOI: 10.1016/j.hjdsi.2015.09.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 09/01/2015] [Accepted: 09/01/2015] [Indexed: 01/18/2023]
Abstract
Adolescents and young adults (AYA) with serious chronic illnesses face costly and dangerous gaps in care as they transition from pediatric to adult health systems. New, financially sustainable approaches to transition are needed to close these gaps. We designed a new transition model for adolescents and young adults with a variety of serious chronic conditions. Our explicit goal was to build a model that would improve the value of care for youth 15-25 years of age undergoing this transition. The design process incorporated a review, analysis, and synthesis of relevant clinical and health services research; stakeholder interviews; and observations of high-performing healthcare systems. We identified three major categories of solutions for a safer and lower cost transition to adult care: (1) building and supporting self-management during the critical transition; (2) engaging receiving care; and (3) providing checklist-driven guide services during the transition. We propose that implementation of a program with these interventions would have a positive impact on all three domains of the triple aim - improving health, improving the experience of care, and reducing per capita healthcare cost. The transition model provides a general framework as well as suggestions for specific interventions. Pilot tests to assess the model's ease of implementation, clinical effects, and financial impact are currently underway.
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Affiliation(s)
- Yana Vaks
- Clinical Excellence Research Center, Stanford University School of Medicine, United States; Department of Pediatrics, Loma Linda University Children's Hospital, United States.
| | - Rachel Bensen
- Clinical Excellence Research Center, Stanford University School of Medicine, United States; Department of Pediatrics, Stanford University School of Medicine, United States
| | - Dana Steidtmann
- Clinical Excellence Research Center, Stanford University School of Medicine, United States; Department of Family Medicine, University of Colorado School of Medicine, United States
| | - Thomas D Wang
- Clinical Excellence Research Center, Stanford University School of Medicine, United States
| | - Terry S Platchek
- Clinical Excellence Research Center, Stanford University School of Medicine, United States; Department of Pediatrics, Stanford University School of Medicine, United States
| | - Donna M Zulman
- Clinical Excellence Research Center, Stanford University School of Medicine, United States; Division of General Medical Disciplines, Stanford University School of Medicine, United States; Center for Innovation to Implementation, VA Palo Alto Health Care System, United States
| | - Elizabeth Malcolm
- Clinical Excellence Research Center, Stanford University School of Medicine, United States
| | - Arnold Milstein
- Clinical Excellence Research Center, Stanford University School of Medicine, United States
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111
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Levy-Shraga Y, Elisha N, Ben-Ami M, Boyko V, Lerner-Geva L, Ziv T, Konvalina N, Cohen O, Pinhas-Hamiel O. Glycemic control and clinic attendance of emerging adults with type 1 diabetes at a transition care clinic. Acta Diabetol 2016; 53:27-33. [PMID: 25794880 DOI: 10.1007/s00592-015-0734-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 03/05/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Emerging adulthood is a challenging period for diabetes management. Our aim was to determine whether a dedicated transition clinic for emerging adults with type 1 diabetes can improve glycemic control and visit attendance. METHODS An observational study of 53 emerging adults (30 males) treated during 2010-2014 in a newly established transition clinic. The clinic was operated jointly by pediatric and adult endocrinologists and included a transition coordinator. Data collected included the source of referral, HbA1c levels, frequency of visit attendance, and acute complications. For 27 patients who had attended the pediatric clinic at the same medical center, data from up to 2 years preceding the transition were also collected. Patients filled the Diabetes Quality of Life-Youth questionnaire at the transition and 1 year later. RESULTS Mean ± SD age at the transfer to the transition clinic was 22.1 ± 2.7 years; mean disease duration was 8.4 ± 5.0 years. Follow-up duration at the transition clinic was 1.2 ± 1.1 years. Mean HbA1c levels decreased from 67 mmol/mol (95 % CI 63-72) [8.3 % (95 % CI 7.9-8.7)] at transfer to 57 mmol/mol (95 % CI 52-63) [7.4 % (95 % CI 6.9-7.9)] after 1 year (p < 0.001). Thirty-six patients (68 %) attended three or more visits during their first year in the transition clinic. The impact of diabetes on quality of life, disease-related worries, and life satisfaction did not change significantly during 1-year attendance in the transition clinic. CONCLUSIONS A dedicated transition clinic for emerging adults, with tailored support according to the developmental needs of emerging adulthood, showed improved glycemic control and visit attendance.
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Affiliation(s)
- Y Levy-Shraga
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 52621, Tel Hashomer, Israel.
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - N Elisha
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 52621, Tel Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - M Ben-Ami
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 52621, Tel Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - V Boyko
- The Women and Children's Health Research Unit, Gertner Institute, Tel Hashomer, Israel
| | - L Lerner-Geva
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- The Women and Children's Health Research Unit, Gertner Institute, Tel Hashomer, Israel
| | - T Ziv
- Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Israel
| | - N Konvalina
- Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Israel
| | - O Cohen
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Israel
| | - O Pinhas-Hamiel
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 52621, Tel Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
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112
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Hergenroeder AC, Wiemann CM, Cohen MB. Current Issues in Transitioning from Pediatric to Adult-Based Care for Youth with Chronic Health Care Needs. J Pediatr 2015; 167:1196-201. [PMID: 26340879 DOI: 10.1016/j.jpeds.2015.08.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 07/13/2015] [Accepted: 08/03/2015] [Indexed: 10/23/2022]
Abstract
For over 25 years, with medical advances increasing the lifespan of YYASHCN, we have been aware of the need to improve health care transition to adult-based care services. Barriers to health care transition have been identified and in a number of settings, recognition of the problem and preliminary success has been achieved for pilot programs. Evidence-based solutions to improve health care transition for YYASHCN are needed. There are barriers at the patient, family, pediatric, and adult provider, and insurance system levels that must be overcome.
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Affiliation(s)
| | | | - Mitchell B Cohen
- University of Alabama at Birmingham Children's of Alabama, Birmingham, AL
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113
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Steinbeck KS, Shrewsbury VA, Harvey V, Mikler K, Donaghue KC, Craig ME, Woodhead HJ. A pilot randomized controlled trial of a post-discharge program to support emerging adults with type 1 diabetes mellitus transition from pediatric to adult care. Pediatr Diabetes 2015; 16:634-9. [PMID: 25385685 DOI: 10.1111/pedi.12229] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 09/17/2014] [Accepted: 09/17/2014] [Indexed: 11/30/2022] Open
Abstract
AIMS There is a paucity of randomized controlled trials (RCT) examining transition from pediatric to adult care in type 1 diabetes mellitus (T1DM). This study aimed to determine if transition in T1DM is more effective with a comprehensive transition program (CTP) compared with standard clinical practice (SCP). METHODS This RCT recruited as young people left pediatric diabetes services. The trial co-ordinator provided CTP participants with standardized telephone communication support at week 1, and 3, 6, and 12 months post-discharge from pediatric care. SCP participants were briefly contacted at 6 and 12 months post-discharge to confirm transfer status; they received no other post-discharge contact as per usual practice. At 12 months, the primary outcomes were engagement and retention in the adult service and secondary outcomes included hemoglobin A1c (HbA1c), diabetes-related hospitalizations, microvascular complication appearance, and global self-worth. RESULTS Most CTP participants (11/14) and all SCP (12/12) participants (P = 0.2) transferred to an adult diabetes service; the median time to transfer was 14-15 wk. Overall, participants' frequency of adult diabetes service visits was sub-optimal but their retention in adult care was high. The only group difference was a higher HbA1c at baseline and follow-up in the CTP group. However, a general linear model found that follow-up HbA1c increased by 1.2% for each percentage increase in baseline HbA1c [95% confidence interval (0.4, 1.9; P = 0.01)], independent of treatment group. CONCLUSIONS Despite the challenges in recruiting adequate numbers, these findings provide valuable insights for future T1DM transition RCTs that are needed to build a more solid evidence-base in this field.
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Affiliation(s)
- Katharine S Steinbeck
- Academic Department of Adolescent Medicine, The Sydney Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia
| | - Vanessa A Shrewsbury
- Academic Department of Adolescent Medicine, The Sydney Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Vanessa Harvey
- Department of Adolescent and Transitional Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Kara Mikler
- Department of Paediatric Endocrinology, The Sydney Children's Hospital at Randwick, Randwick, NSW, Australia
| | - Kim C Donaghue
- Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia.,Institute of Endocrinology and Diabetes, The Sydney Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Maria E Craig
- Discipline of Paediatrics and Child Health, University of Sydney, Sydney, NSW, Australia.,Institute of Endocrinology and Diabetes, The Sydney Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Helen J Woodhead
- Department of Paediatric Endocrinology, The Sydney Children's Hospital at Randwick, Randwick, NSW, Australia
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114
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Wafa S, Nakhla M. Improving the Transition from Pediatric to Adult Diabetes Healthcare: A Literature Review. Can J Diabetes 2015; 39:520-8. [PMID: 26498219 DOI: 10.1016/j.jcjd.2015.08.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 07/16/2015] [Accepted: 08/04/2015] [Indexed: 10/22/2022]
Abstract
Effective transition to adult care is a significant component of an emerging adult's diabetes care. Poor transition places them at risk for disengagement with the health care system and for poor diabetes-related outcomes. The purpose of this paper was to review the literature to date on existing methods of transition care delivery for emerging adults with diabetes. We conducted a literature review using MEDLINE via OvidSP and searching the grey literature. Papers published in English between January 1, 2000 and March 25, 2015 that evaluated transition care programs for emerging adults with diabetes were included. 16 original studies, 1 study protocol and 1 technical brief describing transition programs were reviewed. Common components of care included transition care coordination, young adult clinics, transition preparation, familiarity with adult health care providers and support groups. Overall, when emerging adults are supported during the transition period, clinic attendance and glycemic control can be maintained or improved, and diabetes-related complications reduced. Despite widespread support in the literature for the need for structured transition care delivery, methodologically strong research evaluating transition care services remains limited. The literature to date encompasses a variety of care models that lack consistency in outcome measurements as well as lacking frameworks describing the interventions, which impedes comparison across studies. Further research, using a consistent framework for transition care program design, delivery and evaluation as well as reporting of outcomes, is needed to inform how best to deliver transition care services to this vulnerable population.
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Affiliation(s)
- Sarah Wafa
- Research Institute of the McGill University Health Centre, The Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Meranda Nakhla
- Research Institute of the McGill University Health Centre, The Montreal Children's Hospital, Montreal, Quebec, Canada.
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Michihata N, Matsui H, Fushimi K, Yasunaga H. Clinical Features of Adult Patients Admitted to Pediatric Wards in Japan. J Adolesc Health 2015; 57:421-4. [PMID: 26403841 DOI: 10.1016/j.jadohealth.2015.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 06/16/2015] [Accepted: 07/08/2015] [Indexed: 01/18/2023]
Abstract
PURPOSE Pediatricians generally need to treat adult patients who require long-term care for pediatric diseases. However, little is known about the characteristics of adult patients in pediatric wards. Using a national inpatient database, the aim of this study was to determine the clinical details of adult patients admitted to pediatric wards in Japanese acute-care hospitals. METHODS We extracted all inpatients aged ≥19 years who were admitted to pediatric departments in Japan from April 2012 to March 2013. We examined the patients' main diagnoses and the use of life-supporting home medical devices. RESULTS Of 417,352 patients admitted to pediatric wards during the study period, we identified 4,729 (1.1%) adult patients. The major diagnoses of the adult patients were malignancy, congenital heart disease, epilepsy, and cerebral palsy. More than 35% of the patients with cerebral palsy had a tracheostomy tube, gastrostomy tube, home central venous alimentation, or home respirator. More than 20% of patients aged ≥40 years in pediatric wards had adult diseases, including ischemic heart diseases, cerebrovascular diseases, and adult malignancy. CONCLUSIONS Many adult patients in pediatric wards had adult diseases. It is essential to establish a disease-oriented support system for adults with chronic conditions that originated in their childhood.
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Affiliation(s)
- Nobuaki Michihata
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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116
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Zoffmann V, Vistisen D, Due-Christensen M. Flexible guided self-determination intervention for younger adults with poorly controlled Type 1 diabetes, decreased HbA1c and psychosocial distress in women but not in men: a real-life RCT. Diabet Med 2015; 32:1239-46. [PMID: 25601214 DOI: 10.1111/dme.12698] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2015] [Indexed: 12/27/2022]
Abstract
AIM To report results from an 18-month randomized controlled trial (RCT) testing the effectiveness of a flexible guided self-determination (GSD) intervention on glycaemic control and psychosocial distress in younger adults with poorly controlled Type 1 diabetes. METHODS Between January 2010 and February 2012, we randomly allocated two hundred 18-35-year-olds [mean age 25.7 (5.1) years, 50% men] with Type 1 diabetes for ≥ 1 year [mean duration 13.7 (6.8) years] and HbA1c ≥ 64 mmol/mol (8.0%) to either an immediate GSD (intervention; n = 134) or 18-months delayed GSD group (control; n = 66). Group-based or individual GSD sessions were offered, drawing on reflection sheets and advanced professional communication. The primary outcome was HbA1c (measured at baseline and every three months thereafter) and among secondary outcomes was psychosocial distress (self-reported at baseline and after nine and 18 months). Intention-to-treat analyses included linear regression and repeated measurement analyses. RESULTS A borderline significant decrease in HbA1c in the intervention group compared with the control group ( - 4 vs - 1 mmol/mol or - 0.4% vs - 0.1%; P = 0.073) was driven by a significantly greater reduction in the GSD women ( - 5 vs + 1 mmol/mol or - 0.5% vs + 0.1%; P = 0.017); parallel decreases were observed in the GSD and control men ( - 3 mmol/mol or - 0.3%; P = 0.955). Significantly greater reduction in the GSD group's psychosocial distress was again driven by differences between the GSD and the control women. The men's improvements were not connected with the intervention. CONCLUSIONS The flexible GSD intervention benefitted younger adult women by significantly improving glycaemic control and decreasing diabetes related distress. No effect was seen among men.
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Affiliation(s)
- V Zoffmann
- Steno Diabetes Center A/S, Gentofte, Denmark
- Research Unit Women's and Children's Health, The Juliane Marie Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - D Vistisen
- Steno Diabetes Center A/S, Gentofte, Denmark
| | - M Due-Christensen
- Steno Diabetes Center A/S, Gentofte, Denmark
- King's College Faculty of Nursing and Midwifery, London, UK
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Findley MK, Cha E, Wong E, Faulkner MS. A Systematic Review of Transitional Care for Emerging Adults with Diabetes. J Pediatr Nurs 2015; 30:e47-62. [PMID: 26164412 PMCID: PMC4567467 DOI: 10.1016/j.pedn.2015.05.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 05/28/2015] [Accepted: 05/31/2015] [Indexed: 01/17/2023]
Abstract
The prevalence of diabetes and prediabetes in adolescents is increasing. A systematic review of 31 research articles focusing on transitional care for adolescents or emerging adults with diabetes or prediabetes was completed. Studies focused on those with type 1 diabetes, not type 2 diabetes or prediabetes, and were primarily descriptive. Major findings and conclusions include differences in pediatric versus adult care delivery and the importance of structured transitional programs using established recommendations of leading national organizations. Implications include future research on program development, implementation, and evaluation that is inclusive of adolescents and emerging adults, regardless of diabetes type, or prediabetes.
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Affiliation(s)
- Mary K. Findley
- Correspondence concerning this article should be addressed to MK Findley. Emory University Nell Hodgson Woodruff School of Nursing, 1520 Clifton Road NE Atlanta, GA 30322-4201, Phone: 404-712-9693 Fax: 404-727-9382,
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Bridgett M, Abrahamson G, Ho J. Transition, It's More Than Just An Event: Supporting Young People With Type 1 Diabetes. J Pediatr Nurs 2015; 30:e11-4. [PMID: 26044910 DOI: 10.1016/j.pedn.2015.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/19/2015] [Accepted: 05/20/2015] [Indexed: 11/26/2022]
Abstract
This paper discusses the importance of holistic person-centered care coordination services for young people with type 1 diabetes as they transition to adult health services. In response to the growing need for comprehensive, flexible, person-centered care for young people with chronic conditions, the new service Trapeze: a supported leap into adult health was established. Based in Sydney, Australia, Trapeze is a specialist adolescent chronic care service offering comprehensive care coordination services to young people with chronic conditions aged 14-25 years. Trapeze aims to support young people with type 1 diabetes by focusing on the individual needs of the young person and developing a mutually recognized relationship based on trust and respect, in order to facilitate a process whereby a young person feels safe enough to discuss some of the challenges they face in self-management, keeping their whole of life issues central to this process. The importance of holistic person-centered work is best exemplified through the stories of the young people enrolled in Trapeze. It is hoped that through the 'eyes' of the young people and by sharing their stories the approach to self-management and care coordination can be better understood.
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Affiliation(s)
| | | | - Jane Ho
- Trapeze, The Sydney Children's Hospitals Network, NSW, Australia
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119
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Hilderson D, Moons P, Van der Elst K, Luyckx K, Wouters C, Westhovens R. The clinical impact of a brief transition programme for young people with juvenile idiopathic arthritis: results of the DON’T RETARD project. Rheumatology (Oxford) 2015; 55:133-42. [DOI: 10.1093/rheumatology/kev284] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Indexed: 11/14/2022] Open
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120
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Cole R, Ashok D, Razack A, Azaz A, Sebastian S. Evaluation of Outcomes in Adolescent Inflammatory Bowel Disease Patients Following Transfer From Pediatric to Adult Health Care Services: Case for Transition. J Adolesc Health 2015. [PMID: 26206442 DOI: 10.1016/j.jadohealth.2015.04.012] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE We aimed to evaluate the impact of a transition service on clinical and developmental outcomes in adolescent Inflammatory Bowel Disease (IBD) patients on transfer to adult health care services. METHODS We reviewed the records of IBD patients diagnosed in pediatric care following their transfer/attendance to the adult IBD service. The data on patients who attended the transition service were compared with those who did not pass through the transition service. RESULTS Seventy-two patients were included in the study 41M and 31F. Forty-four patients went through the transition system (Group A), and 28 had no formalized transition arrangement before transfer (Group B). A significantly higher number of Group B patients needed surgery within 2 years of transfer when compared with patients in Group A (46% vs. 25%, p = .01). Sixty-one percent of patients in Group B needed at least one admission within 2 years of transfer when compared with 29% of Group A patients (p = .002). Nonattendance at clinics was higher in Group B patients with 78% having at least one nonattendance, whereas 29% of Group A failed to attend at least one appointment (p = .001). In addition, drug compliance rates were higher in the transition group when compared with Group B (89% and 46%, respectively; p = .002). A higher proportion of transitioned patients achieved their estimated maximum growth potential when completing adolescence. There was a trend toward higher dependence on opiates and smoking in Group B patients. CONCLUSIONS In adolescent IBD patients, transition care is associated with better disease specific and developmental outcomes. Prospective studies of different models of transition care in IBD are needed.
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Affiliation(s)
- Rebecca Cole
- Hull & York Medical School, Hull, United Kingdom
| | - Dhandapani Ashok
- Department of Paediatric Gastroenterology, Hull & East Yorkshire NHS Trust, Hull, United Kingdom
| | - Abdul Razack
- Department of Radiology, Hull & East Yorkshire NHS Trust, Hull, United Kingdom
| | - Amer Azaz
- Department of Paediatric Gastroenterology, Hull & East Yorkshire NHS Trust, Hull, United Kingdom
| | - Shaji Sebastian
- Inflammatory Bowel Disease Unit, Hull & East Yorkshire NHS Trust, Hull, United Kingdom.
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121
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Mistry B, Van Blyderveen S, Punthakee Z, Grant C. Condition-related predictors of successful transition from paediatric to adult care among adolescents with Type 1 diabetes. Diabet Med 2015; 32:881-5. [PMID: 25764182 DOI: 10.1111/dme.12746] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2015] [Indexed: 11/29/2022]
Abstract
AIMS To describe patient attendance for adult treatment after completion by young people of a structured Diabetes Transition Clinic and to identify the predictors of non-attendance at adult clinics by young people with Type 1 diabetes transitioning from paediatric care. METHODS Young people with Type 1 diabetes were consecutively enrolled on a Diabetes Transition Clinic programme at a Canadian paediatric teaching hospital, beginning in December 2007. Data from clinical interviews completed by an adolescent medicine specialist and an adult endocrinologist were prospectively collected at the Diabetes Transition Clinic visit in the patient's 18(th) year, before he/she was transferred at age 18 years to the adult clinic and at the first adult clinic visit. RESULTS As of June 2011, 136 young people participating in the Diabetes Transition Clinic programme had been discharged from paediatric care at least 1 year earlier. Of these, 43 participants were lost to follow-up. Loss to follow-up was more frequent among: those who were diagnosed with diabetes before the age of 12 years; those who were taking insulin twice or three times daily rather than by pump or multiple daily injections; those who had higher HbA1c levels; those who had fewer diabetes physician visits in the year preceding the Diabetes Transition Clinic visit; and those who did not ask questions at the Diabetes Transition Clinic visit. CONCLUSIONS Several factors easily ascertained at a clinical encounter before transition can predict the likelihood of attendance in adult care, including age at diagnosis, mode of insulin administration, frequency of physician visits, and questions asked by patients during a transition visit.
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Affiliation(s)
- B Mistry
- McMaster University, Hamilton, Ontario, Canada
| | | | - Z Punthakee
- McMaster University, Hamilton, Ontario, Canada
| | - C Grant
- McMaster University, Hamilton, Ontario, Canada
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122
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White M, O'Connell MA, Cameron FJ. Transition to adult endocrine services: What is achievable? The diabetes perspective. Best Pract Res Clin Endocrinol Metab 2015; 29:497-504. [PMID: 26051305 DOI: 10.1016/j.beem.2015.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Transition is defined as the 'purposeful, planned movement of adolescents and young adults with chronic physical and medical conditions from child-centred to adult-oriented health care systems' by Blum RW, (2002). The primary goal of transition is to ensure an uninterrupted process in healthcare delivery between the paediatric and adult settings; however, losses to follow up and decreased engagement with specialist services are common during this time. The current transition literature specifically pertaining to type 1 diabetes mellitus (T1DM) is often limited by incomplete data, the absence of control data and lack of follow up data spanning both the paediatric and adult years. This paper serves to review the current transition literature base, highlighting areas which warrant further study.
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Affiliation(s)
- Mary White
- Department of Endocrinology & Diabetes, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia.
| | - Michele A O'Connell
- Department of Endocrinology & Diabetes, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia.
| | - Fergus J Cameron
- Department of Endocrinology & Diabetes, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC 3052, Australia.
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123
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Al-Adsani AM, Abdulla KA. Reasons for hospitalizations in adults with diabetes in Kuwait. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.ijdm.2011.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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124
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Sheehan AM, While AE, Coyne I. The experiences and impact of transition from child to adult healthcare services for young people with Type 1 diabetes: a systematic review. Diabet Med 2015; 32:440-58. [PMID: 25407592 DOI: 10.1111/dme.12639] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2014] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Despite the transition between child and adult services for young people with Type 1 diabetes mellitus being a high-risk period, little is known about the impact of healthcare transition upon young people. METHODS A systematic review was conducted using PubMed, PsycINFO, CINAHL and EMBASE. Papers published between January 2001 and June 2014 that examined the impact or experiences of healthcare transition in young people with Type 1 diabetes were included. Data were extracted by two independent reviewers and integrated by narrative synthesis. RESULTS A total of 8990 citations were reviewed and 43 studies were included in the review, 24 of which explored the impact of transition and 24 examined experiences of transition. There were mixed results in terms of the change in glycaemic control and diabetes-related hospitalizations, but all studies assessing attendance found worse attendance post-transition. Data regarding experiences reported that young people and parents experienced greater difficulty in accessing and maintaining diabetes health care. Young people were required to develop independent self-management and self-advocacy skills to navigate the transition and adult health care, but some were inadequately prepared for this. CONCLUSIONS Although the impact of healthcare transition on outcomes for young people with Type 1 diabetes is unclear due to the paucity of high-quality studies, transition appears to be associated with decreased clinic attendance. There is some preliminary evidence of a positive impact of structured transition programmes. Experiences of healthcare transition illuminate the barriers to smooth transitions and the need for better integration and continuity of care.
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Affiliation(s)
- A M Sheehan
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
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125
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McDonagh JE, Gleeson H. Getting transition right for young people with diabetes. ACTA ACUST UNITED AC 2015. [DOI: 10.1002/edn.170] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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126
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Wright EK, Williams J, Andrews JM, Day AS, Gearry RB, Bampton P, Moore D, Lemberg D, Ravikumaran R, Wilson J, Lewindon P, Radford-Smith G, Rosenbaum J, Catto-Smith A, Desmond PV, Connell WR, Cameron D, Alex G, Bell SJ, De Cruz P. Perspectives of paediatric and adult gastroenterologists on transfer and transition care of adolescents with inflammatory bowel disease. Intern Med J 2015; 44:490-6. [PMID: 24589174 DOI: 10.1111/imj.12402] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 01/08/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Programmes specific to inflammatory bowel disease (IBD) that facilitate transition from paediatric to adult care are currently lacking. AIM We aimed to explore the perceived needs of adolescents with IBD among paediatric and adult gastroenterologists and to identify barriers to effective transition. METHODS A web-based survey of paediatric and adult gastroenterologists in Australia and New Zealand employed both ranked items (Likert scale; from 1 not important to 5 very important) and forced choice items regarding the importance of various factors in facilitating effective transition of adolescents from paediatric to adult care. RESULTS Response rate among 178 clinicians was 41%. Only 23% of respondents felt that adolescents with IBD were adequately prepared for transition to adult care. Psychological maturity (Mean = 4.3, standard deviation (SD) = 0.70) and readiness as assessed by adult caregiver (Mean = 4, SD = 0.72) were prioritised as the most important factors in determining timing of transfer. Self-efficacy and readiness as assessed by adult caregiver were considered the two most important factors to determine timing of transition by both groups of gastroenterologists. Poor medical and surgical handover (Mean = 4.10, SD = 0.8) and patients' lack of responsibility for their own care (Mean= 4.10, SD = 0.82) were perceived as major barriers to successful transition by both paediatric and adult gastroenterologists. CONCLUSIONS Deficiencies exist in current transition care of adolescents with IBD in Australia and New Zealand. Standardising transition care practices with strategies aimed at optimising communication, patient education, self-efficacy and adherence may improve outcomes.
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Affiliation(s)
- E K Wright
- Department of Gastroenterology, St Vincent's Hospital and University of Melbourne, Melbourne, Victoria, Australia
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127
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Martín-Frías M, Álvarez M, Yelmo R, Alonso M, Barrio R. Evaluación de la transición desde la Unidad de Diabetes Pediátrica a la de Adultos en adolescentes con diabetes mellitus tipo 1. An Pediatr (Barc) 2014; 81:389-92. [DOI: 10.1016/j.anpedi.2013.10.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 10/22/2013] [Accepted: 10/28/2013] [Indexed: 10/25/2022] Open
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128
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Martín-Frías M, Álvarez M, Yelmo R, Alonso M, Barrio R. Evaluation of the transition from paediatric to adult diabetic unit for adolescents with type 1 diabetes. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.anpede.2013.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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129
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Davis AM, Brown RF, Taylor JL, Epstein RA, McPheeters ML. Transition care for children with special health care needs. Pediatrics 2014; 134:900-8. [PMID: 25287460 PMCID: PMC4533283 DOI: 10.1542/peds.2014-1909] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Approximately 750,000 children in the United States with special health care needs will transition from pediatric to adult care annually. Fewer than half receive adequate transition care. METHODS We had conversations with key informants representing clinicians who provide transition care, pediatric and adult providers of services for individuals with special health care needs, policy experts, and researchers; searched online sources for information about currently available programs and resources; and conducted a literature search to identify research on the effectiveness of transition programs. RESULTS We identified 25 studies evaluating transition care programs. Most (n = 8) were conducted in populations with diabetes, with a smaller literature (n = 5) on transplant patients. We identified an additional 12 studies on a range of conditions, with no more than 2 studies on the same condition. Common components of care included use of a transition coordinator, a special clinic for young adults in transition, and provision of educational materials. CONCLUSIONS The issue of how to provide transition care for children with special health care needs warrants further attention. Research needs are wide ranging, including both substantive and methodologic concerns. Although there is widespread agreement on the need for adequate transition programs, there is no accepted way to measure transition success. It will be essential to establish consistent goals to build an adequate body of literature to affect practice.
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Affiliation(s)
- Alaina M. Davis
- Division of General Pediatrics, and,Evidence-Based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee; and
| | - Rebekah F. Brown
- Division of Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics;,Evidence-Based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee; and
| | - Julie Lounds Taylor
- Division of General Pediatrics, and,Evidence-Based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee; and,Vanderbilt University Kennedy Center for Research on Education and Human Development, Nashville, Tennessee
| | - Richard A. Epstein
- Division of Child and Adolescent Psychiatry, Department of Psychiatry; and,Evidence-Based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee; and
| | - Melissa L. McPheeters
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee;,Evidence-Based Practice Center, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, Tennessee; and
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130
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Casey R, O'Hara MC, Cunningham A, Wall D, Geoghegan R, Hynes L, McGuire B, Gately M, Bell M, Dinneen SF. Young adult type 1 diabetes care in the West of Ireland: an audit of hospital practice. QJM 2014; 107:903-8. [PMID: 24925824 DOI: 10.1093/qjmed/hcu103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND It is well recognised that management of young adults with type 1 diabetes (T1DM) poses difficult challenges for physicians and health care organisations as a whole. In Ireland and in particular the west of Ireland there has been little audit or research on young adults with T1DM and the services available to them. DESIGN In 2011 a retrospective review of this patient population in our territory referral centre was carried out. RESULTS The average glycaemic control in this population was poor at 81mmols/mol and diabetes related complications were present in 32%. Engagement by this population with services was poor with an average of 3 missed clinic appointments over a 24 month period. CONCLUSION These results have prompted a re think of how health care professionals can deliver a service that better suits the needs of this challenging patient group.
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Affiliation(s)
- R Casey
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
| | - M C O'Hara
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
| | - A Cunningham
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
| | - D Wall
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
| | - R Geoghegan
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
| | - L Hynes
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
| | - B McGuire
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
| | - M Gately
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
| | - M Bell
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
| | - S F Dinneen
- From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland From the Endocrinology and Diabetes Centre, Galway University Hospitals, Galway, Ireland, School of Medicine, NUI Galway, Galway, Ireland, School of Mathematics, Statistics and Applied Mathematics, NUI Galway, Galway, Ireland, Department of Paediatrics, Galway University Hospitals, Galway, Ireland and School of Psychology, NUI Galway, Galway, Ireland
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131
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Garvey KC, Beste MG, Luff D, Atakov-Castillo A, Wolpert HA, Ritholz MD. Experiences of health care transition voiced by young adults with type 1 diabetes: a qualitative study. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2014; 5:191-8. [PMID: 25349485 PMCID: PMC4208350 DOI: 10.2147/ahmt.s67943] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective This qualitative study aimed to explore the experience of transition from pediatric to adult diabetes care reported by posttransition emerging adults with type 1 diabetes (T1D), with a focus on preparation for the actual transfer in care. Methods Twenty-six T1D emerging adults (mean age 26.2±2.5 years) receiving adult diabetes care at a single center participated in five focus groups stratified by two levels of current glycemic control. A multidisciplinary team coded transcripts and conducted thematic analysis. Results Four key themes on the process of transfer to adult care emerged from a thematic analysis: 1) nonpurposeful transition (patients reported a lack of transition preparation by pediatric providers for the transfer to adult diabetes care); 2) vulnerability in the college years (patients conveyed periods of loss to follow-up during college and described health risks and diabetes management challenges specific to the college years that were inadequately addressed by pediatric or adult providers); 3) unexpected differences between pediatric and adult health care systems (patients were surprised by the different feel of adult diabetes care, especially with regards to an increased focus on diabetes complications); and 4) patients’ wish list for improving the transition process (patients recommended enhanced pediatric transition counseling, implementation of adult clinic orientation programs, and peer support for transitioning patients). Conclusion Our findings identify modifiable deficiencies in the T1D transition process and underscore the importance of a planned transition with enhanced preparation by pediatric clinics as well as developmentally tailored patient orientation in the adult clinic setting.
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Affiliation(s)
- Katharine C Garvey
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA ; Harvard Medical School, Boston, MA, USA
| | | | - Donna Luff
- Institute for Professionalism and Ethical Practice, Boston Children's Hospital, Boston, MA, USA ; Harvard Medical School, Boston, MA, USA
| | | | - Howard A Wolpert
- Adult Section, Joslin Diabetes Center, Boston, MA, USA ; Harvard Medical School, Boston, MA, USA
| | - Marilyn D Ritholz
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA
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132
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James S, Gallagher R, Dunbabin J, Perry L. Prevalence of vascular complications and factors predictive of their development in young adults with type 1 diabetes: systematic literature review. BMC Res Notes 2014; 7:593. [PMID: 25182937 PMCID: PMC4167503 DOI: 10.1186/1756-0500-7-593] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 08/04/2014] [Indexed: 11/30/2022] Open
Abstract
Background Vascular complications curtail life expectancy and quality of life in type 1 diabetes and development at younger ages is particularly detrimental. To date no review has summarised the prevalence or factors predicting their development in young adults. Methods A quantitative epidemiological systematic review was conducted to identify the prevalence and predictive factors for development of retinopathy, nephropathy and hypertension in young adults (sample age mean [plus 1SD] 18–30 years) with type 1 diabetes, using processes adapted from established review methods set out by the Centre for Reviews and Dissemination. MEDLINE (Ovid), Scopus (Elsevier), CINAHL, Science Direct (Elsevier), Google Scholar and Cochrane databases were searched to identify relevant articles published between 1993 and June 2014. From this eleven papers were retrieved, appraised and results summarised by three reviewers using established methods. Results Some form of retinopathy occurred in up to almost half of participants; more severe forms affected up to one in ten. One in six was reported with microalbuminuria; one in 14 had macroalbuminuria. Hypertension occurred in almost one in two participants. Applying out-dated high thresholds this decreased to approximately one in ten participants. Glycaemic control was a consistent predictor of vascular disease in this age group. Conclusion Prevalence rates of retinopathy, nephropathy and hypertension in young adults with type 1 diabetes emphasise the importance of regular complication screening for early detection and treatment. The predictive effect of glycaemic control reinforces its importance for prevention of vascular complications. Electronic supplementary material The online version of this article (doi:10.1186/1756-0500-7-593) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Steven James
- Huntsville District Memorial Hospital, Muskoka Algonquin Healthcare, 100 Frank Miller Drive, Huntsville, Ontario P1H 1H7, Canada.
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133
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Pihoker C, Forsander G, Fantahun B, Virmani A, Luo X, Hallman M, Wolfsdorf J, Maahs DM. ISPAD Clinical Practice Consensus Guidelines 2014. The delivery of ambulatory diabetes care to children and adolescents with diabetes. Pediatr Diabetes 2014; 15 Suppl 20:86-101. [PMID: 25182310 DOI: 10.1111/pedi.12181] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 06/13/2014] [Indexed: 01/01/2023] Open
Affiliation(s)
- Catherine Pihoker
- Department of Pediatrics, University of Washington, Seattle, WA, USA
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134
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Rea R. Transitional care for young people with diabetes: a national registry is urgently needed. PRACTICAL DIABETES 2014. [DOI: 10.1002/pdi.1876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Rustam Rea
- Oxford Centre for Diabetes, Endocrinology and Metabolism; Oxford UK
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135
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Garvey KC, Wolpert HA, Laffel LM, Rhodes ET, Wolfsdorf JI, Finkelstein JA. Health care transition in young adults with type 1 diabetes: barriers to timely establishment of adult diabetes care. Endocr Pract 2014; 19:946-52. [PMID: 23807526 DOI: 10.4158/ep13109.or] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine barriers to health care transition reported by young adults with type 1 diabetes and associations between barriers and prolonged gaps between pediatric and adult diabetes care. METHODS We surveyed young adults aged 22 to 30 years with type 1 diabetes about their transition experiences, including barriers to timely establishment of adult diabetes care. We evaluated relationships between barriers and gaps in care using multivariate logistic regression. RESULTS The response rate was 53% (258 of 484 eligible subjects). Respondents (62% female) were 26.7 ± 2.4 years old and transitioned to adult diabetes care at 19.5 ± 2.9 years. Reported barriers included lack of specific adult provider referral name (47%) or contact information (27%), competing life priorities (43%), difficulty getting an appointment (41%), feeling upset about leaving pediatrics (24%), and insurance problems (10%). In multivariate analysis, barriers most strongly associated with gaps in care >6 months were lack of adult provider name (odds ratio [OR], 6.1; 95% confidence interval [CI], 3.0-12.7) or contact information (OR, 5.3; 95% CI, 2.0-13.9), competing life priorities (OR, 5.2; 95% CI, 2.7-10.3), and insurance problems (OR, 3.5; 95% CI, 1.2-10.3). Overall, respondents reporting ≥1 moderate/major barrier (48%) had 4.7-fold greater adjusted odds of a gap in care >6 months (95% CI, 2.8-8.7). CONCLUSION Significant barriers to transition, such as a lack of specific adult provider referrals, may be addressed with more robust preparation by pediatric providers and care coordination. Further study is needed to evaluate strategies to improve young adult self-care in the setting of competing life priorities.
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Elliott J, Jacques RM, Kruger J, Campbell MJ, Amiel SA, Mansell P, Speight J, Brennan A, Heller SR. Substantial reductions in the number of diabetic ketoacidosis and severe hypoglycaemia episodes requiring emergency treatment lead to reduced costs after structured education in adults with Type 1 diabetes. Diabet Med 2014; 31:847-53. [PMID: 24654672 PMCID: PMC4264891 DOI: 10.1111/dme.12441] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 11/25/2013] [Accepted: 03/17/2014] [Indexed: 12/29/2022]
Abstract
AIMS To determine the impact of structured education promoting flexible intensive insulin therapy on rates of diabetic ketoacidosis, and the costs associated with emergency treatment for severe hypoglycaemia and ketoacidosis in adults with Type 1 diabetes. METHODS Using the Dose Adjustment For Normal Eating research database we compared the rates of ketoacidosis and severe hypoglycaemia during the 12 months preceding Dose Adjustment For Normal Eating training with the rates during the 12-month follow-up after this training. Emergency treatment costs were calculated for associated paramedic assistance, Accident and Emergency department attendance and hospital admissions. RESULTS Complete baseline and 1-year data were available for 939/1651 participants (57%). The risk of ketoacidosis in the 12 months after Dose Adjustment For Normal Eating training, compared with that before training, was 0.39 (95% CI: 0.23 to 0.65, P < 0.001), reduced from 0.07 to 0.03 episodes/patient/year. For every 1 mmol/mol unit increase in HbA1c concentration, the risk of a ketoacidosis episode increased by 6% (95% CI: 5 to 7%; 88% for a 1% increase), and for each 5-year increase in diabetes duration, the relative risk reduced by 20% (95% CI: 19 to 22%). The number of emergency treatments decreased for ketoacidosis (P < 0.001), and also for severe hypoglycaemia, including paramedic assistance (P < 0.001), Accident and Emergency department attendance (P = 0.029) and hospital admission (P = 0.001). In the study cohort, the combined cost of emergency treatment for ketoacidosis and severe hypoglycaemia fell by 64%, from £119,470 to £42,948. CONCLUSIONS Structured training in flexible intensive insulin therapy is associated with a 61% reduction in the risk of ketoacidosis and with 64% lower emergency treatment costs for ketoacidosis and severe hypoglycaemia.
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Affiliation(s)
- J Elliott
- Academic Unit of Diabetes, Endocrinology and Metabolism, Department of Human Metabolism, The University of Sheffield, Sheffield, UK
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138
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Rollo A, Salardi S, Ciavarella A, Forlani G, Scipione M, Maltoni G, Balsamo C, Martini AL, Zucchini S. Transition from pediatric to adult care. eight years after the transition from pediatric to adult diabetes care: metabolic control, complications and associated diseases. J Endocrinol Invest 2014; 37:653-9. [PMID: 24852416 DOI: 10.1007/s40618-014-0090-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 04/30/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Transition from pediatric to adult care is a critical process in the life of patients with diabetes. AIM Primary aim of the study was to compare the metabolic control between pediatric care and adult care at least 5 years in a group of patients with type 1 diabetes mellitus (T1DM). Secondary aim was to evaluate the presence of complications, associated diseases and psychological-psychiatric disorders. SUBJECTS AND METHODS We obtained data from 73 % (69/94) patients (current mean age 34 years) transferred to local adult centers between 1985 and 2005 at a mean age of 23.8 years. Data were collected for HbA1c, diabetic complications and associated diseases. RESULTS Mean HbA1c did not change during the pediatric, transition and adult period [8.4 ± 1.8 % (68 ± 18 mmol/mol), 8.3 ± 1.4 % (67 ± 15 mmol/mol) and 8.4 ± 1.3 % (68 ± 14 mmol/mol), respectively]. 13 patients dropped out, after 2-12 years since transition, and their HbA1c mean value at transition was 10.4 %. After a mean of 25.9 years of disease, 35/69 patients (50.7 %) showed retinopathy, and 12/69 patients (17.3 %) nephropathy. Thyroid diseases were the most frequent associated diseases (18.3 %), followed by depression (11.2 %) and benign neoplasms (9.8 %). Drug or alcohol addictions were present in four cases (5.6 %). CONCLUSIONS After a mean follow-up of 8 years metabolic control after transition did not change significantly in patients constantly attending to adult care centre. Patients with diabetes onset between 20 and 40 years ago were free from complications in 50 % of cases when considering retinopathy and in more than 80 % considering nephropathy. Thyroid problems were the most common associated diseases. Poor metabolic control at transition is associated with higher risk of drop-out and psychosocial morbidity.
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Affiliation(s)
- Alessandra Rollo
- Department of Pediatrics, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 11, 40100, Bologna, Italy,
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Steinbeck K, Towns S, Bennett D. Adolescent and young adult medicine is a special and specific area of medical practice. J Paediatr Child Health 2014; 50:427-31. [PMID: 24547968 DOI: 10.1111/jpc.12491] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2013] [Indexed: 10/25/2022]
Abstract
Adolescent and young adult medicine is a concept that has gained traction in the last decade or so. The medical literature has come primarily from oncology. Advances in neuroscience that document continuing brain development into the third decade, and research that shows risk behaviours associated with adolescence both remain and may increase in the third decade, have been two of the drivers in the conversation around linking these two age groups together as a medical practice group. A third driver of importance is transition care in chronic illness, where older adolescents and young adults continue to have difficulties making effective linkages with adult care. The case for specific training in adolescent and young adult medicine, including the developmental concepts behind it, the benefits of the delineation and the particular challenges in the Australian health-care system, are discussed. On balance, there is a strong case for managing the health issues of adolescents and young adults together. This scenario does not fit easily with the age demarcations that are in place in acute care facilities. However, this is less the case in community services and can work in focused private practice. Such a situation suggests that both paediatric and adult physicians might be interested in adolescent and young adult medicine training and practice.
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Affiliation(s)
- Kate Steinbeck
- The Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; The Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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140
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Schwartz LA, Daniel LC, Brumley LD, Barakat LP, Wesley KM, Tuchman LK. Measures of readiness to transition to adult health care for youth with chronic physical health conditions: a systematic review and recommendations for measurement testing and development. J Pediatr Psychol 2014; 39:588-601. [PMID: 24891440 DOI: 10.1093/jpepsy/jsu028] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Review measures of readiness to transition to adult-oriented care for youth with chronic physical health conditions. METHODS Identified measures via online searches and reference lists and reviewed methods of development, theoretical underpinnings, characteristics, and psychometrics. Measures were classified according to American Psychological Association Division 54 Evidence-Based Assessment (EBA) Task Force criteria. Strengths and weaknesses of reviewed measures were described. RESULTS 56 measures were identified, of which 10 met inclusion criteria for this review. 6 were disease specific and 4 were generic. Some psychometric properties were reported for each; none reported predictive validity for transition outcomes. According to EBA criteria, the 10 measures met criteria for "promising" assessment. CONCLUSIONS Measurement development in transition readiness is still an underdeveloped area. Measures require further testing and new measures are needed. Recommendations include testing measures with larger and diverse samples, ground measures in theory, test psychometrics, and involve multiple stakeholders in measure development.
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Affiliation(s)
- Lisa A Schwartz
- Division of Oncology, The Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania School of Medicine, Department of Psychology, LaSalle University, Division of Adolescent and Young Adult Medicine and Center for Translational Science, Children's National Medical Center, and Department of Pediatrics, George Washington University School of Medicine and Health SciencesDivision of Oncology, The Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania School of Medicine, Department of Psychology, LaSalle University, Division of Adolescent and Young Adult Medicine and Center for Translational Science, Children's National Medical Center, and Department of Pediatrics, George Washington University School of Medicine and Health Sciences
| | - Lauren C Daniel
- Division of Oncology, The Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania School of Medicine, Department of Psychology, LaSalle University, Division of Adolescent and Young Adult Medicine and Center for Translational Science, Children's National Medical Center, and Department of Pediatrics, George Washington University School of Medicine and Health Sciences
| | - Lauren D Brumley
- Division of Oncology, The Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania School of Medicine, Department of Psychology, LaSalle University, Division of Adolescent and Young Adult Medicine and Center for Translational Science, Children's National Medical Center, and Department of Pediatrics, George Washington University School of Medicine and Health Sciences
| | - Lamia P Barakat
- Division of Oncology, The Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania School of Medicine, Department of Psychology, LaSalle University, Division of Adolescent and Young Adult Medicine and Center for Translational Science, Children's National Medical Center, and Department of Pediatrics, George Washington University School of Medicine and Health SciencesDivision of Oncology, The Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania School of Medicine, Department of Psychology, LaSalle University, Division of Adolescent and Young Adult Medicine and Center for Translational Science, Children's National Medical Center, and Department of Pediatrics, George Washington University School of Medicine and Health Sciences
| | - Kimberly M Wesley
- Division of Oncology, The Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania School of Medicine, Department of Psychology, LaSalle University, Division of Adolescent and Young Adult Medicine and Center for Translational Science, Children's National Medical Center, and Department of Pediatrics, George Washington University School of Medicine and Health Sciences
| | - Lisa K Tuchman
- Division of Oncology, The Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania School of Medicine, Department of Psychology, LaSalle University, Division of Adolescent and Young Adult Medicine and Center for Translational Science, Children's National Medical Center, and Department of Pediatrics, George Washington University School of Medicine and Health SciencesDivision of Oncology, The Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania School of Medicine, Department of Psychology, LaSalle University, Division of Adolescent and Young Adult Medicine and Center for Translational Science, Children's National Medical Center, and Department of Pediatrics, George Washington University School of Medicine and Health Sciences
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Rica I, Ferrer-García JC, Barrio R, Gómez Gila AL, Fornos JA. Transición del paciente con diabetes tipo 1 desde la Unidad de Diabetes pediátrica a la Unidad de Diabetes de adultos. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.avdiab.2014.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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142
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Stanczyk J, Chobot A, Polanska J, Jarosz-Chobot P. Patients with type 1 diabetes transition from pediatric to adult care in Poland—an example from Silesia. Int J Diabetes Dev Ctries 2014. [DOI: 10.1007/s13410-013-0182-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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143
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HERSH AIMEE. Growing Up and Moving On — Transition of Care for Patients with Childhood-onset Rheumatic Disease. J Rheumatol 2014; 41:829-31. [DOI: 10.3899/jrheum.140140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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144
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Sawyer SM, Ambresin AE. Successful transitions: beyond disease control to better life chances. J Adolesc Health 2014; 54:365-6. [PMID: 24656532 DOI: 10.1016/j.jadohealth.2014.01.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 01/24/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Susan M Sawyer
- Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Murdoch Childrens Research Institute, Melbourne, Australia
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145
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Zoffmann V, Vistisen D, Due-Christensen M. A cross-sectional study of glycaemic control, complications and psychosocial functioning among 18- to 35-year-old adults with type 1 diabetes. Diabet Med 2014; 31:493-9. [PMID: 24236961 DOI: 10.1111/dme.12363] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 10/02/2013] [Accepted: 11/12/2013] [Indexed: 11/28/2022]
Abstract
AIMS To describe the level of glycaemic control, complications and psychosocial functioning and the relationships between these variables in the under-researched group of younger adults with type 1 diabetes. METHODS Local electronic health records provided data on age, gender, disease duration, HbA1c and complications for 710 younger adults (18-35 years) with type 1 diabetes. A questionnaire with wide-ranging psychometric scales was used to measure various aspects of psychosocial functioning: the burden of diabetes-related problems, well-being, self-esteem, perceived competence in managing diabetes, perceived autonomy support from health professionals and self-management motivations. Furthermore, patients reported weekly self-monitored blood glucose measurements and insulin administration. Associations between HbA1c , complication and psychosocial indicators were tested using linear and logistic regression models, adjusted stepwise for confounders, including age, gender, diabetes duration, continuous subcutaneous insulin infusion, smoking and BMI. RESULTS In total, 406 (57%) participants responded. The responders had a mean age of 27.1 (5.1) years, a mean diabetes duration of 13.5 (7.9) years and an HbA1c of 66 mmol/mol (8.2%), with similar values for both genders (P = 0.87). Complications were observed among women more commonly than among men (31.6 vs. 18.8%, P < 0.01), and high distress levels were more prevalent among women compared with men (51.2 vs. 31.9%, P < 0.0001). Except for perceived autonomy support, the psychosocial variables were all associated with HbA1c (P < 0.001). CONCLUSIONS The high prevalence of poor glycaemic control, early complications and psychosocial distress require health-promoting interventions tailored to the interrelated clinical and psychosocial needs of younger adults with type 1 diabetes.
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Affiliation(s)
- V Zoffmann
- Patient Care Center, Steno Diabetes Center, Gentofte, Denmark; NKLMS, Oslo University Hospital, Oslo, Norway
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146
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Nguyen TT, Jayadeva V, Cizza G, Brown RJ, Nandagopal R, Rodriguez LM, Rother KI. Challenging recruitment of youth with type 2 diabetes into clinical trials. J Adolesc Health 2014; 54:247-54. [PMID: 24161585 PMCID: PMC4163943 DOI: 10.1016/j.jadohealth.2013.08.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 08/26/2013] [Accepted: 08/27/2013] [Indexed: 01/20/2023]
Abstract
PURPOSE To better understand and overcome difficulties with recruitment of adolescents with type 2 diabetes into clinical trials at three United States institutions, we reviewed recruitment and retention strategies in clinical trials of youth with various chronic conditions. We explored whether similar strategies might be applicable to pediatric patients with type 2 diabetes. METHODS We compiled data on recruitment and retention of adolescents with type 2 diabetes at three centers (National Institutes of Health, Bethesda, Maryland; Baylor College of Medicine, Houston, Texas; and Children's National Medical Center, Washington, DC) from January 2009 to December 2011. We also conducted a thorough literature review on recruitment and retention in adolescents with chronic health conditions. RESULTS The number of recruited patients was inadequate for timely completion of ongoing trials. Our review of recruitment strategies in adolescents included monetary and material incentives, technology-based advertising, word-of-mouth referral, and continuous patient-research team contact. Cellular or Internet technology appeared promising in improving participation among youths in studies of various chronic conditions and social behaviors. CONCLUSIONS Adolescents with type 2 diabetes are particularly difficult to engage in clinical trials. Monetary incentives and use of technology do not represent "magic bullets," but may presently be the most effective tools. Future studies should be conducted to explore motivation in this population. We speculate that (1) recruitment into interventional trials that address the main concerns of the affected youth (e.g., weight loss, body image, and stress management) combined with less tangible outcomes (e.g., blood glucose control) may be more successful; and (2) study participation and retention may be improved by accommodating patients' and caregivers' schedules, by scheduling study visits before and after working hours, and in more convenient locations than in medical facilities.
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Affiliation(s)
- Tammy T. Nguyen
- Section on Pediatric Diabetes and Metabolism, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Vikas Jayadeva
- Section on Pediatric Diabetes and Metabolism, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Giovanni Cizza
- Section on Neuroendocrinology of Obesity, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Rebecca J. Brown
- Section on Pediatric Diabetes and Metabolism, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Radha Nandagopal
- Division of Endocrinology, Children’s National Medical Center, Washington, DC
| | - Luisa M. Rodriguez
- Section of Endocrinology and Metabolism, Baylor College of Medicine, Houston, Texas
| | - Kristina I. Rother
- Section on Pediatric Diabetes and Metabolism, Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland,Address correspondence to: Kristina I. Rother, M.D., M.H.Sc., Section on Pediatric Diabetes and Metabolism, DEOB, NIDDK, NIH, 9000 Rockville Pike, Building 10, Room 8C-432A, Bethesda, MD 20852. (K.I. Rother)
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Lyons SK, Becker DJ, Helgeson VS. Transfer from pediatric to adult health care: effects on diabetes outcomes. Pediatr Diabetes 2014; 15:10-7. [PMID: 24350767 PMCID: PMC4097315 DOI: 10.1111/pedi.12106] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 10/18/2013] [Accepted: 11/06/2013] [Indexed: 01/22/2023] Open
Abstract
The transfer from pediatric to adult diabetes health care for emerging adults with type 1 diabetes (T1D) has received increasing attention in the literature. This review analyzes the effect of this health care transfer on the outcomes of diabetes care visit attendance, glycemic control, and acute diabetes-related complications, and assesses the methodological strength of the studies reporting observational and interventional data. Observational studies, often limited by incomplete data, report a decline in diabetes care visits but an improvement or no change in hemoglobin A1c (HbA1c) after transfer to adult care. Results from studies reporting a transition intervention are restricted by lack of appropriate control groups and the collection of data both before and after transfer of care. Very few methodologically strong studies are available to guide clinicians with the transition from pediatric to adult care, and these shortcomings should be addressed in future studies designed to facilitate and improve the care of emerging adults with T1D.
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Affiliation(s)
- Sarah K Lyons
- Division of Pediatric Endocrinology, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Dorothy J Becker
- Division of Pediatric Endocrinology, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Vicki S Helgeson
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, USA
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148
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Abstract
Transfer of care is when a patient and his or her medical records move from one provider to another at a distinct point in time. By contrast, transition of care is a gradual process of change in knowledge, attitudes and behaviour through which the adolescent can learn to assume personal responsibility for his or her health care. IBD is a prevalent disorder, often diagnosed during childhood. Because mortality of this condition is fortunately low, children diagnosed with IBD will, at some point, transition from a paediatric to adult health-care model. Paediatric and adult health-care paradigms, including IBD-specific care, are different in a number of key areas and it is becoming increasingly apparent that young adults with chronic illness often face challenging transitions, resulting in compromised physical and emotional health outcomes. In the past decade, refining the processes related to transition of care for adolescents with chronic medical conditions has gained traction as an important public health initiative. The aim of this paper is to review concepts pertinent to transition of management for adolescents and young adults with IBD, and to review the current literature and evidence supporting transitional care in paediatric IBD.
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149
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Hilliard ME, Perlus JG, Clark LM, Haynie DL, Plotnick LP, Guttmann-Bauman I, Iannotti RJ. Perspectives from before and after the pediatric to adult care transition: a mixed-methods study in type 1 diabetes. Diabetes Care 2014; 37:346-54. [PMID: 24089544 PMCID: PMC3898755 DOI: 10.2337/dc13-1346] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Among the many milestones of adolescence and young adulthood, transferring from pediatric to adult care is a significant transition for those with type 1 diabetes. The aim of this study was to understand the concerns, expectations, preferences, and experiences of pretransition adolescents and parents and posttransition young adults. RESEARCH DESIGN AND METHODS Participants completed questionnaires and responded to open-ended qualitative questions regarding self-management, self-efficacy, and their expectations and experiences with pediatric and adult care providers across the transition process. RESULTS At a mean age of 16.1 years, most pretransition adolescents had not yet discussed transferring care with their parents or doctors. Although many posttransition young adults reported positive, supportive interactions, several described challenges locating or establishing a relationship with an adult diabetes care provider. Qualitative themes emerged related to the anticipated timing of transfer, early preparation for transition, the desire for developmentally appropriate interactions with providers, the maintenance of family and social support, and strategies for coordinating care between pediatric and adult care providers. CONCLUSIONS Standardizing transition preparation programs in pediatric care and introducing transition-oriented clinics for late adolescents and young adults prior to adult care may help address patients' preferences and common transfer-related challenges.
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150
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Farrell K, Griffiths R, Fernandez R. Factors determining diabetes care outcomes in patients with type 1 diabetes after transition from pediatric to adult health care: a systematic review. ACTA ACUST UNITED AC 2014. [DOI: 10.11124/jbisrir-2014-1077] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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