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Wilson R, Jennings A, Redaniel MT, Samarakoon K, Dawson S, Lyttle MD, Savović J, Schofield B. Factors associated with repeat emergency department visits for mental health care in adolescents: A scoping review. Am J Emerg Med 2024; 81:23-34. [PMID: 38631148 DOI: 10.1016/j.ajem.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 03/06/2024] [Accepted: 04/08/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVES The aim of this review was to identify factors associated with multiple visits to emergency department (ED) services for mental health care in adolescents. METHODS Electronic databases (MEDLINE, PsycINFO, Embase, CINAHL, Web of Science and ProQuest Dissertations & Thesis Global) were searched for evidence that presented an association between risk factors or correlates of multiple visits to the emergency departmental for mental health care by 10-24 year olds. High impact use was defined as at least one return ED visit for mental health care. Primary studies of any quantitative design were included, with no exclusions based on language or country and all possible risk factors were considered. Data were extracted and synthesised using quantitative methods; frequencies of positive, negative and null associations were summarised for categories of potential risk factors. RESULTS Sixty-five studies were included in the review. Most studies were from North America and reported a wide range of measures of high impact ED use, the most common being a binary indicator of multiple ED visits. Sex/gender and age were the most frequently reported risk factors. Measure of previous or concurrent access to mental health care was consistently positively associated with high impact use. Having private health insurance, compared with public or no insurance, was generally negatively associated with high impact use. Proxy measures of socioeconomic position (SEP) showed associations between lower SEP and more high impact use in a small number of studies. No other factors were consistently or uniformly associated with high impact use. CONCLUSIONS The review identified a substantial evidence base but due to the variability in study design and measurement of both risk factors and outcomes, no consistent risk factors emerged. More research is needed, particularly outside North America, using robust methods and high quality routinely collected data.
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Affiliation(s)
- Rebecca Wilson
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK; University of Bristol, Bristol, UK.
| | | | - Maria Theresa Redaniel
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK; University of Bristol, Bristol, UK.
| | - Kithsiri Samarakoon
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK; University of Bristol, Bristol, UK.
| | - Sarah Dawson
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK; University of Bristol, Bristol, UK.
| | - Mark D Lyttle
- University of the West of England, Bristol, UK; Bristol Royal Hospital for Children, Bristol, UK.
| | - Jelena Savović
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK; University of Bristol, Bristol, UK.
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Gilsbach S, Borzikowsy C, Herpertz-Dahlmann B. Lost in between-the transition process from a child and adolescent eating disorder service to adult mental health services in the German health care system. EUROPEAN EATING DISORDERS REVIEW 2024; 32:547-556. [PMID: 38303544 DOI: 10.1002/erv.3070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/03/2024]
Abstract
INTRODUCTION In young adults with anorexia nervosa (AN), the process of transition from a child and adolescent mental health service (CAMHS) to an adult mental health service (AMHS) has been recognized as critical, and many patients fear falling through the gap between the two types of service. As reports about the transition process in emerging adults with AN are scarce, the present study aimed to explore the problems and experiences of this age group. METHOD We screened our registry for patients with AN who had been treated as inpatients during childhood and/or adolescence and come of age during the last 3 years. Thirty-two female patients [mean age 20.3 (1.2) y.] agreed to participate in a semistructured personal or telephone interview assessing their demographic and clinical data, whether they had finalised the transition, and their wishes and experiences regarding the transition process. RESULTS Only approximately one-third of the participants had already undergone the transition. Nearly 60% of the former patients were still cared for by a CAMHS, and only 12.5% had stopped treatment for AN. Approximately 60% were exclusively or additionally cared for by their general practitioner. More than 50% of the participants still lived with their parents. Approximately 90% of the participants who remained in a CAMHS expressed concerns about transitioning, mostly about losing their trusted therapist and the assumption of personal responsibility. CONCLUSION Patients with AN often delay the transition from a CAMHS to an AMHS, which they experience as intimidating and overwhelming. Thus, patients should be better prepared for the transition, which should be linked to "developmental readiness" and not to chronological age. Because many patients still live with their family of origin, parents and their family physician should be closely involved in the transition process.
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Affiliation(s)
- Susanne Gilsbach
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH University, Aachen, Germany
| | - Christoph Borzikowsy
- Fachhochschule für Verwaltung und Dienstleistung (FHVD), Campus Altenholz Rehmkamp, Altenholz, Germany
| | - Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH University, Aachen, Germany
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Punjwani Z, Patton M, Alladin-Karan A, Samborn S, Samuel S. Role of primary care in enhancing continuity of care for adolescents and young adults with chronic kidney disease undergoing transition to adult health services. Pediatr Nephrol 2024; 39:1077-1084. [PMID: 37667084 DOI: 10.1007/s00467-023-06140-4] [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: 03/22/2023] [Revised: 08/08/2023] [Accepted: 08/14/2023] [Indexed: 09/06/2023]
Abstract
The transition from pediatric to adult health care is a vulnerable period for adolescents and young adults (AYA) with chronic conditions as it involves a multitude of changes and challenges while they enter adulthood. The transition to adult care can be particularly challenging for AYA living with chronic kidney disease (CKD) due to the complex care needed for treatment. Continuity of care is crucial for a successful transition to adult health care. The aim of this educational review is to discuss the potential role of primary care providers in the transition from pediatric to adult health services for AYA with CKD and kidney failure treated with dialysis and/or transplant. We address the significance of the medical home model and how it can provide continuity of care for AYA with CKD. Primary care providers can enhance care for AYA with chronic conditions by providing continuity of care, reducing exacerbation of chronic health conditions, providing holistic care, and fostering collaboration with specialists. Despite their vital role, primary care providers face barriers in maintaining this continuity, necessitating further attention and support in this area. By addressing these barriers and encouraging primary care providers to work alongside pediatric and adult nephrologists during the transition to adult health care, there are significant opportunities to improve the care and health outcomes of AYA with CKD.
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Affiliation(s)
- Zoya Punjwani
- Department of Pediatrics, University of Calgary, 28 Oki Drive NW, CalgaryAlberta, AB, T3B 6A8, Canada
| | - Megan Patton
- Department of Pediatrics, University of Calgary, 28 Oki Drive NW, CalgaryAlberta, AB, T3B 6A8, Canada
| | - Areefa Alladin-Karan
- Department of Pediatrics, University of Calgary, 28 Oki Drive NW, CalgaryAlberta, AB, T3B 6A8, Canada
| | - Sophie Samborn
- Department of Pediatrics, University of Calgary, 28 Oki Drive NW, CalgaryAlberta, AB, T3B 6A8, Canada
| | - Susan Samuel
- Department of Pediatrics, University of Calgary, 28 Oki Drive NW, CalgaryAlberta, AB, T3B 6A8, Canada.
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Persaud N, Sabir A, Woods H, Sayani A, Agarwal A, Chowdhury M, de Leon-Demare K, Ibezi S, Jan SH, Katz A, LaFortune FD, Lewis M, McFarlane T, Oberai A, Oladele Y, Onyekwelu O, Peters L, Wong P, Lofters A. Recommandations pour des soins préventifs pour promouvoir l’équité en matière de santé. CMAJ 2023; 195:E1674-E1701. [PMID: 38081626 PMCID: PMC10718275 DOI: 10.1503/cmaj.230237-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Contexte: Malgré des investissements importants dans un système de soins de santé public qui comprend des services préventifs, on continue d’observer des disparités évitables en matière de santé au Canada. L’équipe avait pour objectif de formuler des recommandations pour des soins de santé préventifs qui puissent améliorer l’équité en matière de santé par la priorisation des interventions efficaces à l’intention des groupes défavorisés. Méthodes: La ligne directrice a été élaborée par un comité composé de spécialistes en soins primaires et de membres de la patientèle, avec la contribution d’un groupe de patientes-et patientspartenaires ayant vécu diverses expériences. Après avoir sélectionné les sujets à prioriser, nous avons recensé les revues systématiques, les essais randomisés et contrôlés récents sur les méthodes de dépistage et d’autres études pertinentes sur l’efficacité du dépistage et de la prise en charge. Nous avons utilisé l’approche GRADE (Grading of Recommendations, Assessment, Development and Evaluation) pour formuler les recommandations et avons suivi le guide AGREE II (Appraisal of Guidelines for Research and Evaluation) pour rédiger le rapport. Il en a été de même avec les principes du Guidelines International Network pour la gestion des intérêts concurrents. Les recommandations ont été passées en revue par un comité externe d’experts en contenu avant d’être distribuées à des intervenants à l’échelle nationale pour approbation. Recommandations: Nous avons formulé 15 recommandations concernant le dépistage et d’autres soins préventifs et 1 recommandation de nature politique visant à améliorer l’accès aux soins primaires. Ainsi, nous recommandons de prioriser une stratégie de communication pour le dépistage du cancer colorectal à partir de l’âge de 45 ans et pour l’évaluation du risque de maladie cardiovasculaire pour lutter contre les iniquités en matière de santé et promouvoir la santé. Les interventions particulières qui devraient être déployées pour lutter contre les iniquités comprennent l’autodépistage du virus du papillome humain (VPH) et du VIH, et le test de libération de l’interféron γ pour l’infection tuberculeuse. Le dépistage de la dépression, de la toxicomanie, de la violence conjugale et de la pauvreté devrait également permettre aux personnes touchées d’accéder plus facilement à des interventions éprouvées. Nous recommandons une prise de contact systématique avec des professionnels de la santé en soins primaires pour les personnes défavorisées. Interprétation: Les interventions préventives éprouvées peuvent aider à combattre les iniquités en matière de santé si la priorité est accordée aux personnes défavorisées. Les médecins, les organisations de santé et les gouvernements devraient adopter des mesures fondées sur des données probantes et en faire le suivi s’ils veulent promouvoir l’équité en matière de santé partout au Canada.
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Affiliation(s)
- Nav Persaud
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont.
| | - Areesha Sabir
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Hannah Woods
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Ambreen Sayani
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Arnav Agarwal
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Muna Chowdhury
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Kathleen de Leon-Demare
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Somtochukwu Ibezi
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Saadia Hameed Jan
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Alan Katz
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Frantz-Daniel LaFortune
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Melanie Lewis
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Trudy McFarlane
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Anjali Oberai
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Yinka Oladele
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Onyema Onyekwelu
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Lisa Peters
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Patrick Wong
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
| | - Aisha Lofters
- Centre MAP pour des solutions de santé urbaine (Persaud, Sabir, Woods); Département de médecine familiale et communautaire (Persaud, Lofters), Université de Toronto; Département de médecine familiale et communautaire (Persaud), Hôpital St. Michael, Réseau universitaire de santé de Toronto; Institut de recherche de l'Hôpital Women's College (Sayani, Lofters), Hôpital Women's College, Toronto, Ont.; Centre Peter Gilgan pour les cancers féminins (Lofters), Hôpital Women's College, Toronto, Ont.; Division de médecine générale interne (Agarwal), Département de médecine, Université McMaster, Hamilton, Ont.; Département des méthodes, données et incidence de la recherche en santé (Agarwal), Université McMaster, Hamilton, Ont.; Université Dalhousie (Chowdhury), Halifax, N.-É.; École de sciences infirmières (de Leon-Demare), Faculté de sciences de la santé Rady, Université du Manitoba, Winnipeg, Man.; Département de médecine familiale (Ibezi), Saskatoon, Sask.; Département de médecine familiale (Jan, LaFortune, Onyekwelu), Université McGill, Montréal, Qc; Sciences de la santé communautaire et médecine familiale (Katz), Faculté de médecine Max Rady, Université du Manitoba, Winnipeg, Man.; Centre de santé de Port Elgin et des régions environnantes, Réseau de santé Horizon (Lewis Peters), Port Elgin, N.-B.; Association des médecins noirs de l'Ontario (McFarlane), Brampton, Ont.; École de médecine du Nord de l'Ontario (Oberai), Sudbury, Ont.; organisme African Cancer Support Group (Oladele), Calgary, Alb.; Centre de santé communautaire Parkdale Queen West (Wong), Toronto, Ont
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Raju RM, Tsai LH. Dismantling silos: The case for an integrated approach to address childhood determinants of lifelong brain health. Neuron 2023; 111:3706-3709. [PMID: 37794591 DOI: 10.1016/j.neuron.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 08/31/2023] [Accepted: 09/06/2023] [Indexed: 10/06/2023]
Abstract
Early-life environments have an immense influence on long-term health outcomes. We have started to elucidate the mechanisms underlying this association but have made little progress in reducing the disease burden of environmentally mediated neurological and psychiatric illness. Here, we highlight barriers to innovation and how they may be overcome.
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Affiliation(s)
- Ravikiran M Raju
- Division of Newborn Medicine, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA; Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, USA.
| | - Li-Huei Tsai
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, USA; Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA; Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, MA, USA
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Yorke E, Toulany A, Chiu M, Gandhi S, Guttmann A, Emerson SD, Kurdyak P, Vigod S, Fung K, Saunders N. Population-Based Repeated Cross-Sectional Study of Hospitalizations for Comorbid Physical and Psychiatric Disorders in Young Adults in Ontario, Canada. J Adolesc Health 2023; 73:715-723. [PMID: 37410004 DOI: 10.1016/j.jadohealth.2023.05.031] [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: 10/07/2022] [Revised: 03/06/2023] [Accepted: 05/28/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE To measure trends in the rates and costs of hospitalizations over a 15-year period among young adults with physical and/or psychiatric disorders. METHODS This population-based, repeated cross-sectional study identified all 18- to 26- year-olds hospitalized in Ontario, Canada from April 1, 2003 and March 31, 2018 (fiscal years 2003-2017). Using discharge diagnoses, we assigned hospitalizations to one of four categories: 1) psychiatric disorder only; 2) primary psychiatric disorder with comorbid physical illness; 3) primary physical with comorbid psychiatric disorder; and 4) physical illness only. We compared health service utilization and changes in rates of hospitalizations over time using restricted cubic spline regression. Secondary outcome measures included change in hospital costs for each hospitalization category over the study period. RESULTS Of 1,076,951 hospitalizations in young adults (73.7% female), 195,726 (18.2%) had a psychiatric disorder (either primary or comorbid). There were 129,676 hospitalizations (12.0%) with psychiatric disorders only, 36,287 (3.4%) with primary psychiatric and comorbid physical disorders, 29,763 (2.8%) with primary physical and comorbid psychiatric disorders, and 881,225 (81.8%) with physical disorders only. Rates of hospitalization for psychiatric disorders only increased 81% from 4.32 to 7.84/1,000 population, and those with physical health disorders with comorbid psychiatric disorders increased 172% from 0.47 to 1.28/1,000 population. Substance-related disorders were the most common comorbid psychiatric disorders among youth hospitalized for physical illness and increased 260% from 0.9 to 3.3/1,000 population. DISCUSSION Hospitalizations among young adults with primary and comorbid psychiatric disorders have increased significantly over the past 15 years. Health system resources should be adequately directed to meet the shifting and complex needs of hospitalized young adults.
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Affiliation(s)
- Elisabeth Yorke
- Department of General Academic Paediatrics, Children's Hospital of Western Ontario, London, Ontario, Canada
| | - Alene Toulany
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Edwin S. H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Maria Chiu
- ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sima Gandhi
- ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
| | - Astrid Guttmann
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Edwin S. H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Scott D Emerson
- ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
| | - Paul Kurdyak
- ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Simone Vigod
- ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Kinwah Fung
- ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
| | - Natasha Saunders
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; ICES (formerly the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Edwin S. H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.
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Navein A, Gonzalez-Viana E, Mehmeti A, Hargreaves D, Elvins R, Churchill R. Barriers and facilitators to continuity and co-ordination of healthcare for under 18 years old: a systematic review. Arch Dis Child 2023; 108:783-788. [PMID: 36650031 DOI: 10.1136/archdischild-2022-324456] [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: 05/20/2022] [Accepted: 01/04/2023] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To determine views and experiences of babies, children and young people relating to continuity of their healthcare. DESIGN Qualitative systematic review. SETTING Primary research from UK settings where NHS-commissioned or local authority-commissioned healthcare is provided. Systematic reviews from UK and non-UK high-income countries. POPULATION Babies, children and young people under 18 years old with experience of healthcare. Parental and/or carer perspectives only included if children are under 5 years old or unable to express their own view. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Thematic analysis of the benefits and facilitators to continuity of care for babies, children and young people. RESULTS 20 047 abstracts were screened; 186 full-text articles were reviewed; 11 papers fulfilled the review criteria. From these, four main themes and 14 subthemes were identified. The theme 'individuals' had four subthemes: 'knowledge of healthcare system', 'support', 'personal lives' and 'results'. The theme 'healthcare professionals' had four subthemes: 'interservice communication', 'collaboration with babies, children and young people', 'communications' and 'relationships with healthcare professionals'. The theme 'practical' had four subthemes: 'colocation', 'appointment times', 'referrals' and 'waiting times'. The theme 'technological' had two subthemes: 'ease of use' and 'complements current healthcare management'. CONCLUSIONS Continuity of healthcare for babies, children and young people can enhance clinical outcomes but requires active facilitation by healthcare providers and services, especially in circumstances where individuals or their families are less able to advocate for themselves. A range of barriers and facilitators were identified together with recommendations for enhancing continuity of care. PROSPERO REGISTRATION NUMBER CRD42019145566.
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Affiliation(s)
- Alice Navein
- National Institute for Health and Care Excellence, London, UK
| | - Eva Gonzalez-Viana
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Agnesa Mehmeti
- National Institute for Health and Care Excellence, London, UK
| | - Dougal Hargreaves
- Mohn Centre for Children's Health & Wellbeing, School of Public Health, Imperial College, London, UK
| | - Rachel Elvins
- Child and Adolescent Mental Health CSU, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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Persaud N, Sabir A, Woods H, Sayani A, Agarwal A, Chowdhury M, de Leon-Demare K, Ibezi S, Jan SH, Katz A, LaFortune FD, Lewis M, McFarlane T, Oberai A, Oladele Y, Onyekwelu O, Peters L, Wong P, Lofters A. Preventive care recommendations to promote health equity. CMAJ 2023; 195:E1250-E1273. [PMID: 37748784 PMCID: PMC10519166 DOI: 10.1503/cmaj.230237] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Avoidable disparities in health outcomes persist in Canada despite substantial investments in a publicly funded health care system that includes preventive services. Our objective was to provide preventive care recommendations that promote health equity by prioritizing effective interventions for people experiencing disadvantages. METHODS The guideline was developed by a primary care provider-patient panel, with input from a patient-partner panel with diverse lived experiences. After selecting priority topics, we searched for systematic reviews and recent randomized controlled trials of screening and other relevant studies of screening accuracy and management efficacy. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to develop recommendations and followed the Appraisal of Guidelines for Research and Evaluation (AGREE II) reporting guidance. We managed competing interests using the Guideline International Network principles. The recommendations were externally reviewed by content experts and circulated for endorsement by national stakeholders. RECOMMENDATIONS We developed 15 screening and other preventive care recommendations and 1 policy recommendation on improving access to primary care. We recommend prioritized outreach for colorectal cancer screening starting at age 45 years and for cardiovascular disease risk assessment, to help address inequities and promote health. Specific interventions that should be rolled out in ways that address inequities include human papillomavirus (HPV) self-testing, HIV self-testing and interferon-γ release assays for tuberculosis infection. Screening for depression, substance use, intimate partner violence and poverty should help connect people experiencing specific disadvantages with proven interventions. We recommend automatic connection to primary care for people experiencing disadvantages. INTERPRETATION Proven preventive care interventions can address health inequities if people experiencing disadvantages are prioritized. Clinicians, health care organizations and governments should take evidence-based actions and track progress in promoting health equity across Canada.
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Affiliation(s)
- Nav Persaud
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont.
| | - Areesha Sabir
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Hannah Woods
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Ambreen Sayani
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Arnav Agarwal
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Muna Chowdhury
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Kathleen de Leon-Demare
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Somtochukwu Ibezi
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Saadia Hameed Jan
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Alan Katz
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Frantz-Daniel LaFortune
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Melanie Lewis
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Trudy McFarlane
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Anjali Oberai
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Yinka Oladele
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Onyema Onyekwelu
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Lisa Peters
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Patrick Wong
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
| | - Aisha Lofters
- MAP Centre for Urban Health Solutions (Persaud, Sabir, Woods); Department of Family and Community Medicine (Persaud, Lofters), University of Toronto; Department of Family and Community Medicine (Persaud), St Michael's Hospital, Unity Health Toronto; Women's College Hospital Research Institute (Sayani, Lofters), Women's College Hospital, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Division of General Internal Medicine (Agarwal), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence and Impact (Agarwal), McMaster University, Hamilton, Ont.; Dalhousie University (Chowdhury), Halifax, NS; College of Nursing (de Leon-Demare), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Department of Family Medicine (Ibezi), Saskatoon, Sask.; Department of Family Medicine (Jan, LaFortune, Onyekwelu), McGill University, Montréal, Que.; Community Health Sciences and Family Medicine (Katz), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Port Elgin & Region Health Centre, Horizon Health Network (Lewis Peters), Port Elgin, NB; Black Physicians' Association of Ontario (McFarlane), Brampton, Ont.; Northern Ontario School of Medicine University (Oberai), Sudbury, Ont.; African Cancer Support Group (Oladele), Calgary, Alta.; Parkdale Queen West Community Health Centre (Wong), Toronto, Ont
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Splane J, Doucet S, Luke A. Transitioning from paediatric to adult healthcare: Exploring the practices and experiences of care providers. J Child Health Care 2023:13674935231202870. [PMID: 37728067 DOI: 10.1177/13674935231202870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Complex paediatric health conditions are increasingly associated with survival into adulthood resulting in more youth with complex care needs (CCN) transitioning from paediatric to adult healthcare. Current transition practices, when present, are disorganized, resulting in health status deterioration and complications due to unmet needs. The aim of this qualitative descriptive study is to develop a broader understanding of the current transition practices and experiences, as well as recommendations of care providers who support youth with CCN in the transition from paediatric to adult healthcare. Fifteen care providers from two Eastern Canadian provinces were interviewed using a semi-structured interview guide. The data collected were analyzed using inductive thematic analysis following the six phases outlined by Braun and Clarke (2006). The findings from this research demonstrate (1) a shortage of care providers, (2) inconsistent timing for transition initiation, and (3) lack of available community resources and services. Participant recommendations include (1) a designated transition coordinator; (2) transition policy implementation; (3) improved collaboration between and across care teams; and (4) the integration of virtual care to facilitate the transition process. The results of this study can potentially improve transition practices and policies and guide future research in this area.
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Affiliation(s)
- Jennifer Splane
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Shelley Doucet
- Department of Nursing & Health Sciences, University of New Brunswick Saint John, Saint John, NB, Canada
- Centre for Research in Integrated Care, University of New Brunswick Saint John, Saint John, NB, Canada
| | - Alison Luke
- Department of Nursing & Health Sciences, University of New Brunswick Saint John, Saint John, NB, Canada
- Centre for Research in Integrated Care, University of New Brunswick Saint John, Saint John, NB, Canada
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Dimitropoulos G, Singh M, Mushquash C, Kimber M, Hutt-MacLeod D, Moore EK, Perri A, Webb C, Norman L, Sauerwein J, Nicula M, Couturier J. TransitionED: A protocol for Co-designing and implementing Canadian practice guidelines for transitions for youth with eating disorders. EUROPEAN EATING DISORDERS REVIEW 2023. [PMID: 37690096 DOI: 10.1002/erv.3026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/16/2023] [Accepted: 08/17/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE Limited guidelines inform the transition from paediatric to adult healthcare for youth and young adults (YYA) with eating disorders (EDs). This study will develop, implement, and evaluate Canadian Clinical Practice Guidelines for ED transition, including identifying the relevant measurement and evaluation tools for transition readiness and continuity of care. METHODS This study consists of three phases. Phase 1 involves conducting a scoping review of the evidence on transition interventions, outcomes, and measurement tools for YYA with EDs, along with guideline development using the modified Delphi method. Phase 2 identifies the contextual/cultural factors relevant to guideline implementation and co-designing an implementation protocol with governance committees and research partners. Phase 3 involves the application and evaluation of the proposed guide lines using the implementation protocol, and assessing the acceptability and feasibility of a prototype transition intervention in two Canadian paediatric ED programs. CONCLUSIONS Results will provide the knowledge needed to enhance the lives of YYA, improve the effectiveness of the ED care system, and support the scale of the transition guidelines across Canada. These guidelines will have international relevance by potentially informing the field on how to support young people with EDs transitioning in similar funding structures and systems of care.
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Affiliation(s)
- Gina Dimitropoulos
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Manya Singh
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Christopher Mushquash
- Department of Psychology, Lakehead University, Thunder Bay, Ontario, Canada
- Dilico Anishinabek Family Care, Fort William First Nation, Ontario, Canada
- Thunder Bay Regional Health Sciences Centre/Thunder Bay Regional Health Research Institute, Thunder Bay, Ontario, Canada
| | - Melissa Kimber
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Andrea Perri
- Child and Adolescent Addictions, Mental Health and Psychiatry Program, Alberta Health Services, Edmonton, Alberta, Canada
| | - Cheryl Webb
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Lia Norman
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Jessica Sauerwein
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Maria Nicula
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Jennifer Couturier
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
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11
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Nicula M, Kimber M, Boylan K, Grant C, Laliberté M, Miller K, Dimitropoulos G, Trollope K, Webb C, Couturier J. Assessing the feasibility of an intervention for adolescents and parents transitioning out of paediatric eating disorder services: A mixed methods study. EUROPEAN EATING DISORDERS REVIEW 2023. [PMID: 37632341 DOI: 10.1002/erv.3027] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/28/2023] [Accepted: 08/17/2023] [Indexed: 08/28/2023]
Abstract
OBJECTIVE To assess the feasibility of a new intervention designed to support adolescents and parents in the transition from paediatric eating disorder (ED) treatment to adult mental health services. METHOD Pre-transition adolescents with EDs, and their parents, were invited to complete up to five transition intervention components over 3 months. A mixed methods design was used to assess intervention feasibility, comprised of acceptability and preliminary effectiveness. A single-arm pre-post design was used to collect and analyse quantitative survey and feasibility data. Individual qualitative interviews and written reflections were collected and analysed using content analysis. RESULTS This study yielded a 33% (10/31) recruitment rate and 68% (13/19) retention rate. On average, participants completed 75% of the expected components in under 3 months, with varied completion of each expected intervention component (40%-100%). Participants found the intervention convenient and helpful. Parents reported a significant decrease in guilt (Z = -2.02, p = 0.04, d = -0.83). By 1-month post-transition, three adolescents transitioned to interim supports and none started specialist adult treatment. CONCLUSIONS Although this transition intervention did not demonstrate adequate feasibility, its acceptability and effectiveness should be evaluated after an update based on participant feedback. Other solutions to bridge the transition gap for adolescents with EDs should continue to be identified. CLINICAL TRIAL REGISTRATION NUMBER NCT04888273.
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Affiliation(s)
| | | | - Khrista Boylan
- McMaster University, Hamilton, Ontario, Canada
- McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Christina Grant
- McMaster University, Hamilton, Ontario, Canada
- McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Michele Laliberté
- St. Joseph's Healthcare Hamilton, West 5th Campus, Hamilton, Ontario, Canada
| | - Kathryn Miller
- St. Joseph's Healthcare Hamilton, West 5th Campus, Hamilton, Ontario, Canada
| | | | | | - Cheryl Webb
- McMaster University, Hamilton, Ontario, Canada
- McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Jennifer Couturier
- McMaster University, Hamilton, Ontario, Canada
- McMaster Children's Hospital, Hamilton, Ontario, Canada
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12
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Mooney J, Dominic A, Lewis A, Chafe R. Young adults with eating disorders perspectives on educational resources to support the transition into adult medicine: a thematic analysis. J Eat Disord 2023; 11:46. [PMID: 36959660 PMCID: PMC10034871 DOI: 10.1186/s40337-023-00771-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/13/2023] [Indexed: 03/25/2023] Open
Abstract
Background Eating disorders (EDs) commonly develop in adolescence and can be a chronic condition. Once patients reach the age when it is no longer permitted or appropriate for them to be seen in a children’s healthcare setting, they will need to transition into adult-focused care. This transition period can be challenging, with increased risks of negative health outcomes and disruptions in care. Appropriate educational resources could be an effective support for patients during this transition. Our objectives were to engage patients about the value of developing educational supports and determine how these supports should be structured to be most useful to young adults with EDs. Methods Patients who had transitioned out of a hospital-based ED program between 2017 and 2020 were invited to participate in a semi-structured interview. Data were analyzed using thematic analysis and qualitative description. Results Six young adults (5 females and 1 male) with EDs were interviewed. All participants thought it would be helpful to have an educational resource. Three main themes and seven subthemes were identified. Themes identified related to the unique challenges of transition for ED patients given the age of onset and cycle of symptoms; issues in adult care related to comorbidities and new level of autonomy; and the value of educational resources as both a connection tool and a benchmark. Participants also thought it would be useful to include in any educational resource a summary of their previous treatments, information regarding the transition process, a list of main healthcare providers they saw for their ED, a description of the differences and expectations of the adult system, a list of their follow up appointments, and a list of community and emergency mental health resources. Conclusions Participants said that educational supports can play a useful role for young adults with EDs during their transition into adult care. They also provided valuable insights into the desired contents of such supports and expanded on the roles that educational resources could serve for ED patients. Most adolescents who have an eating disorder will reach an age when it is no longer appropriate for them to receive care in a children’s health program. They will then need to transition to an adult-focused program. This transition period can be challenging, with increased risks of negative health outcomes and disruptions in care. One approach for better supporting patients during transition is through the development of appropriate educational resources. Before developing these resources, it is important to hear from patients about how they should be structured to be as useful as possible. We interviewed six patients who had recently transitioned out of a pediatric eating disorder program about the value of an educational transition resource and what should be included in it. Patients identified several unique transition issues for young adults with eating disorders. We identified valuable insights and seven key themes from these interviews. While all patients recognized the value of educational resources, rather than being just a static source of information, they envisioned a resource that could also be a dynamic record of their previous care and a tool for engaging with their new adult-focused health care providers.
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Affiliation(s)
- Jennifer Mooney
- grid.17091.3e0000 0001 2288 9830Division of Adolescent Health and Medicine, Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Anna Dominic
- grid.25055.370000 0000 9130 6822Discipline of Pediatrics, Faculty of Medicine, Memorial University of Newfoundland, Room 409, Janeway Hostel, 300 Prince Phillip Drive, St. John’s, NL A1B 3V6 Canada
| | - Alyona Lewis
- grid.25055.370000 0000 9130 6822Canadian Longitudinal Study On Aging (CLSA), Memorial University of Newfoundland, St. John’s, Canada
| | - Roger Chafe
- grid.25055.370000 0000 9130 6822Discipline of Pediatrics, Faculty of Medicine, Memorial University of Newfoundland, Room 409, Janeway Hostel, 300 Prince Phillip Drive, St. John’s, NL A1B 3V6 Canada
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13
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Wade TD. A systematic review: Solutions to problems caused by age transition between eating disorder services. EUROPEAN EATING DISORDERS REVIEW 2023; 31:247-257. [PMID: 35951534 DOI: 10.1002/erv.2945] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/18/2022] [Accepted: 07/21/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This systematic review examines age transition issues specific to young people with eating disorders, including the extent of, and reasons for, problematic transition. Suggested solutions are examined, with focus on age-integrated services. METHOD PsycINFO, Medline and SCOPUS databases were searched on 4 April, 2022 using two inclusion criteria: (1) a peer-reviewed journal article in English, (2) focus on service transition caused by moving from childhood to adulthood for people with eating disorders. A narrative integration of the content was used. RESULTS Of the 17 non-overlapping studies located in the review, 6 involved quantitative data. Problematic transition between age-based services was indicated, where a substantial minority of young people who still require help lose contact with speciality services. A variety of reasons for this problematic transition were identified, including differing and sometimes adversarial cultures between age-based services. While a variety of solutions have been suggested, the least explored was the development of age integrated services; only 3 papers focussed primarily on this. CONCLUSION The consideration of the advantages of integration and the similarities between age-based services suggested that these potentially outweigh the barriers to integration. An implementation science research agenda is required to test this hypothesis.
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Affiliation(s)
- Tracey D Wade
- Blackbird Initiative, Órama Research Institute, Flinders University, Adelaide, South Australia, Australia
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14
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Culnane E, Efron D, Williams K, Marraffa C, Antolovich G, Prakash C, Loftus H. Carer perspectives of a transition to adult care model for adolescents with an intellectual disability and/or autism spectrum disorder with mental health comorbidities. Child Care Health Dev 2023; 49:281-291. [PMID: 35947107 DOI: 10.1111/cch.13040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/23/2022] [Accepted: 08/07/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Transition to adult care for adolescents with an intellectual disability and/or autism spectrum disorder with coexisting mental health disorders, often termed 'dual disability', is complex. It requires a family-centred approach, with collaboration among health, disability and social services and early planning. AIM To describe carer perspectives of transition to adult care and the outcomes of a transition support intervention, Fearless, Tearless Transition, for adolescents with dual disabilities piloted at a tertiary children's hospital. METHODS Carers of adolescents with a dual disability were invited to complete a survey at the commencement of their participation in the Fearless, Tearless Transition model, and again at the conclusion of the project. Within this intervention, carers and adolescents were encouraged to attend dedicated transition clinics and participate in a shared care general practitioner (GP) and paediatrician process. RESULTS One hundred and fifty-one carers of adolescents with dual disabilities were included in Fearless, Tearless Transition. Of this cohort, 138 adolescents and their carers received support in a dedicated transition clinic with 99 carers completing the initial survey at the commencement of the model. Eighty-two per cent of carers reported moderate to high levels of anxiety about transitioning from paediatric to adult care with 39% feeling 'unprepared' about transition. Eighty-one per cent reported having inadequate access to respite care with 47% reporting a lack of access to services in the community and 56% expressing dissatisfaction with their GPs. One hundred and two families participated in the shared care process with 80 GPs and 33 paediatricians. Twenty-two carers completed the second survey reporting a modest but significant improvement in preparedness for transition to adult care. CONCLUSION This study highlights the potential to improve transition outcomes for adolescents with dual disabilities and their carers through early, centralized transition planning, consistent methods of assessing adolescent and carer needs and shared care.
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Affiliation(s)
- Evelyn Culnane
- Transition Support Service, Department of Adolescent Medicine, The Royal Children's Hospital (RCH) Melbourne, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Daryl Efron
- University of Melbourne, Melbourne, Victoria, Australia.,Department of General Medicine, The Royal Children's Hospital (RCH) Melbourne, Melbourne, Victoria, Australia.,Centre for Community Child Health, The Royal Children's Hospital (RCH) Melbourne, Melbourne, Victoria, Australia
| | - Katrina Williams
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Catherine Marraffa
- University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Neurodevelopment and Disability, The Royal Children's Hospital (RCH) Melbourne, Melbourne, Victoria, Australia
| | - Giuliana Antolovich
- University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Neurodevelopment and Disability, The Royal Children's Hospital (RCH) Melbourne, Melbourne, Victoria, Australia
| | - Chidambaram Prakash
- Department of Mental Health, The Royal Children's Hospital (RCH) Melbourne, Melbourne, Victoria, Australia
| | - Hayley Loftus
- Transition Support Service, Department of Adolescent Medicine, The Royal Children's Hospital (RCH) Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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15
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Murphy KA, Daumit GL. Establishing a Care Continuum for Cardiometabolic Conditions for Patients with Serious Mental Illness. Curr Cardiol Rep 2023; 25:193-202. [PMID: 36847991 PMCID: PMC10042919 DOI: 10.1007/s11886-023-01848-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/03/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE OF REVIEW Addressing cardiometabolic risk factors in persons with serious mental illness requires early screening and proactive medical management in both medical and mental health settings. RECENT FINDINGS Cardiovascular disease remains the leading cause of death for persons with serious mental illness (SMI), such as schizophrenia or bipolar disorder, much of which is driven by a high prevalence of metabolic syndrome, diabetes, and tobacco use. We summarize barriers and recent approaches to screening and treatment for metabolic cardiovascular risk factors within physical health and specialty mental health settings. Incorporating system-based and provider-level support within physical health and psychiatric clinical settings should contribute to improvement for screening, diagnosis, and treatment for cardiometabolic conditions for patients with SMI. Targeted education for clinicians and leveraging multi-disciplinary teams are important first steps to recognize and treat populations with SMI at risk of CVD.
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Affiliation(s)
- Karly A Murphy
- Division of General Internal Medicine, University of California San Francisco School of Medicine, 1701 Divisidero Street, Suite 500, 94117, San Francisco, CA, USA.
| | - Gail L Daumit
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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16
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Teoh CW, Licht C. Transition of care of adolescent kidney transplant recipients-a call to action. Nephrol Dial Transplant 2023; 38:7-9. [PMID: 36029280 DOI: 10.1093/ndt/gfac243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Indexed: 01/26/2023] Open
Affiliation(s)
- Chia Wei Teoh
- Division of Nephrology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Christoph Licht
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
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17
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Wildes DM, Costigan CS, Kinlough M, Flynn J, Dolan N, Riordan M, Sweeney C, Stack M, Waldron M, Walsh O, Gorman KM, Awan A. Transitional care models in adolescent kidney transplant recipients-a systematic review. Nephrol Dial Transplant 2023; 38:49-55. [PMID: 35554567 DOI: 10.1093/ndt/gfac175] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Adolescence is a time of significant change for patients, guardians and clinicians. The paediatrician must ensure patients develop the necessary skills and knowledge required to transition and to function as an independent entity, with autonomy over their own care. The transfer from paediatric to adult care carries an increased risk of graft-related complications attributable to a multitude of reasons, particularly non-adherence to immunosuppressive medicines and poor attendance at scheduled appointments. This systematic review was conducted to ascertain the transitional care models available to clinicians caring for kidney transplant recipients and to compare the approach in each respective case. METHODS A systematic review was performed, in a methodology outlined by the PRISMA guidelines. OVID MEDLINE and EMBASE databases were searched for studies that outlined valid, replicable models pertaining to transitional care of paediatric kidney transplant recipients between 1946 and Quarter 3 of 2021. The reference lists of selected articles were also perused for further eligible studies and experts in the field were consulted for further eligible articles. Two investigators assessed all studies for eligibility and independently performed data extraction. Any discrepancies were settled by consensus. RESULTS A total of 1121 abstracts were identified, which was reduced to 1029 upon removal of duplicates. A total of 51 articles were deemed appropriate for full-text review and critical appraisal. A total of 12 articles that described models for transition pertaining to kidney transplant patients were included in qualitative synthesis. Every paper utilized a different transition model. All but one model included a physician and nurse at minimum in the transition process. The involvement of adult nephrologists, medical social work, psychology and psychiatry was variable. The mean age for the initiation of transition was 13.4 years (range: 10-17.5 years). The mean age at transfer to adult services was 18.3 years (range: 16-20.5 years). CONCLUSIONS Despite the well-established need for good transitional care for paediatric solid-organ transplant recipients, models tailored specifically for kidney transplant recipients are lacking. Further research and validation studies are required to ascertain the best method of providing effective transitional care to these patients. Transitional care should become a standardized process for adolescents and young adults with kidney transplants.
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Affiliation(s)
- Dermot Michael Wildes
- The Department of Paediatric Nephrology & Transplantation, Children's Health Ireland at Temple St, Dublin, Ireland
| | - Caoimhe S Costigan
- The Department of Paediatric Nephrology & Transplantation, Children's Health Ireland at Temple St, Dublin, Ireland
| | - Mairead Kinlough
- The Department of Paediatric Nephrology & Transplantation, Children's Health Ireland at Temple St, Dublin, Ireland
| | - Joan Flynn
- The Department of Paediatric Nephrology & Transplantation, Children's Health Ireland at Temple St, Dublin, Ireland
| | - Niamh Dolan
- The Department of Paediatric Nephrology & Transplantation, Children's Health Ireland at Temple St, Dublin, Ireland.,The Department of Paediatric Nephrology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Michael Riordan
- The Department of Paediatric Nephrology & Transplantation, Children's Health Ireland at Temple St, Dublin, Ireland.,The Department of Paediatric Nephrology, Children's Health Ireland at Crumlin, Dublin, Ireland.,The Department of Paediatrics and Child Health, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Clodagh Sweeney
- The Department of Paediatric Nephrology & Transplantation, Children's Health Ireland at Temple St, Dublin, Ireland.,The Department of Paediatric Nephrology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Maria Stack
- The Department of Paediatric Nephrology & Transplantation, Children's Health Ireland at Temple St, Dublin, Ireland.,The Department of Paediatric Nephrology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Mary Waldron
- The Department of Paediatric Nephrology & Transplantation, Children's Health Ireland at Temple St, Dublin, Ireland.,The Department of Paediatric Nephrology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Orla Walsh
- The Department of Paediatrics and Child Health, Royal College of Surgeons in Ireland, Dublin, Ireland.,The Department of General Paediatrics, Children's Health Ireland at Temple St, Dublin, Ireland
| | - Kathleen M Gorman
- The Department of Neurology and Clinical Neurophysiology, Children's Health Ireland at Temple St, Dublin, Ireland.,School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Atif Awan
- The Department of Paediatric Nephrology & Transplantation, Children's Health Ireland at Temple St, Dublin, Ireland.,The Department of Paediatrics and Child Health, Royal College of Surgeons in Ireland, Dublin, Ireland.,School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
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18
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Cleverley K, Davies J, Brennenstuhl S, Bennett KJ, Cheung A, Henderson J, Korczak DJ, Kurdyak P, Levinson A, Pignatiello A, Stevens K, Voineskos AN, Szatmari P. The Longitudinal Youth in Transition Study (LYiTS) Cohort Profile: Exploration by Hospital- Versus Community-Based Mental Health Services. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:928-938. [PMID: 35924416 PMCID: PMC9659798 DOI: 10.1177/07067437221115947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Youth face numerous challenges in receiving coordinated and continuous mental health services, particularly as they reach the age of transition from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS). The Longitudinal Youth in Transition Study (LYiTS) follows youth prospectively as they cross this transition boundary to better understand their transition pathways and resulting symptoms and health service use outcomes. The current paper presents the baseline profile description for the LYiTS cohort and additionally examines differences in symptoms and functioning and health service utilization between youth receiving services at hospital- versus community-based CAMHS. METHODS A cross-sectional design was used. A sample of 237 16-18-year-old youth recruited from outpatient CAMHS at two hospitals and two community sites completed self-report measures at their first of four annual assessments. A latent profile analysis was conducted to identify symptomology profiles, and youth were compared on symptoms and health service use between hospital- and community-based sites. RESULTS Four distinct symptomology profiles were identified (subclinical, moderate internalizing, moderate externalizing, and high symptomology). Symptom profiles and functioning levels reported by youth were no different across both types of organization, although there were differences detected in health service utilization, such as type of provider seen and use of medications. CONCLUSIONS These findings suggest that there is little difference in symptomology between youth accessing hospital versus community-based CAMHS. With growing interest in understanding the effectiveness and cost-effectiveness of different models of mental health care, these findings provide a new understanding of the clinical and service use profiles of transition-aged youth that will be explored further as this cohort is followed across the CAMHS to AMHS transition boundary.
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Affiliation(s)
- Kristin Cleverley
- Lawrence S. Bloomberg Faculty of Nursing, 7938University of Toronto, Toronto, ON, Canada.,7978Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, 7938University of Toronto, Toronto, ON, Canada
| | - Julia Davies
- Lawrence S. Bloomberg Faculty of Nursing, 7938University of Toronto, Toronto, ON, Canada.,7978Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Sarah Brennenstuhl
- Lawrence S. Bloomberg Faculty of Nursing, 7938University of Toronto, Toronto, ON, Canada
| | - Kathryn J Bennett
- Health Research Methods, Evidence and Impact (formerly Clinical Epidemiology and Biostatistics), 62703McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - Amy Cheung
- Department of Psychiatry, Temerty Faculty of Medicine, 7938University of Toronto, Toronto, ON, Canada.,71545Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Joanna Henderson
- 7978Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, 7938University of Toronto, Toronto, ON, Canada
| | - Daphne J Korczak
- Department of Psychiatry, Temerty Faculty of Medicine, 7938University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, 7979Hospital for Sick Children, Toronto, ON, Canada
| | - Paul Kurdyak
- 7978Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, 7938University of Toronto, Toronto, ON, Canada
| | - Andrea Levinson
- 7978Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, 7938University of Toronto, Toronto, ON, Canada
| | - Antonio Pignatiello
- Department of Psychiatry, Temerty Faculty of Medicine, 7938University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, 7979Hospital for Sick Children, Toronto, ON, Canada
| | - Katye Stevens
- 7978Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Aristotle N Voineskos
- 7978Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, 7938University of Toronto, Toronto, ON, Canada
| | - Peter Szatmari
- 7978Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, 7938University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, 7979Hospital for Sick Children, Toronto, ON, Canada
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19
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Davidson AR, Morgan M, Ball L, Reidlinger DP. Patient advocates' views of patient roles in interprofessional collaborative practice in primary care: A constructivist grounded theory study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5775-e5785. [PMID: 36134601 PMCID: PMC10087047 DOI: 10.1111/hsc.14009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/22/2022] [Accepted: 08/20/2022] [Indexed: 06/16/2023]
Abstract
Interprofessional collaborative practice has been shown to be an appropriate model of care for chronic disease management in primary care. However, how patients play a role in this model is relatively unknown. The aim of this constructivist grounded theory focus group study was to explore the perceptions of patient advocates regarding the role of patients in interprofessional collaborative practice for chronic conditions in primary care. Primary data were collected from patient advocates, from public and private Australian organisations and who represent patients with chronic disease in primary care, through focus groups in July-August 2020. Videoconference focus groups were recorded, transcribed verbatim and inductively, thematically analysed using the five-step approach by Charmaz: (1) initial line-by-line coding, (2) focused coding, (3) memo writing, (4) categorisation and (5) theme and sub-theme development. Three focus groups comprising 17 patient advocates with diverse cultural and professional backgrounds participated. Two themes and five sub-themes relating to interprofessional collaborative practice teams were constructed from the data. In theme 1, patients 'shifted across the spectrum of roles' from 'relinquishing control to the team', 'joining the team' to 'disengaging from the team'. The second theme was the need for 'juggling roles' by 'integrating patient role with life roles', and 'learning about the patient role'. The diversity and variability of patient roles as described by patient advocates highlight the challenges of working with people with chronic conditions. The diverse patient roles described by advocates are an important finding that may better inform communication between patients and health professionals when managing chronic conditions. From the health professional perspective, identification of the role of a patient may be challenging. Therefore, future research should explore the development of a tool to assist both patients and health professionals to identify patient roles as they move across the spectrum, with the support of policy makers. This tool should aim to identify and promote patient engagement in interprofessional collaborative practice in primary care settings.
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Affiliation(s)
| | - Mark Morgan
- Faculty of Health Sciences and MedicineBond UniversityGold CoastQueenslandAustralia
| | - Lauren Ball
- Menzies Health Institute QueenslandGriffith UniversityGold CoastQueenslandAustralia
- The University of QueenslandBrisbaneQueenslandAustralia
| | - Dianne P. Reidlinger
- Faculty of Health Sciences and MedicineBond UniversityGold CoastQueenslandAustralia
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20
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Toulany A, Gorter JW, Harrison M. A call for action: Recommendations to improve transition to adult care for youth with complex health care needs. Paediatr Child Health 2022; 27:297-309. [PMID: 36016593 PMCID: PMC9394635 DOI: 10.1093/pch/pxac047] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 01/07/2022] [Indexed: 11/12/2022] Open
Abstract
Youth with complex health care needs, defined as those requiring specialized health care and services for physical, developmental, and/or mental health conditions, are often cared for by paediatricians and paediatric specialists. In Canada, the age at which provincial/territorial funders mandate the transfer of paediatric care to adult services varies, ranging between 16 and 19 years. The current configuration of distinct paediatric and adult care service boundaries is fragmentary, raising barriers to continuity of care during an already vulnerable developmental period. For youth, the lack of care integration across sectors can negatively impact health engagement and jeopardize health outcomes into adulthood. To address these barriers and improve transition outcomes, paediatric and adult care providers, as well as family physicians and other community partners, must collaborate in meaningful ways to develop system-based strategies that streamline and safeguard care for youth transitioning to adult services across tertiary, community, and primary care settings. Flexible age cut-offs for transfer to adult care are recommended, along with considering each youth's developmental stage and capacity as well as patient and family needs and circumstances. Specialized training and education in transitional care issues are needed to build capacity and ensure that health care providers across diverse disciplines and settings are better equipped to accept and care for young people with complex health care needs.
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Affiliation(s)
- Alene Toulany
- Canadian Paediatric Society, Adolescent Health Committee, Ottawa, Ontario, Canada
| | - Jan Willem Gorter
- Canadian Paediatric Society, Adolescent Health Committee, Ottawa, Ontario, Canada
| | - Megan Harrison
- Canadian Paediatric Society, Adolescent Health Committee, Ottawa, Ontario, Canada
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21
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Toulany A, Gorter JW, Harrison ME. Appel à l'action : des recommandations pour améliorer la transition des jeunes ayant des besoins de santé complexes vers les soins aux adultes. Paediatr Child Health 2022; 27:297-309. [PMID: 36016598 PMCID: PMC9394631 DOI: 10.1093/pch/pxac046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 01/07/2022] [Indexed: 11/14/2022] Open
Abstract
Les jeunes qui ont des besoins de santé complexes, définis comme ceux qui nécessitent des soins et services spécialisés en raison d'affections physiques, développementales ou mentales, sont souvent traités par des pédiatres et autres spécialistes en pédiatrie. Au Canada, l'âge auquel les bailleurs de fonds provinciaux et territoriaux exigent le transfert des soins pédiatriques aux soins pour adultes varie entre 16 et 19 ans. La délimitation actuelle entre les services de santé pédiatriques et aux adultes est fragmentaire, ce qui entrave la continuité des soins pendant une période déjà vulnérable du développement. Le peu d'intégration des soins entre les domaines peut nuire à l'engagement des jeunes en matière de santé et compromettre leur santé à l'âge adulte. Pour renverser ces obstacles et améliorer les résultats de la transition, les dispensateurs de soins pédiatriques et de soins aux adultes, de même que les médecins de famille et d'autres partenaires communautaires, doivent collaborer de manière satisfaisante à l'élaboration de stratégies systémiques qui rationalisent et préservent les soins aux jeunes en transition vers des soins aux adultes en milieu tertiaire, communautaire et primaire. Il est recommandé de privilégier des limites d'âge flexibles pour effectuer cette transition vers les soins aux adultes et de tenir compte de la phase de développement et de l'aptitude de chaque jeune, ainsi que des besoins et de la situation de chaque patient et de chaque famille. Une formation et un enseignement spécialisés sur les enjeux liés aux soins de transition s'imposent pour renforcer les capacités et s'assurer que les professionnels de la santé des diverses disciplines et des divers milieux soient mieux outillés pour accepter et traiter les jeunes qui ont des besoins de santé complexes.
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Affiliation(s)
- Alene Toulany
- Société canadienne de pédiatrie, comité de la santé de l'adolescent, Ottawa (Ontario)Canada
| | - Jan Willem Gorter
- Société canadienne de pédiatrie, comité de la santé de l'adolescent, Ottawa (Ontario)Canada
| | - Megan E Harrison
- Société canadienne de pédiatrie, comité de la santé de l'adolescent, Ottawa (Ontario)Canada
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22
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Healthcare use in commercially insured youth with mental health disorders. BMC Health Serv Res 2022; 22:952. [PMID: 35883138 PMCID: PMC9323879 DOI: 10.1186/s12913-022-08353-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of this study is to describe age-related patterns of outpatient healthcare utilization in youth and young adults with mental health disorders. METHOD We used the IBM® MarketScan® Commercial Database to identify 359,413 youth and young adults (12-27 years) with a mental health disorder continuously enrolled in private health insurance in 2018. Exploratory analysis was used to describe patterns of outpatient healthcare use (e.g., primary, reproductive, mental health care) and therapeutic management (e.g., medication prescriptions, psychotherapy) by age. Period prevalence and median number of visits are reported. Additional analysis explored utilization patterns by mental health disorder. RESULTS The prevalence of outpatient mental health care and primary care decreased with age, with a larger drop in primary care utilization. While 74.0-78.4% of those aged 12-17 years used both outpatient mental health care and primary care, 53.1-59.7% of those aged 18-27 years did. Most 18-19-year-olds had a visit with an internal medicine or family medicine specialist, a minority had a pediatrician visit. The prevalence of medication management increased with age, while the prevalence of psychotherapy decreased. CONCLUSIONS Taken together, this descriptive study illustrates age-related differences in outpatient healthcare utilization among those with mental health disorders. Additionally, those with the most severe mental health disorders seem to be least connected to outpatient care. This knowledge can inform efforts to improve utilization of healthcare across the transition to adulthood.
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Schraeder K, Nettel-Aguirre A, Mackie AS, McBrien K, Barrett O, Dimitropoulos G, Samuel S. Primary care service use during adolescence and young adulthood: Tertiary care cohort affected by chronic health conditions. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:e151-e160. [PMID: 35552227 PMCID: PMC9097743 DOI: 10.46747/cfp.6805e151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To understand use of family physician services and emergency department visits by adolescents and young adults with chronic health conditions. DESIGN Longitudinal retrospective observational cohort study using administrative health data. SETTING Chronic care clinics at a tertiary care pediatric hospital in Calgary, Alta. PARTICIPANTS In total, 1326 adolescents who were between 12 and 15 years old in 2008, who were observed until 2016, and who received medical services for chronic conditions were enrolled in the study. Eligible participants had at least 4 visits to the same chronic disease clinic in any 2-year window before age 18. MAIN OUTCOMES MEASURES Group-based trajectory modeling was used to identify groups of adolescents with distinct patterns of health care use (for visits to emergency departments and to primary care practices), while 2 tests explored trajectory group differences (eg, sex, location of residence). RESULTS Median age was 14 years (range 12 to 17 years) at study entry, and 22 years (range 14 to 24 years) at study exit. Half were female and most (85.4%) lived in an urban area. Median observation period was 8.7 person-years (range 1.3 to 9.1 years). Group-based trajectory modeling identified 5 distinct trajectory groups of primary care use and 4 groups of emergency services use. Groups differed by sex and location of residence in each trajectory model. CONCLUSION Many adolescents increased their use of emergency services between the ages of 12 and 24 years, with distinct patterns of primary care use being observed. Association of additional patient- and system-level factors (eg, disease severity, distance to nearest family physician office) should be explored.
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Affiliation(s)
- Kyleigh Schraeder
- Registered clinical psychologist in Alberta; at the time this manuscript was submitted, Dr Schraeder was a postdoctoral scholar in the Department of Pediatrics at the University of Calgary.
| | - Alberto Nettel-Aguirre
- Statistician in the Cumming School of Medicine at the University of Calgary at the time this manuscript was submitted
| | - Andrew S Mackie
- Associate Professor in the Department of Pediatrics at the University of Alberta in Edmonton
| | - Kerry McBrien
- Associate Professor in Community Health Sciences at the University of Calgary
| | - Olesya Barrett
- Senior Analyst in Clinical Analytics at Alberta Health Services in Calgary
| | - Gina Dimitropoulos
- Associate Professor in the Faculty of Social Work at the University of Calgary
| | - Susan Samuel
- Associate Professor in the Departments of Pediatrics and Community Health Sciences at the University of Calgary
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Lavergne MR, Loyal JP, Shirmaleki M, Kaoser R, Nicholls T, Schütz CG, Vaughan A, Samji H, Puyat JH, Kaulius M, Jones W, Small W. The relationship between outpatient service use and emergency department visits among people treated for mental and substance use disorders: analysis of population-based administrative data in British Columbia, Canada. BMC Health Serv Res 2022; 22:477. [PMID: 35410219 PMCID: PMC8996395 DOI: 10.1186/s12913-022-07759-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 03/07/2022] [Indexed: 01/02/2023] Open
Abstract
Background Research findings on the association between outpatient service use and emergency department (ED) visits for mental and substance use disorders (MSUDs) are mixed and may differ by disorder type. Methods We used population-based linked administrative data in British Columbia, Canada to examine associations between outpatient primary care and psychiatry service use and ED visits among people ages 15 and older, comparing across people treated for three disorder categories: common mental disorders (MDs) (depressive, anxiety, and/or post-traumatic stress disorders), serious MDs (schizophrenia spectrum and/or bipolar disorders), and substance use disorders (SUDs) in 2016/7. We used hurdle models to examine the association between outpatient service use and odds of any ED visit for MSUDs as well count of ED visits for MSUDs, stratified by cohort in 2017/8. Results Having had one or more MSUD-related primary care visit was associated with lower odds of any ED visit among people treated for common MDs and SUDs but not people treated for serious MDs. Continuity of primary care was associated with slightly lower ED use in all cohorts. One or more outpatient psychiatrist visits was associated with lower odds of ED visits among people treated for serious MDs and SUDs, but not among people with common MDs. Conclusion Findings highlight the importance of expanded access to outpatient specialist mental health services, particularly for people with serious MDs and SUDs, and collaborative models that can support primary care providers treating people with MSUDs. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07759-z.
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Affiliation(s)
- M Ruth Lavergne
- Department of Family Medicine, Faculty of Medicine, Primary Care Research Unit, Dalhousie University, 1465 Brenton Street, Suite 402, Halifax, NS, B3J 3T4, Canada.
| | - Jackson P Loyal
- Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Vancouver, BC, Canada.,BC Centre for Disease Control, Vancouver, BC, Canada
| | - Mehdi Shirmaleki
- Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Vancouver, BC, Canada
| | - Ridhwana Kaoser
- Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Vancouver, BC, Canada
| | - Tonia Nicholls
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,Department of Psychology, Simon Fraser University, Burnaby, BC, Canada.,BC Mental Health and Substance Use Services, Vancouver, BC, Canada
| | - Christian G Schütz
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.,BC Mental Health and Substance Use Services, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Adam Vaughan
- School of Criminal Justice and Criminology, Texas State University, San Marcos, TX, Canada
| | - Hasina Samji
- BC Centre for Disease Control, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Joseph H Puyat
- Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Megan Kaulius
- Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Vancouver, BC, Canada
| | - Wayne Jones
- Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Vancouver, BC, Canada
| | - William Small
- Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.,BC Centre on Substance Use, Vancouver, BC, Canada
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25
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de Oliveira C, Gatov E, Rosella L, Chen S, Strauss R, Azimaee M, Paterno E, Guttmann A. Describing the linkage between administrative social assistance and health care databases in Ontario, Canada. Int J Popul Data Sci 2022; 7:1689. [PMID: 35310557 PMCID: PMC8900651 DOI: 10.23889/ijpds.v6i1.1689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background The linkage of records across administrative databases has become a powerful tool to increase information available to undertake research and analytics in a privacy protective manner. Objective The objective of this paper was to describe the data integration strategy used to link the Ontario Ministry of Children, Community and Social Services (MCCSS)-Social Assistance (SA) database with administrative health care data. Methods Deterministic and probabilistic linkage methods were used to link the MCCSS-SA database (2003-2016) to the Registered Persons Database, a population registry containing data on all individuals issued a health card number in Ontario, Canada. Linkage rates were estimated, and the degree of record linkage and representativeness of the dataset were evaluated by comparing socio-demographic characteristics of linked and unlinked records. Results There were a total of 2,736,353 unique member IDs in the MCCSS-SA database from the 1st January 2003 to 31st December 2016; 331,238 (12.1%) were unlinked (linkage rate = 87.9%). Despite 16 passes, most record linkages were obtained after 2 deterministic (76.2%) and 14 probabilistic passes (11.7%). Linked and unlinked samples were similar for most socio-demographic characteristics (i.e., sex, age, rural dwelling), except migrant status (non-migrant versus migrant) (standardized difference of 0.52). Linked and unlinked records were also different for SA program-specific characteristics, such as social assistance program, Ontario Works and Ontario Disability Support Program (standardized difference of 0.20 for each), data entry system, Service Delivery Model Technology only and both Service Delivery Model Technology and Social Assistance Management System (standardized difference of 0.53 and 0.52, respectively), and months on social assistance (standardized difference of 0.43). Conclusions Additional techniques to account for sub-optimal linkage rates may be required to address potential biases resulting from this data linkage. Nonetheless, the linkage between administrative social assistance and health care data will provide important findings on the social determinants of health.
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Affiliation(s)
- Claire de Oliveira
- ICES, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada,Centre for Health Economics and Hull York Medical School, University of York, York, United Kingdom,Corresponding author: Claire de Oliveira
| | | | - Laura Rosella
- ICES, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Ontario, Canada,Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada,Public Health Ontario, Toronto, Ontario, Canada
| | | | | | | | - Elizabeth Paterno
- Business Intelligence and Practice Division, Ministry of Children, Community and Social Services, Toronto, Ontario, Canada
| | - Astrid Guttmann
- ICES, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada,Division of Paediatric Medicine and Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada,Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
| | - Ministry of Children, Community and Social Services-ICES Working Group (Nelson Chong, Peter Lonescu, Sean Ji, Alexander Kopp, Annie Lan, Charlotte Ma, Miranda Pring, Priyanka Raj, Steven Ryan, Refik Saskin, Fiona Wong)
- ICES, Toronto, Ontario, Canada,Business Intelligence and Practice Division, Ministry of Children, Community and Social Services, Toronto, Ontario, Canada
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'The experiences, perspectives, and needs of young people who access support for mental health in primary care: a systematic review'. Br J Gen Pract 2022; 72:e161-e167. [PMID: 34990387 PMCID: PMC8843382 DOI: 10.3399/bjgp.2021.0335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 09/14/2021] [Indexed: 11/30/2022] Open
Abstract
Background There is an increasing demand for mental health support in primary care, especially for young people. To improve mental health support for young people in general practice, the needs of young people must be considered. Aim To explore the experiences of young people (aged 12–25 years) on receiving mental health care in primary care and identify the needs of young people who present with mental health concerns. Design and setting A systematic review and narrative synthesis. Method This was a systematic review and narrative synthesis. Six databases were searched for literature relating to young people’s experiences of receiving mental health care in primary care. Additional handsearching and manual internet searching were conducted. Narrative synthesis was employed. Results Five papers and a further two reports from manual internet searching were found, resulting in the inclusion of 1823 young people from four different countries (UK, US, Ireland, and Canada) for synthesis. The synthesis generated four themes: the centrality of a trusting relationship; showing empathy and taking concerns seriously; being given time to talk; and barriers to accessing mental health support in primary care. Conclusion Young people need a trusting relationship to discuss sensitive issues. To enable high-quality and effective mental health consultations with young people and the development of trust, GPs require unhurried consultations and the ability to maintain continuity of care.
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Schraeder K, Allemang B, Felske AN, Scott CM, McBrien KA, Dimitropoulos G, Samuel S. Community based Primary Care for Adolescents and Young Adults Transitioning From Pediatric Specialty Care: Results from a Scoping Review. J Prim Care Community Health 2022; 13:21501319221084890. [PMID: 35323055 PMCID: PMC8961382 DOI: 10.1177/21501319221084890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Ongoing primary care during adolescence is recommended by best practice
guidelines for adolescents and young adults (AYAs; ages 12-25) with chronic
conditions. A synthesis of the evidence on the roles of Primary Care
Physicians (PCPs) and benefits of primary care is needed to support existing
guidelines. Methods: We used Arksey and O’Malley’s scoping review framework, and searched
databases (MEDLINE, EMBASE, PsychINFO, CINAHL) for studies that (i) were
published in English between 2004 and 2019, (ii) focused on AYAs with a
chronic condition(s) who had received specialist pediatric services, and
(iii) included relevant findings about PCPs. An extraction tool was
developed to organize data items across studies (eg, study design,
participant demographics, outcomes). Results: Findings from 58 studies were synthesized; 29 (50%) studies focused
exclusively on AYAs with chronic health conditions (eg, diabetes, cancer),
while 19 (33%) focused exclusively on AYAs with mental health conditions.
Roles of PCPs included managing medications, “non-complex” mental health
conditions, referrals, and care coordination, etc. Frequency of PCP
involvement varied by AYAs; however, female, non-Black, and older AYAs, and
those with severe/complex conditions appeared more likely to visit a PCP.
Positive outcomes were reported for shared-care models targeting various
conditions (eg, cancer, concussion, mental health). Conclusion: Our findings drew attention to the importance of effective collaboration
among multi-disciplinary specialists, PCPs, and AYAs for overcoming multiple
barriers to optimal transitional care. Highlighting the need for further
study of the implementation of shared care models to design strategies for
care delivery during transitions to adult care.
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Affiliation(s)
- Kyleigh Schraeder
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Brooke Allemang
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada
| | - Ashley N Felske
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Cathie M Scott
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kerry A McBrien
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Susan Samuel
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Schraeder K, Dimitropoulos G, Allemang B, McBrien K, Samuel S. Strategies for improving primary care for adolescents and young adults transitioning from pediatric services: perspectives of Canadian primary health care professionals. Fam Pract 2021; 38:329-338. [PMID: 33128378 PMCID: PMC8211142 DOI: 10.1093/fampra/cmaa113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Family physicians and other members of the primary health care (PHC) team may be ideally positioned to provide transition care to adolescents and young adults (AYAs; aged 12-25 years) exiting pediatric specialty services. Potential solutions to well-known challenges associated with integrating PHC and specialty care need to be explored. OBJECTIVE To identify strategies to transition care by PHC professionals for AYAs with chronic conditions transitioning from pediatric to adult-oriented care. METHODS Participants were recruited from six Primary Care Networks in Calgary, Alberta. A total of 18 semi-structured individual interviews were completed, and transcribed verbatim. Data were analyzed using a qualitative description approach, involving thematic analysis. RESULTS Participants offered a range of strategies for supporting AYAs with chronic conditions. Our analysis resulted in three overarching themes: (i) educating AYAs, families, and providers about the critical role of primary care; (ii) adapting existing primary care supports for AYAs and (iii) designing new tools or primary care practices for transition care. CONCLUSIONS Ongoing and continuous primary care is important for AYAs involved with specialty pediatric services. Participants highlighted a need to educate AYAs, families and providers about the critical role of PHC. Solutions to improve collaboration between PHC and pediatric specialist providers would benefit from additional perspectives from providers, AYAs and families. These findings will inform the development of a primary care-based intervention to improve transitional care.
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Affiliation(s)
| | - Gina Dimitropoulos
- Faculty of Social Work
- Mathison Centre for Mental Health Research & Education
| | | | - Kerry McBrien
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Susan Samuel
- Department of Pediatrics, Cumming School of Medicine
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29
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Robinson ME, Simard M, Larocque I, Shah J, Rahme E, Nakhla M. Psychiatric disorders in emerging adults with diabetes transitioning to adult care: A retrospective cohort study. Diabet Med 2021; 38:e14541. [PMID: 33576092 DOI: 10.1111/dme.14541] [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: 09/25/2020] [Revised: 01/28/2021] [Accepted: 02/10/2021] [Indexed: 11/29/2022]
Abstract
AIMS During transition from paediatric to adult diabetes care, adolescents with diabetes are at increased risk of psychiatric disorders compared with those without diabetes. Prolonged gaps between the last paediatric and first adult diabetes care visit are associated with higher perceived stress and lower life satisfaction. We assessed the effect of a gap (>180 days) in establishing adult diabetes care on the risk of psychiatric disorders and determined other risk factors associated with psychiatric disorders during the transfer to adult care. METHODS Using provincial health administrative databases, we conducted a retrospective cohort study of individuals from Québec, Canada, diagnosed with diabetes between ages 1 and 15 years in 1997-2015. These individuals were followed from 6 months after their last paediatric visit until age 25 years. We used multivariable Cox proportional hazard models to determine the association of gap in care with psychiatric disorders risk. RESULTS Among 1772 youth with diabetes, 740 (42%) had a gap in care. There was a non-statistically significant association between gap in care and mood disorders diagnosed in the emergency department or hospital (hazard ratio [HR] 1.38, 95% confidence interval [CI]: [0.92, 2.07]). Older age at transfer, recent birth year and higher number of all-cause emergency department visits in the year before transfer increased the risks of psychiatric disorders. CONCLUSIONS Prolonged gaps in care during transfer to adult care are common and may be associated with increased psychiatric disorder risk. Developmental factors associated with adolescence and emerging adulthood may further amplify this risk.
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Affiliation(s)
- Marie-Eve Robinson
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Division of Endocrinology, Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
- Division of Endocrinology, Department of Pediatrics, McGill University Health Centre, Montreal, QC, Canada
| | - Marc Simard
- Institut National de Santé Publique du Québec, Quebec City, QC, Canada
| | - Isabelle Larocque
- Institut National de Santé Publique du Québec, Quebec City, QC, Canada
| | - Jai Shah
- Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Elham Rahme
- The Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Division of Clinical Epidemiology, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Meranda Nakhla
- Division of Endocrinology, Department of Pediatrics, McGill University Health Centre, Montreal, QC, Canada
- The Research Institute of the McGill University Health Centre, Montreal, QC, Canada
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30
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Nadarajah A, Dimitropoulos G, Grant C, Webb C, Couturier J. Impending Transition From Pediatric to Adult Health Services: A Qualitative Study of the Experiences of Adolescents With Eating Disorders and Their Caregivers. Front Psychiatry 2021; 12:624942. [PMID: 34122164 PMCID: PMC8187588 DOI: 10.3389/fpsyt.2021.624942] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 04/22/2021] [Indexed: 02/04/2023] Open
Abstract
Background: There is a dearth of research that identifies pediatric to adult health care transition practices that yield positive outcomes for young people with eating disorders (EDs). Further, adolescent and caregiver perspectives are poorly understood and underrepresented in the literature. The purpose of this study, focused on the impending transition from pediatric to adult health services, was twofold: (a) to identify adolescent and caregiver perspectives of barriers and facilitators of a successful transition for adolescents with EDs; and (b) to understand adolescent and caregiver suggestions of interventions for a successful transition. Design/Method: We recruited five adolescents with EDs who were about to be transferred out of pediatric care as well as their caregivers. We conducted a qualitative study in accordance with the principles of interpretive description. Through conducting semi-structured, in-depth interviews with adolescents and caregivers, we investigated their knowledge about health system transitions and anticipated experiences. We identified participants' perceptions of barriers and facilitators regarding a successful transition, as well as their recommendations to improve the transfer of care. Results: Participants possessed a limited understanding of transition processes despite the fact that they were about to be transferred to adult care. From our analyses, the following themes were identified as barriers during the transition process: re-explaining information to adult healthcare providers, lack of professional support while waiting for uptake into the adult health system, and late timing of transition of care discussions. Both adolescents and caregivers expressed that involvement of parents and the pediatric healthcare team helped to facilitate a successful transfer of care. In addition, participants expressed that the implementation of a Transition Coordinator and Transition Passport would be helpful in facilitating a seamless transfer between systems of care. Discussion: These findings demonstrate a significant gap in the system and highlight the importance of developing interventions that facilitate a successful transition. The themes that emerged from this study can inform the development of interventions to facilitate a coordinated transition from pediatric to adult health services for adolescents with EDs.
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Affiliation(s)
| | | | - Christina Grant
- Department of Pediatrics, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Cheryl Webb
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Jennifer Couturier
- Department of Pediatrics, McMaster Children's Hospital, Hamilton, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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Kurdyak P, Gandhi S, Holder L, Rashid M, Saunders N, Chiu M, Guttmann A, Vigod S. Incidence of Access to Ambulatory Mental Health Care Prior to a Psychiatric Emergency Department Visit Among Adults in Ontario, 2010-2018. JAMA Netw Open 2021; 4:e215902. [PMID: 33852001 PMCID: PMC8047734 DOI: 10.1001/jamanetworkopen.2021.5902] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE Psychiatric emergency department (ED) visits may be avoidable if individuals have access to adequate outpatient care, but the extent to which individuals use the ED itself as a key point of access is largely unknown. OBJECTIVE To describe the extent to which the ED is a first point of contact for mental health care among adults, and identify key factors associated with this outcome. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted from 2010 to 2018 in Ontario, Canada. Using health care administrative data, all individuals aged 16 years and older with an incident psychiatric ED visit were included. Statistical analysis was performed from September 2019 to February 2021. MAIN OUTCOMES AND MEASURES The primary outcome was no outpatient mental health or addictions contact in the 2 years preceding the incident ED visit. The study also measured predisposing (age, sex, immigrant status, comorbidity), enabling (neighborhood income, rurality, continuity of primary care), and need factors (diagnosis from incident ED visit) associated with the so-called first-contact ED visits, generating adjusted odds ratios (aORs) and 95% CIs. RESULTS The cohort included 659 084 patients who visited the ED. Among these patients, 340 354 were female individuals (51.6%), and the mean (SD) age was 39.1 (18.5) years. The incident ED visit was a first contact for 298 924 individuals (45.4%). Patients who had increased odds of first-contact ED visits included older individuals (aged 65-84 years vs 16-24 years; aOR, 1.13; 95% CI, 1.12-1.14), male individuals (aOR, 1.14; 95% CI, 1.13-1.15), immigrants (eg, economic class immigrant vs nonimmigrant status: aOR, 1.20; 95% CI, 1.18-1.21), rural residents (aOR, 1.21; 95% CI, 1.20-1.21), and in those with minimal primary care (aOR, 1.68; 95% CI, 1.67-1.69). All diagnoses had a higher likelihood of first-contact ED visits than mood disorders, particularly substance and alcohol use disorders (aOR, 1.66; 95% CI, 1.65-1.68). CONCLUSIONS AND RELEVANCE This study's results suggest that nearly half of incident psychiatric ED visits were first-contact visits, which may be avoidable. Targeted efforts to improve outpatient access should focus on populations with risk factors for first-contact ED presentations, including men, older adults, rural residents, those with poor primary care connectivity, and those with substance-related diagnoses.
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Affiliation(s)
- Paul Kurdyak
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | | | | | - Natasha Saunders
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Maria Chiu
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Astrid Guttmann
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Simone Vigod
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women’s College Hospital, Toronto, Ontario, Canada
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32
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Schraeder K, Allemang B, Scott C, McBrien K, Dimitropoulos G, Felske A, Samuel S. Primary care during the transition to adult care for adolescents involved with pediatric specialty services: a scoping review protocol. Syst Rev 2021; 10:46. [PMID: 33531077 PMCID: PMC7856752 DOI: 10.1186/s13643-021-01593-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 01/18/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Of the 15-20% of youth in North America affected by a chronic health condition (e.g., type 1 diabetes, cystic fibrosis) and/or mental health or neurodevelopmental disorder (e.g., depression, eating disorder, Attention Deficit-Hyperactivity Disorder), many often require lifelong specialist healthcare services. Ongoing primary care during childhood and into young adulthood is recommended by best practice guidelines. To date, it is largely unknown if, how, and when primary care physicians (PCPs; such as family physicians) collaborate with specialists as AYAs leave pediatric-oriented services. The proposed scoping review will synthesize the available literature on the roles of PCPs for AYAs with chronic conditions leaving pediatric specialty care and identify potential benefits and challenges of maintaining PCP involvement during transition. METHODS Arksey and O'Malley's original scoping review framework will be utilized with guidance from Levac and colleagues and the Joanna Briggs Institute. A search of databases including MEDLINE (OVID), EMBASE, PsycINFO, and CINAHL will be conducted following the development of a strategic search strategy. Eligible studies will (i) be published in English from January 2004 onwards, (ii) focus on AYAs (ages 12-25) with a chronic condition(s) who have received specialist services during childhood, and (iii) include relevant findings about the roles of PCPs during transition to adult services. A data extraction tool will be developed and piloted on a subset of studies. Both quantitative and qualitative data will be synthesized. DISCUSSION Key themes about the roles of PCPs for AYAs involved with specialist services will be identified through this review. Findings will inform the development and evaluation of a primary-care based intervention to improve transition care for AYAs with chronic conditions.
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Affiliation(s)
- Kyleigh Schraeder
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Brooke Allemang
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - Cathie Scott
- PolicyWise for Children & Families, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kerry McBrien
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Ashley Felske
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Susan Samuel
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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33
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Levy BB, Song JZ, Luong D, Perrier L, Bayley MT, Andrew G, Arbour-Nicitopoulos K, Chan B, Curran CJ, Dimitropoulos G, Hartman L, Huang L, Kastner M, Kingsnorth S, McCormick A, Nelson M, Nicholas D, Penner M, Thompson L, Toulany A, Woo A, Zee J, Munce SEP. Transitional Care Interventions for Youth With Disabilities: A Systematic Review. Pediatrics 2020; 146:peds.2020-0187. [PMID: 33046586 DOI: 10.1542/peds.2020-0187] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2020] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Transition from the pediatric to the adult health care system is a complex process that should include medical, psychosocial, educational, recreational, and vocational considerations. OBJECTIVE In this systematic review, we aim to synthesize the evidence on transitional care interventions (TCIs) to improve the quality of life (QoL) for adolescents and young adults with childhood-onset disabilities, including neurodevelopmental disorders. DATA SOURCES Four electronic databases (Medline, Embase, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature) were searched. STUDY SELECTION In the included studies, researchers examined TCIs for adolescents and young adults (12-24 years of age) with childhood-onset disabilities. Studies were experimental, quasi-experimental, and observational studies published in the last 26 years. DATA EXTRACTION Two reviewers independently completed study screening, data extraction, and risk-of-bias assessment. RESULTS Fifty-two studies were included. Five studies reported on QoL, but statistically significant improvements were noted in only 1 of these studies. Significant improvements were also found in secondary outcomes including disability-related knowledge and transitional readiness. TCIs targeted patients, families and/or caregivers, and health care providers and exhibited great heterogeneity in their characteristics and components. LIMITATIONS Inconsistent reporting on interventions between studies hindered synthesis of the relationships between specific intervention characteristics and outcomes. CONCLUSIONS Although there is limited evidence on the impact of TCIs on the QoL for youth with childhood-onset disabilities, there is indication that they can be effective in improving patient and provider outcomes. The initiation of transition-focused care at an early age may contribute to improved long-term health outcomes in this population.
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Affiliation(s)
- Ben B Levy
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Jessica Z Song
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Dorothy Luong
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | | | - Mark T Bayley
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, and.,Division of Physical Medicine, and
| | - Gail Andrew
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Kelly Arbour-Nicitopoulos
- Faculty of Kinesiology and Physical Education, and.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Brian Chan
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, and
| | - Cynthia J Curran
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | | | - Laura Hartman
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Lennox Huang
- Departments of Paediatrics.,The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Monika Kastner
- Institute of Health Policy, Management and Evaluation, and.,Family and Community Medicine, and.,North York General Hospital, Toronto, Ontario, Canada
| | - Shauna Kingsnorth
- Rehabilitation Sciences Institute, and.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Anna McCormick
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; and
| | - Michelle Nelson
- Institute of Health Policy, Management and Evaluation, and.,Sinai Health System, Toronto, Ontario, Canada
| | - David Nicholas
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
| | - Melanie Penner
- Institute of Health Policy, Management and Evaluation, and.,Departments of Paediatrics.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Laura Thompson
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Alene Toulany
- Departments of Paediatrics.,The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Amanda Woo
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Joanne Zee
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, and
| | - Sarah E P Munce
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada; .,Institute of Health Policy, Management and Evaluation, and.,Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
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Stunden C, Zasada J, VanHeerwaarden N, Hollenberg E, Abi-Jaoudé A, Chaim G, Cleverley K, Henderson J, Johnson A, Levinson A, Lo B, Robb J, Shi J, Voineskos A, Wiljer D. Help-Seeking Behaviors of Transition-Aged Youth for Mental Health Concerns: Qualitative Study. J Med Internet Res 2020; 22:e18514. [PMID: 33016882 PMCID: PMC7573698 DOI: 10.2196/18514] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/23/2020] [Accepted: 07/27/2020] [Indexed: 01/29/2023] Open
Abstract
Background Transition-aged youth are particularly vulnerable to mental health problems, yet they are one of the least likely demographic groups to seek help. Objective The aim of this study is to explore the influences on and patterns in help-seeking for mental health concerns among transition-aged youth who attend postsecondary schools in Canada. Methods A qualitative research design was used, involving 12 semistructured focus groups with transition-aged youth (17-29 years) who attended postsecondary schools in Canada. A thematic analysis was conducted to code the transcripts and develop themes. Results Four main themes and subthemes regarding the process and experience of help-seeking were generated: (1) the influence of formal service providers (accessibility and experiences), (2) the influence of social factors (system navigation and stigma), (3) the influence of health literacy (symptom recognition, acting on symptoms, digital tools and the internet, and mental health awareness campaigns), and (4) the influence of low-intensity sources of support, namely, self-help. Conclusions Transition-aged youth seek help for mental health problems in different ways. Despite efforts to improve access to mental health services, transition-aged youth continue to face barriers to accessing these services, especially formal sources of support. The factors identified in this study that either hinder or facilitate help-seeking have pragmatic implications for developing help-seeking interventions and delivering mental health services for this population. In addition to other facilitators, family physicians are an important resource in the help-seeking process. Furthermore, digital help-seeking tools have unique characteristics that may make them an important source of support for transition-aged youth.
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Affiliation(s)
- Chelsea Stunden
- School of Population and Public Health, Simon Fraser University, Burnaby, BC, Canada.,Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Julie Zasada
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Nicole VanHeerwaarden
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada
| | - Elisa Hollenberg
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Alexxa Abi-Jaoudé
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Gloria Chaim
- Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Kristin Cleverley
- Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Joanna Henderson
- Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Andrew Johnson
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Andrea Levinson
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Health and Wellness, University of Toronto, Toronto, ON, Canada
| | - Brian Lo
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada.,Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Janine Robb
- Health and Wellness, University of Toronto, Toronto, ON, Canada
| | - Jenny Shi
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Aristotle Voineskos
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - David Wiljer
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Education, Technology & Innovation, University Health Network, Toronto, ON, Canada
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35
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Schraeder K, Dimitropoulos G, McBrien K, Li JY, Samuel S. Perspectives from primary health care providers on their roles for supporting adolescents and young adults transitioning from pediatric services. BMC FAMILY PRACTICE 2020; 21:140. [PMID: 32660598 PMCID: PMC7359255 DOI: 10.1186/s12875-020-01189-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 06/12/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND Transitioning from pediatric care to adult-oriented care at age 18 (the age of transfer in most countries and jurisdictions) is a complex process for adolescents and young adults affected by chronic physical health and/or mental health conditions. The role of primary health care (PHC) providers for this population is poorly understood. Perspectives from these providers, such as family physicians and other members of the primary care team, have not been explored in depth. METHODS A total of 18 participants (e.g., family physicians, social workers, nurses) were recruited from 6 Primary Care Networks in Calgary, Alberta, Canada. Semi-structured individual interviews were conducted, and transcribed verbatim. A qualitative description approach was used to analyze the data, and included thematic analysis. RESULTS Five distinct, yet overlapping, roles of primary health care providers for adolescents and young adults transitioning to adult care resulted from our analysis: (1) being the "common thread" (continuous accessible care); (2) caring for the "whole patient" (comprehensive care); (3) "knowing families" (family-partnered care); (4) "empowering" adolescents and young adults to develop "personal responsibility" (developmentally-appropriate care); and (5) "quarterbacking" care (coordination of specialist and/or community-based care). Participants identified potential benefits of these roles for adolescents and young adults transitioning to adult care, and barriers in practice (e.g., lack of time, having minimal involvement in pediatric care). CONCLUSIONS Input from family physicians, who follow their patients across the lifespan and provide the majority of primary care in Canada, are critical for informing and refining recommended transition practices. Our findings provide insights, from PHC providers themselves, to bolster the rationale for primary care involvement during transitions from pediatric specialty and community-based care for AYAs. Solutions to overcome barriers for integrating primary care and specialty care for adolescents and young adults need to be identified, and tested, with input from key stakeholders.
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Affiliation(s)
- Kyleigh Schraeder
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, 28 Oki Drive, Calgary, Alberta, Canada.
| | - Gina Dimitropoulos
- Faculty of Social Work, University of Calgary, Calgary, Alberta, Canada
- Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Alberta, Canada
| | - Kerry McBrien
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jessica Yijia Li
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, 28 Oki Drive, Calgary, Alberta, Canada
| | - Susan Samuel
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, 28 Oki Drive, Calgary, Alberta, Canada
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Shulman R, Cohen E, Benchimol EI, Nakhla M. Methods for Measuring the Time of Transfer from Pediatric to Adult Care for Chronic Conditions Using Administrative Data: A Scoping Review. Clin Epidemiol 2020; 12:691-698. [PMID: 32636683 PMCID: PMC7335294 DOI: 10.2147/clep.s256846] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/11/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To describe methods used to identify the timing of transfer from pediatric to adult care within health administrative data and to identify the advantages and limitations of each method to guide future research. STUDY DESIGN AND SETTINGS We conducted a scoping review to identify studies, summarized challenges of identifying the timing of transfer, and proposed methodological approaches for each. RESULTS Studies use the following approaches to capture individuals who transfer from pediatric to adult care by 1) defining the timing of transfer by the last pediatric and first adult care visit last and 2) defining transfer to adult care based on a specific age. CONCLUSION There are important limitations of administrative data that must be recognized in designing studies examining the transfer to adult care.
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Affiliation(s)
- Rayzel Shulman
- Department of Pediatrics, Division of Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada
- Sickkids Research Institute, Child Health Evaluative Sciences, Toronto, ON, Canada
| | - Eyal Cohen
- Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Eric I Benchimol
- Department of Pediatrics, Division of Gastroenterology, Children’s Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Meranda Nakhla
- Department of Pediatrics, Division of Endocrinology, Montreal Children’s Hospital, Montreal, QC, Canada
- Center of Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
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Shulman R, Fu L, Knight JC, Guttmann A, Chafe R. Acute diabetes complications across transition from pediatric to adult care in Ontario and Newfoundland and Labrador: a population-based cohort study. CMAJ Open 2020; 8:E69-E74. [PMID: 32046971 PMCID: PMC7012632 DOI: 10.9778/cmajo.20190019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Transition to adult diabetes care is a high-risk period for acute complications, yet the optimal transition care model is unknown. To gain insight into the impact on health outcomes of system-level transition processes that reflect resourcing differences, we examined acute complications in youth with diabetes across transition in 2 Canadian provinces with different transition care models. METHODS We used linked provincial health administrative data for Ontario and Newfoundland and Labrador to create 2 parallel cohorts of youth with diabetes diagnosed before age 15 years who turned 17 between 2006 and 2011. Participants were followed until 2015 (maximum age 21 yr). We described rates of and proportion of participants with at least 1 diabetes-related hospital admission at age 15-17 years and 18-20 years, standardized according to material deprivation based on the 2006 Canadian Marginalization Index. We compared diabetes-related admissions at age 15-17 years and 18-20 years in the Ontario cohort. RESULTS The cohorts consisted of 2525 youth in Ontario and 93 in Newfoundland and Labrador. In Newfoundland and Labrador, 39 participants (42.0%) were in the lowest socioeconomic quintile, versus 326 (12.9%) in Ontario. The standardized rate of diabetes-related hospital admissions per 100 person-years was 13.5 (95% confidence interval [CI] 12.6-14.4) at age 15-17 years and 14.4 (95% CI 13.5-15.3) at age 18-20 years in Ontario, and 11.4 (95% CI 7.0-15.8) at age 15-17 years and 10.5 (95% CI 6.4-14.6) at age 18-20 years in Newfoundland and Labrador. In Ontario, there was no association between the rate (adjusted rate ratio 1.10, 95% CI 0.94-1.28) or occurrence (adjusted odds ratio 1.03, 95% CI 0.91-1.17) of diabetes-related admissions across transition. INTERPRETATION Although posttransition care is delivered differently in the 2 provinces, rates of adverse events across transition were stable in both. Coordinated support during transition is needed to help mitigate adverse events for young adults in both provinces. Delivery of other health care and social services, including primary care, may be influencing the risk of adverse events after transition to adult care.
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Affiliation(s)
- Rayzel Shulman
- Department of Pediatrics (Shulman, Guttmann), The Hospital for Sick Children, University of Toronto; ICES (Shulman, Fu, Guttmann); Institute for Health Policy, Management and Evaluation (Shulman, Guttmann), University of Toronto, Toronto, Ont.; Faculty of Medicine (Knight, Chafe), Memorial University of Newfoundland, St. John's, Nfld.
| | - Longdi Fu
- Department of Pediatrics (Shulman, Guttmann), The Hospital for Sick Children, University of Toronto; ICES (Shulman, Fu, Guttmann); Institute for Health Policy, Management and Evaluation (Shulman, Guttmann), University of Toronto, Toronto, Ont.; Faculty of Medicine (Knight, Chafe), Memorial University of Newfoundland, St. John's, Nfld
| | - John C Knight
- Department of Pediatrics (Shulman, Guttmann), The Hospital for Sick Children, University of Toronto; ICES (Shulman, Fu, Guttmann); Institute for Health Policy, Management and Evaluation (Shulman, Guttmann), University of Toronto, Toronto, Ont.; Faculty of Medicine (Knight, Chafe), Memorial University of Newfoundland, St. John's, Nfld
| | - Astrid Guttmann
- Department of Pediatrics (Shulman, Guttmann), The Hospital for Sick Children, University of Toronto; ICES (Shulman, Fu, Guttmann); Institute for Health Policy, Management and Evaluation (Shulman, Guttmann), University of Toronto, Toronto, Ont.; Faculty of Medicine (Knight, Chafe), Memorial University of Newfoundland, St. John's, Nfld
| | - Roger Chafe
- Department of Pediatrics (Shulman, Guttmann), The Hospital for Sick Children, University of Toronto; ICES (Shulman, Fu, Guttmann); Institute for Health Policy, Management and Evaluation (Shulman, Guttmann), University of Toronto, Toronto, Ont.; Faculty of Medicine (Knight, Chafe), Memorial University of Newfoundland, St. John's, Nfld
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