1
|
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.
Collapse
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
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Schraeder KE, Barwick M, Cairney J, Carter J, Kurdyak P, Neufeld RWJ, Stewart SL, St Pierre J, Tobon J, Vingilis E, Zaric G, Reid GJ. Re-Accessing Mental Health Care After Age 18: A Longitudinal Cohort Study of Youth Involved with Community-based Child and Youth Mental Health Agencies in Ontario. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2021; 30:12-24. [PMID: 33552169 PMCID: PMC7837527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 10/26/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE About 20-26% of children and youth with a mental health disorder (depending on age and respondent) report receiving services from a community-based Child and Youth Mental Health (CYMH) agency. However, because agencies have an upper age limit of 18-years old, youth requiring ongoing mental health services must "transition" to adult-oriented care. General healthcare providers (e.g., family physicians) likely provide this care. The objective of this study was to compare the likelihood of receiving physician-based mental health services after age 18 between youth who had received community-based mental health services and a matched population sample. METHOD A longitudinal matched cohort study was conducted in Ontario, Canada. A CYMH cohort that received mental health care at one of five CYMH agencies, aged 7-14 years at their first visit (N=2,822), was compared to age, sex, region-matched controls (N=8,466). RESULTS CYMH youth were twice as likely as the comparison sample to have a physician-based mental health visit (i.e., by a family physician, pediatrician, psychiatrists) after age 18; median time to first visit was 3.3 years. Having a physician mental health visit before age 18 was associated with a greater likelihood of experiencing the outcome than community-based CYMH services alone. CONCLUSION Most youth involved in community-based CYMH agencies will re-access services from physicians as adults. Youth receiving mental health services only within community agencies, and not from physicians, may be less likely to receive physician-based mental health services as adults. Collaboration between CYMH agencies and family physicians may be important for youth who require ongoing care into adulthood.
Collapse
Affiliation(s)
| | - Melanie Barwick
- The Hospital for Sick Children, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - John Cairney
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario
| | - Jeff Carter
- Department of Psychology, Western University, London, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
- Vanier Children's Services, London, Ontario
| | - Paul Kurdyak
- Department of Psychiatry, University of Toronto, Toronto, Ontario
- Mental Health and Addictions Research Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario
- Center for Addiction and Mental Health, Toronto, Ontario
| | - Richard W J Neufeld
- Department of Psychology, Western University, London, Ontario
- Department of Psychiatry, Western University, London, Ontario
| | - Shannon L Stewart
- Faculty of Education, Western University, London, Ontario
- Children's Health and Therapeutics, Children's Health Research Institute, London, Ontario
| | | | - Juliana Tobon
- Department of Psychiatry and Behavioural Sciences, McMaster University, Hamilton, Ontario
| | - Evelyn Vingilis
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario
- Department of Epidemiology and Biostatistics, Western University, London, Ontario
| | - Gregory Zaric
- Department of Epidemiology and Biostatistics, Western University, London, Ontario
- Department of Management Science, Ivey School of Business, Western University, London, Ontario
| | - Graham J Reid
- Department of Psychology, Western University, London, Ontario
- Children's Health and Therapeutics, Children's Health Research Institute, London, Ontario
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario
- Department of Paediatrics, The University of Western Ontario, London, Ontario
| |
Collapse
|
4
|
Markoulakis R, Chan S, Levitt A. The needs and service preferences of caregivers of youth with mental health and/or addictions concerns. BMC Psychiatry 2020; 20:409. [PMID: 32795285 PMCID: PMC7427896 DOI: 10.1186/s12888-020-02801-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 07/30/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Caregivers experience significant strains as a result of navigating the complex mental health and/or addiction (MHA) system for their youth with MHA issues. We examined the characteristics of Ontario families with youth with MHA issues and their service needs. METHODS A cross-sectional survey study investigated the characteristics and service needs of families with youth with MHA issues across the province of Ontario, Canada. A total of 840 caregivers were recruited. RESULTS 259 participants (Mage = 45.94, SD = 7.11) identified as caregiving for at least one youth with MHA issues. The majority of the participants were female (70.7%), married (73.4%), and completed at least some college/Bachelor degree (59.1%). The mean age of youth was 16.72 years (SD = 5.33) and the most frequently reported diagnoses were Depression (30.1%), ADHD (27.8%) and Generalized Anxiety Disorder (21.2%). Regression results demonstrated that presently accessing services, presently seeking services, and higher levels of barriers MHA services were significantly predictive of identifying navigation as helpful for finding appropriate MHA services (χ2(7) = 28.69, p < .001, Nagelkerke R2 = .16). Furthermore, presently accessing services was significantly predictive of identifying case management as helpful (χ2(7) = 29.59, p < .001, Nagelkerke R2 = .156), and of identifying a primary healthcare provider as helpful (χ2(7) = 38.75, p < .001, Nagelkerke R2 = .197) for finding appropriate MHA services. CONCLUSION Identifying the nature and extent of youth MHA issues, service needs, and family preferences can inform the development of services that address families' needs and lend vital support for accessing services within a complex system.
Collapse
Affiliation(s)
- Roula Markoulakis
- Family Navigation Project, Sunnybrook Research Institute, Toronto, Ontario, Canada.
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Samantha Chan
- Family Navigation Project, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Anthony Levitt
- Family Navigation Project, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program and Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Dimitropoulos G, Morgan-Maver E, Allemang B, Schraeder K, Scott SD, Pinzon J, Andrew G, Guilcher G, Hamiwka L, Lang E, McBrien K, Nettel-Aguirre A, Pacaud D, Zwaigenbaum L, Mackie A, Samuel S. Health care stakeholder perspectives regarding the role of a patient navigator during transition to adult care. BMC Health Serv Res 2019; 19:390. [PMID: 31208417 PMCID: PMC6580652 DOI: 10.1186/s12913-019-4227-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/06/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Transition to adult care represents a vulnerable period for young people with special health care needs as they navigate multiple life transitions and developmental issues. Patient navigators are a promising intervention designed to facilitate the transfer from pediatric to adult care. However, consistent definitions, key tasks, roles and responsibilities are lacking in guiding the scope of practice and the implementation of patient navigators. METHODS Fundamental qualitative description was utilized in this study to identify perceptions from health care providers about implementing a patient navigator service for young people with special health care needs in transition to adult care. A purposive sample of health care providers with a variety of backgrounds within pediatric and adult systems in Alberta, Canada were recruited. Semi-structured interviews with participants were analyzed using thematic analysis to inductively identify perceptions regarding the role of patient navigators. RESULTS A total of 43 health care providers highlighted the need for a patient navigator service to encompass 4 key stages for young people with special health care needs transitioning from pediatric to adult services: (1) identification of young people with special health care needs and families requiring support, (2) preparation for transfer, (3) health system navigation and, (4) post-transfer support. CONCLUSIONS The results of this qualitative study provide guidance for the development of patient navigator interventions for young people with special health care needs, as well as provide support for current transition services offered across Canada.
Collapse
Affiliation(s)
- Gina Dimitropoulos
- Faculty of Social Work, Professional Faculties 4212, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4 Canada
- Department of Psychiatry, University of Calgary, Calgary, Alberta Canada
- Alberta Children’s Hospital Research Institute, Calgary, Alberta Canada
| | | | - Brooke Allemang
- Faculty of Social Work, Professional Faculties 4212, University of Calgary, 2500 University Dr. NW, Calgary, AB T2N 1N4 Canada
| | - Kyleigh Schraeder
- Alberta Children’s Hospital Research Institute, Calgary, Alberta Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta Canada
| | - Shannon D. Scott
- Faculty of Nursing, University of Alberta, Edmonton, Alberta Canada
| | - Jorge Pinzon
- Alberta Children’s Hospital Research Institute, Calgary, Alberta Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta Canada
| | - Gail Andrew
- Department of Pediatrics, University of Alberta, Edmonton, Alberta Canada
| | - Gregory Guilcher
- Department of Pediatrics, University of Calgary, Calgary, Alberta Canada
- Section of Pediatric Oncology and Blood and Marrow Transplant, Alberta Children’s Hospital, Calgary, Alberta Canada
| | - Lorraine Hamiwka
- Department of Pediatrics, University of Calgary, Calgary, Alberta Canada
- Section of Nephrology, Alberta Children’s Hospital, Calgary, Alberta Canada
| | - Eddy Lang
- Department of Emergency Medicine, University of Calgary, Calgary, Alberta Canada
| | - Kerry McBrien
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta Canada
- Department of Family Medicine, University of Calgary, Calgary, Alberta Canada
| | - Alberto Nettel-Aguirre
- Alberta Children’s Hospital Research Institute, Calgary, Alberta Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta Canada
| | - Daniele Pacaud
- Alberta Children’s Hospital Research Institute, Calgary, Alberta Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta Canada
- Section of Diabetes and Endocrinology, Alberta Children’s Hospital, Calgary, Alberta Canada
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, University of Alberta, Edmonton, Alberta Canada
| | - Andrew Mackie
- Department of Pediatrics, University of Alberta, Edmonton, Alberta Canada
- Division of Cardiology, Stollery Children’s Hospital, Edmonton, Alberta Canada
| | - Susan Samuel
- Alberta Children’s Hospital Research Institute, Calgary, Alberta Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta Canada
- Section of Nephrology, Alberta Children’s Hospital, Calgary, Alberta Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta Canada
| |
Collapse
|
7
|
Community Services for Mental Illnesses and Substance Use Disorders: the Moral Test of Our Time. J Behav Health Serv Res 2018; 45:157-159. [DOI: 10.1007/s11414-018-9593-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|