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Edmondson EK, Garcia SM, Gregory EF, Vajravelu ME, Szalda D, Shea JA, Virudachalam S. Emerging Adults With Type 2 Diabetes: Understanding Illness Experience and Transition to Adult Care. J Adolesc Health 2024; 75:107-114. [PMID: 38520432 DOI: 10.1016/j.jadohealth.2024.02.021] [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: 10/27/2023] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE Youth-onset type 2 diabetes (T2D) is increasingly common and is often diagnosed shortly before transition from pediatric to adult care. Little is known about the experience of emerging adults (EAs) with T2D and the readiness, barriers, and facilitators to transition. This study sought to describe the illness experience of EAs with T2D and perceptions about transition, and explore themes by "transition readiness," measured by the Transition Readiness Assessment Questionnaire (TRAQ). METHODS In this mixed-methods study, we conducted semi-structured interviews with EAs with T2D using a guide grounded in the health belief model, administered the TRAQ, and collected disease metrics from the electronic medical record. We developed a coding scheme using a directed content-analysis approach and triangulated qualitative and quantitative data to compare themes stratified by mean TRAQ score. RESULTS Participants described modifying factors like adjusting to life with a chronic illness and coping with mental health issues as critical elements of the illness experience that influence transition. Individual beliefs emerged including the perceived risk of disease complications being informed by experience of family members, self-efficacy in diabetes care hinging on the ability to be highly organized, and transition as a daunting obstacle with numerous emotional and logistical barriers. Participants emphasized the need for support from caregivers and providers throughout transition. Themes did not vary significantly by TRAQ score. DISCUSSION Experiences of EAs with T2D suggest more assistance is needed in the transition period to address factors such as mental health, organizational skills, and identifying support people to facilitate care.
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Affiliation(s)
- Emma K Edmondson
- Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Policy Lab and Clinical Futures, Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - Stephanie M Garcia
- Policy Lab and Clinical Futures, Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, Philadelphia, Pennsylvania
| | - Emily F Gregory
- Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Policy Lab and Clinical Futures, Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, Philadelphia, Pennsylvania
| | - Mary Ellen Vajravelu
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Dava Szalda
- Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Judy A Shea
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Senbagam Virudachalam
- Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Policy Lab and Clinical Futures, Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Casado E, Gómez-Alonso C, Pintos-Morell G, Bou-Torrent R, Barreda-Bonis AC, Torregrosa JV, Broseta-Monzó JJ, Arango-Sancho P, Chocrón-de-Benzaquen S, Olmedilla-Ishishi Y, Soler-López B. Transition of patients with metabolic bone disease from paediatric to adult healthcare services: current situation and proposals for improvement. Orphanet J Rare Dis 2023; 18:245. [PMID: 37644568 PMCID: PMC10463506 DOI: 10.1186/s13023-023-02856-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/20/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND There are currently no models for the transition of patients with metabolic bone diseases (MBDs) from paediatric to adult care. The aim of this project was to analyse information on the experience of physicians in the transition of these patients in Spain, and to draw up consensus recommendations with the specialists involved in their treatment and follow-up. METHODS The project was carried out by a group of experts in MBDs and included a systematic review of the literature for the identification of critical points in the transition process. This was used to develop a questionnaire with a total of 48 questions that would determine the degree of consensus on: (a) the rationale for a transition programme and the optimal time for the patient to start the transition process; (b) transition models and plans; (c) the information that should be specified in the transition plan; and (d) the documentation to be created and the training required. Recommendations and a practical algorithm were developed using the findings. The project was endorsed by eight scientific societies. RESULTS A total of 86 physicians from 53 Spanish hospitals participated. Consensus was reached on 45 of the 48 statements. There was no agreement that the age of 12 years was an appropriate and feasible point at which to initiate the transition in patients with MBD, nor that a gradual transition model could reasonably be implemented in their own hospital. According to the participants, the main barriers for successful transition in Spain today are lack of resources and lack of coordination between paediatric and adult units. CONCLUSIONS The TEAM Project gives an overview of the transition of paediatric MBD patients to adult care in Spain and provides practical recommendations for its implementation.
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Affiliation(s)
- Enrique Casado
- Rheumatology Department, Hospital Universitario Parc Taulí, Sabadell, Barcelona, Spain
| | - Carlos Gómez-Alonso
- Bone and Mineral Metabolism Clinical Management Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Guillem Pintos-Morell
- Hereditary Metabolic Diseases, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Rosa Bou-Torrent
- Paediatric Rheumatology Unit, Hospital Sant Joan de Déu, Barcelona, Spain
| | | | - José Vicente Torregrosa
- Department of Nephrology and Renal Transplant, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Pedro Arango-Sancho
- Department of Paediatric Nephrology, Hospital Sant Joan de Déu, Barcelona, Spain
| | | | | | - Begoña Soler-López
- Medical Department, E-C-BIO, S.L., c/Rosa de Lima, 1, Edificio ALBA, Office 016, 28230, Las Rozas, Madrid, Spain.
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Holmström Rising M, Söderberg S. Experiences of transitions in daily life for parents of children with type 1 diabetes: An interpretive description. Res Nurs Health 2023; 46:313-322. [PMID: 36815583 DOI: 10.1002/nur.22303] [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: 09/30/2022] [Revised: 02/03/2023] [Accepted: 02/11/2023] [Indexed: 02/24/2023]
Abstract
In this study, we aimed to explore and describe the experiences of parents whose children have been diagnosed with type 1 diabetes (T1D) and the transitions of daily life. T1D is a long-term illness, and parents of children with T1D often become informal caregivers and face many challenges in their daily lives. A qualitative study design, in line with interpretive description, was used, and a sample of 10 parents of children with T1D participated in individual interviews. The COnsolidated criteria for REporting Qualitative Research (COREQ) checklist was used. The interviews were analyzed using interpretive descriptions. The analysis resulted in one main theme: "The realization of having taken 'daily life' for granted and having to accept a new reality," with six themes showing different transitions in the parents' daily lives, including transitions in daily life patterns, parenthood, in relationships with family and friends, relationships with school personnel, relationships with healthcare personnel, and in knowledge and learning about the illness. Parents experienced multifaceted changes that affected their lives, as shown by the six identified transitions. Being the parent of a child with T1D implies a new reality with complex, irreversible life changes that may be unknown and unspoken to healthcare professionals and society. Healthcare systems, school personnel, and society at large need to improve their knowledge regarding parents' situations to better support them in embracing a new reality for themselves and their children long after the onset of T1D.
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Affiliation(s)
| | - Siv Söderberg
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden
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Wyngaert KV, Nédée ML, Piessevaux O, De Martelaer T, Van Biesen W, Cocquyt V, Van Daele S, De Munter J. The role and the composition of a liaison team to facilitate the transition of adolescents and young adults: an umbrella review. Eur J Pediatr 2023; 182:1483-1494. [PMID: 36735061 DOI: 10.1007/s00431-023-04835-2] [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: 08/25/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 02/04/2023]
Abstract
Adolescents and young adults (AYAs) benefit from healthcare transition (HCT) programs. Despite the well-established literature reviewing HCT, a considerable heterogeneity exists on the involved healthcare professionals. This review aims to explore systematic reviews on the practices and recommendations on which disciplines of professionals should be involved in HCT. An umbrella review was performed using the MEDLINE, EMBASE, and Web of Science databases. To be eligible, systematic reviews had to report on the composition and/or the rationale of members of a transition team. Seventeen reviews were included in this systematic review. A healthcare professional that coordinates HCT was identified as a key caregiver in all reviews. Other reported members of a HCT team were nurses (75% of the reviews), social workers (44%), and peers/mentors (35%). The reported key responsibilities of a HCT team were to (i) manage communication, (ii) ensure continuity of care, and (iii) maintain contact with community services. Conclusions: A team responsible for HCT should be active on the organizational, medical, and social levels. Key members of a HCT team vary little between diseases and included a coordinator, social worker, and nurse. A coordinating physician could facilitate transition in complex conditions. At all times, the condition and needs of the AYA should determine who should be involved as caregiver. What is Known: • The psychosocial needs of adolescents and young adults during healthcare transition are largely similar between chronic diseases. What is New: • Coordinators, nurses and social workers were the most involved, independent of the condition. • A liaison team should be active on organizational-, medical- and social-levels.
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Affiliation(s)
- Karsten Vanden Wyngaert
- Department of Internal Medicine, Renal Division, Ghent University Hospital, Corneel-Heymanslaan 10, Ghent, 9000, Belgium.
| | - Marie-Lise Nédée
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Odile Piessevaux
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Tine De Martelaer
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Wim Van Biesen
- Department of Internal Medicine, Renal Division, Ghent University Hospital, Corneel-Heymanslaan 10, Ghent, 9000, Belgium
| | - Veronique Cocquyt
- Department of Internal Medicine, Medical Oncology Division, Ghent University Hospital, Ghent, Belgium
| | - Sabine Van Daele
- Pediatric Pulmonology, Ghent University Hospital, Ghent, Belgium
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Limbert C, Tinti D, Malik F, Kosteria I, Messer L, Jalaludin MY, Benitez-Aguirre P, Biester S, Corathers S, von Sengbusch S, Marcovecchio ML. ISPAD Clinical Practice Consensus Guidelines 2022: The delivery of ambulatory diabetes care to children and adolescents with diabetes. Pediatr Diabetes 2022; 23:1243-1269. [PMID: 36537530 DOI: 10.1111/pedi.13417] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Catarina Limbert
- Unit of Paediatric Endocrinology and Diabetes, Hospital Dona Estefânia, Lisbon, Portugal.,Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Davide Tinti
- Department of Pediatrics, University of Turin, Turin, Italy
| | - Faisal Malik
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Ioanna Kosteria
- Department of Endocrinology, Growth & Development, "P&A Kyriakou" Children's Hospital, Athens, Greece
| | - Laurel Messer
- Barbara Davis Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Paul Benitez-Aguirre
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
| | - Sarah Biester
- Diabetes-Center for Children and Adolescents, Children's Hospital "Auf der Bult", Hannover, Germany
| | - Sarah Corathers
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Simone von Sengbusch
- Division of Pediatric Endocrinology and Diabetology, Campus Lübeck, University Medical Centre Schleswig-Holstein, Lübeck, Germany
| | - M Loredana Marcovecchio
- Department of Paediatrics, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Varshney K, Iriowen R, Morrell K, Pillay P, Fossi A, Stephens MM. Disparities and outcomes of patients living with Down Syndrome undergoing healthcare transitions from pediatric to adult care: A scoping review. Am J Med Genet A 2022; 188:2293-2302. [PMID: 35686676 PMCID: PMC9545419 DOI: 10.1002/ajmg.a.62854] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/01/2022] [Accepted: 05/13/2022] [Indexed: 11/11/2022]
Abstract
Down Syndrome (DS) is one of the most common chromosomal disorders worldwide, and people with DS experience more co-morbidities and have poorer health outcomes compared to the general population. An area that is not well understood is how patients with DS transition from pediatric to adult care, as well as the details, barriers, and difficulties of these transitions for patients. Hence, we aimed to provide a scoping review of the literature in PubMed, Scopus, and CINAHL on the topic of healthcare transitions (HCTs) for patients with DS. Findings suggest patients with DS who continued receiving care as an adult from a pediatric care provider tended to experience co-morbidities and other adverse health issues at higher rates than those who entirely switch to an adult-care team. Patients with DS were unable to undergo transition due to multiple barriers, such as low income, limited/public insurance, gender, and race. We propose potential steps for transition, which focus on ensuring early planning, communicating better, coordinating services, assessing decision-making capacity, and providing ongoing social and financial support. Future research must further identify and address barriers to HCTs for people with DS.
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Affiliation(s)
- Karan Varshney
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Rosemary Iriowen
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kayla Morrell
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Preshon Pillay
- School of Medicine, Deakin University, Geelong, Victoria, Australia
| | - Alexander Fossi
- Center for Autism and Neurodiversity, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mary M Stephens
- Department of Family & Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Center for Special Healthcare Needs, Christiana, Delaware, USA
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Sawyer B, Hilliard E, Hackney KJ, Stastny S. Barriers and Strategies for Type 1 Diabetes Management Among Emerging Adults: A Qualitative Study. Clin Med Insights Endocrinol Diabetes 2022; 15:11795514221098389. [PMID: 35615101 PMCID: PMC9125103 DOI: 10.1177/11795514221098389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 04/08/2022] [Indexed: 11/15/2022] Open
Abstract
Purpose: Individuals in the emerging adult age group (18-30 years) with type 1 diabetes (T1DM) have unique medical and social needs. The purpose of this study was to observe barriers and strategies for diabetes management among emerging adults with T1DM. Methods: A qualitative grounded theory model was utilized. An open-ended approach with a telephone interview was designed to allow a deeper understanding of the T1DM experience. The participants were from a larger survey-volunteer participant group and were asked to complete 1 interview in spring 2020 (n = 21, diagnosed age: mean 15.00 ± 8.00, females, n = 19). The data were analyzed for cohesive themes using grounded theory. Results: Participants indicated three main barrier themes (physiology, environment, and insurance) and 3 barrier subthemes (mental health, lack of social support, and weather). Three main strategy themes to diabetes management were recognized (medical technology, access to social support, and physical activity). There were 2 strategy subthemes (social media and social accountability). Conclusions: Regular use of social media can be a key tool for social accountability while lack of social support and physiological shifts can be barriers to management of T1DM. Physical activity should be considered as part of an individualized plan for management of diabetes.
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Affiliation(s)
- Bailee Sawyer
- Department of Medical Laboratory Sciences, Public Health, and Nutrition Science, Tarleton State University, Stephenville, TX USA
| | - Elizabeth Hilliard
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND, USA
| | - Kyle J Hackney
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND, USA
| | - Sherri Stastny
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, ND, USA
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Ali N, Longson J, Myszka R, Park K, Low GKK, Leong GM, Bhurawala H, Liu A. Comparison of compliance and outcomes in adolescents with type 1 diabetes mellitus attending a co-located pediatric and transition diabetes service. JOURNAL OF TRANSITION MEDICINE 2022. [DOI: 10.1515/jtm-2021-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objectives
Adolescence is a challenging period for diabetes management, particularly when transitioning to adult care. There are reports highlighting concerns that transition to adult care may lead to poor glycemic control and clinic engagement. Our aim was to determine if a co-located pediatric and transition diabetes service would lead to better transition outcomes.
Methods
A retrospective medical records review was conducted on patients with type 1 diabetes attending a transition clinic in a metropolitan teaching hospital in Sydney, Australia. Patients referred from the hospital’s co-located pediatric diabetes clinic to the transition clinic were compared to those referred from external sources regarding important clinical outcomes such as glycosylated haemoglobin (HbA1c), clinic attendances, and complication rates between referral sources. Confounders such as age, gender, duration of diabetes and socioeconomic status were considered.
Results
Data was collected from 356 patients of which 121 patients were referred from the co-located pediatric diabetes clinic (IRG) and 235 patients from external sources (ERG). Improvements in HbA1c were only seen in the ERG at 6 and 12 months (p<0.001). Altogether 93% attended one or more medical appointments in the IRG compared to 83% in the ERG (p=0.03). There were more admissions for acute diabetes complications (17 vs. 8%, p=0.01) and more microvascular complications (20 vs. 9%, p<0.01) in the IRG vs. ERG group.
Conclusions
Although co-location of a pediatric and transition clinic improved medical engagement, this did not equate to better glycemic control or complication rates. Further research is warranted to determine what other strategies are required to optimise the transition process in diabetes care.
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Affiliation(s)
- Naushad Ali
- Department of Paediatrics , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
| | - Julie Longson
- Department of Endocrinology and Diabetes , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
| | - Rickie Myszka
- Department of Endocrinology and Diabetes , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
| | - Kris Park
- Department of Endocrinology and Diabetes , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
| | - Gary K. K. Low
- Research Operations , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
| | - Gary M. Leong
- Department of Paediatrics , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
- Discipline of Paediatrics , The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney , Derby St , Kingswood , NSW , 2750 , Australia
| | - Habib Bhurawala
- Department of Paediatrics , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
- Discipline of Paediatrics , The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney , Derby St , Kingswood , NSW , 2750 , Australia
| | - Anthony Liu
- Department of Paediatrics , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
- Discipline of Paediatrics , The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney , Derby St , Kingswood , NSW , 2750 , Australia
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Time to First Completed Visit and Health Care Utilization Among Young Adults Transferring From Pediatric to Adult Rheumatologic Care in a Safety‐Net Hospital. Arthritis Care Res (Hoboken) 2021; 73:1730-1738. [DOI: 10.1002/acr.24409] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 08/04/2020] [Indexed: 12/13/2022]
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Leung JMWS, Tang TS, Lim CE, Laffel LM, Amed S. The four I's of adolescent transition in type 1 diabetes care: A qualitative study. Diabet Med 2021; 38:e14443. [PMID: 33107064 DOI: 10.1111/dme.14443] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/23/2020] [Indexed: 02/05/2023]
Abstract
AIMS To explore adolescent perspectives on programme design in the transition to adult care. METHODS We conducted five focus groups on adolescents with type 1 diabetes nearing the age of transition to adult care. Study participants also completed an embedded survey where they rated a wide range of potential transition interventions. Focus group transcripts were analysed with three iterations of line-by-line coding to triangulate themes and subthemes. RESULTS Four themes were identified: Individualization-how to personalize the transition experience (having choices in the transition experience, meeting adult provider before transition and specific transition preparation); Identity-how the world relates to my diabetes (stigma of type 1 diabetes, confusion with type 2 diabetes, diagnosis disclosure and resilience); Interconnection-how my support system can help me with my diabetes (peer support, near peer support, parental support, loss of bond with paediatric team and fear of not having a bond with adult team); and Impediment-how my diabetes limits me (self-care takes work and time, unpredictability and restrictiveness, and emotional burden). Highly rated interventions from the survey included: good communication between the paediatric and adult teams, medical summary of past diabetes care, and having paediatric and adult teams in the same building. CONCLUSIONS The design of future transition interventions for adolescents with type 1 diabetes should address the issues of Individualization, Identity, Interconnection and Impediment. Collaborative processes between paediatric and adult providers were also rated as important strategies to facilitate the transition to adult care.
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Affiliation(s)
- Joseph M W S Leung
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Tricia S Tang
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Catherine E Lim
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | | | - Shazhan Amed
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
- Department of Pediatrics, The University of British Columbia, Vancouver, BC, Canada
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Nursing's Influence on the Evolution of the Field of Health Care Transition and Future Implications. J Pediatr Health Care 2021; 35:408-413. [PMID: 34053794 DOI: 10.1016/j.pedhc.2021.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/07/2021] [Indexed: 11/20/2022]
Abstract
Health care transition (HCT) is an emerging field of practice and research with unlimited opportunities for nursing involvement. This article will highlight the unique contributions of nurse clinicians and researchers worldwide that have influenced HCT practice and research. The historical underpinnings of nursing practice will be discussed and feature the distinctive models and concepts of care that have and will continue to be contributed to HCT practice and research. Dimensions of prominent nursing contributions in collaboration with interdisciplinary partners as it pertains to scholarship, research, practice, and policymaking will be presented. The implications for future nursing involvement in this emerging field will be discussed.
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Jiang I, Major G, Singh-Grewal D, Teng C, Kelly A, Niddrie F, Chaitow J, O'Neill S, Hassett G, Damodaran A, Bernays S, Manera K, Tong A, Tunnicliffe DJ. Patient and parent perspectives on transition from paediatric to adult healthcare in rheumatic diseases: an interview study. BMJ Open 2021; 11:e039670. [PMID: 33397662 PMCID: PMC7783517 DOI: 10.1136/bmjopen-2020-039670] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES To describe the experiences, priorities, and needs of patients with rheumatic disease and their parents during transition from paediatric to adult healthcare. SETTING Face-to-face and telephone semistructured interviews were conducted from December 2018 to September 2019 recruited from five hospital centres in Australia. PARTICIPANTS Fourteen young people and 16 parents were interviewed. Young people were included if they were English speaking, aged 14-25 years, diagnosed with an inflammatory rheumatic disease (eg, juvenile idiopathic arthritis, juvenile dermatomyositis, systemic lupus erythematosus, panniculitis, familial Mediterranean fever) before 18 years of age. Young people were not included if they were diagnosed in the adult setting. RESULTS We identified four themes with respective subthemes: avoid repeat of past disruption (maintain disease stability, preserve adjusted personal goals, protect social inclusion); encounter a daunting adult environment (serious and sombre mood, discredited and isolated identity, fear of a rigid system); establish therapeutic alliances with adult rheumatology providers (relinquish a trusting relationship, seek person-focused care, redefine personal-professional boundaries, reassurance of alternative medical supports, transferred trust to adult doctor) and negotiate patient autonomy (confidence in formerly gained independence, alleviate burden on patients, mediate parental anxiety). CONCLUSIONS During transition, patients want to maintain disease stability, develop a relationship with their adult provider centralised on personal goals and access support networks. Strategies to comprehensively communicate information between providers, support self-management, and negotiate individualised goals for independence during transition planning may improve satisfaction, and health and treatment outcomes.
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Affiliation(s)
- Ivy Jiang
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Gabor Major
- Department of Rheumatology, Bone and Joint Centre, Royal Newcastle Centre, John Hunter Hospital, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle Faculty of Health and Medicine, Callaghan, New South Wales, Australia
| | - Davinder Singh-Grewal
- Department of Rheumatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Department of Rheumatology, The Sydney Children's Hospitals Network Randwick and Westmead, Westmead, New South Wales, Australia
| | - Claris Teng
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Ayano Kelly
- Rheumatology, Canberra Rheumatology, Canberra City, Australian Capital Territory, Australia
- College of Health and Medicine, Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Fiona Niddrie
- Department of Rheumatology, Bone and Joint Centre, Royal Newcastle Centre, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Jeffrey Chaitow
- Department of Rheumatology, Bone and Joint Centre, Royal Newcastle Centre, John Hunter Hospital, Newcastle, New South Wales, Australia
- Department of Rheumatology, The Sydney Children's Hospitals Network Randwick and Westmead, Westmead, New South Wales, Australia
| | - Sean O'Neill
- Department of Rheumatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Geraldine Hassett
- Department of Rheumatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Arvin Damodaran
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Rheumatology, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
| | - Sarah Bernays
- School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
- Global Health and Development, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Karine Manera
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - David J Tunnicliffe
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- University of Sydney, Sydney School of Public Health, New South Wales Ministry of Health, Sydney, New South Wales, Australia
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13
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Butalia S, McGuire KA, Dyjur D, Mercer J, Pacaud D. Youth with diabetes and their parents' perspectives on transition care from pediatric to adult diabetes care services: A qualitative study. Health Sci Rep 2020; 3:e181. [PMID: 32782975 PMCID: PMC7410016 DOI: 10.1002/hsr2.181] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/28/2020] [Accepted: 07/09/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND AIMS When youth with diabetes transition from pediatric to adult diabetes care, they are at high risk for loss to follow up and worsening glucose control. We aimed to gain insight on how to improve the transition of youth with type 1 diabetes from pediatric to adult diabetes care from the patients' and parents' perspective. METHODS We conducted focus groups in youth with type 1 diabetes in transition from pediatric to adult diabetes care and their parents, in Calgary, Alberta, between June and August 2014. Eligibility criteria included: (a) type 1 diabetes; (b) aged 15 to 25 years; (c) have or had received care at the pediatric hospital; and, (d) either pre or post-transfer; or, (e) parents of recently transferred youth. Purposive sampling was used, and the theoretical framework used was the Integrated Behaviour Model. Participants were asked about positive, negative, or challenging experiences related to diabetes and transition, solutions to challenges, and tools and strategies to improve and better support transition. Thematic analysis was conducted after focus groups were recorded and transcribed. RESULTS Three focus groups were conducted: pre-transfer youth with diabetes (4 females and 3 males; median age 17.5 years, IQR 1.3 years); post-transfer young adults with diabetes (2 females and 2 males; median age 23.5 years, IQR 1.2 years); and parents of recently transferred young adults with diabetes (n = 3). Main themes were: (a) communication technology; (b) the need for more transition and diabetes education and preparation during transition; and, (c) the importance and need for social and peer support. CONCLUSION This study describes specific areas that may improve diabetes transfer and transition from pediatric to adult diabetes care. This information can help inform clinical care delivery for transition and the development of programs, strategies, and interventions to improve transition care.
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Affiliation(s)
- Sonia Butalia
- Division of Endocrinology and Metabolism, Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- O'Brien Institute for Public Health, Cumming School of Medicine, CalgaryUniversity of CalgaryCalgaryAlbertaCanada
- Libin Cardiovascular Institute, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - K. Ashlee McGuire
- Provincial Primary Health CareAlberta Health ServicesCalgaryAlbertaCanada
- Department of Family Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - David Dyjur
- Diabetes Centre CalgaryAlberta Health ServicesCalgaryAlbertaCanada
| | - Julia Mercer
- Alberta Children's Hospital, Diabetes ClinicAlberta Health ServicesCalgaryAlbertaCanada
| | - Daniele Pacaud
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Alberta Children's Hospital Research Institute, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
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14
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The Scope of Research on Transfer and Transition in Young Persons With Chronic Conditions. J Adolesc Health 2019; 65:581-589. [PMID: 31540780 DOI: 10.1016/j.jadohealth.2019.07.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/13/2019] [Accepted: 07/15/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE To determine the amount, type, and evidence level of published literature on transfer and/or transition of young people with chronic conditions (CCs) and to describe the characteristics of such studies. METHODS Databases including PubMed, CINAHL, Web of Science, and Scopus were searched for publications in English, French, Spanish, Dutch, or Swedish. Included publications were related to transfer and/or transition of young persons (10-25 years) with a CC. Grey literature was excluded. Region and country where the study was performed, type of study design, study population (i.e., type of CC, sample size, group), and data collection methods were extracted from the studies. RESULTS We included 952 publications for data analysis, of which 790 were quantitative, 128 qualitative, and 34 multimethods or mixed methods studies. Only seven studies were experimental designs, and the majority (n = 341) were categorized as expert opinion or narrative reviews. Endocrinology and neurology were the most common medical specialties involved in the studies, and young persons were the most represented group, while health-care providers were involved the least. CONCLUSIONS The majority of publications are categorized at the lowest evidence level. Furthermore, evidence is limited to a certain group of medical specialties.
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15
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González-Agüero M, Chenhall R, Basnayake P, Vaughan C. Inequalities in the Age of Universal Health Coverage: Young Chileans with Diabetes Negotiating for Their Right to Health. Med Anthropol Q 2019; 34:210-226. [PMID: 31637732 DOI: 10.1111/maq.12555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 09/10/2019] [Accepted: 09/23/2019] [Indexed: 01/05/2023]
Abstract
While universal health coverage (UHC) has been praised as a powerful means to reduce inequalities and improve access to health globally, little has been said about how patients experience and understand its implementation locally. In this article, we explore the experiences of young Chileans with type 1 diabetes when seeking care in Santiago, within Chile's UHC program, which sought to improve people's access to health care. We argue that the implementation of UHC, within a structurally fragmented health system, did not lead to the promised equitable health care delivery. Although UHC aimed to equitably provide universal care, locally it materialized in heterogeneous configurations forcing individuals into positions of precarity and generating new inequalities. Furthermore, for the young people in the study, UHC intersected with their health insurance and socioeconomic status, impacting on the health care they could access, consequently making diabetes care and management a difficult challenge.
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Affiliation(s)
| | - Richard Chenhall
- Melbourne School of Population and Global Health, The University of Melbourne
| | - Prabhathi Basnayake
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne
| | - Cathy Vaughan
- Gender and Women's Health Unit, Melbourne School of Population and Global Health, The University of Melbourne
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16
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Jewell RR, Gorey KM. Psychosocial Interventions for Emergent Adults With Type 1 Diabetes: Near-Empty Systematic Review and Exploratory Meta-Analysis. Diabetes Spectr 2019; 32:249-256. [PMID: 31462881 PMCID: PMC6695259 DOI: 10.2337/ds18-0063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Risk for developing mental health concerns is increased for people with diabetes. Coupled with stressors related to the transition from adolescence to adulthood, emergent adults may be in greater need of psychosocial interventions to help them cope. This review summarizes the literature on interventions used with people with diabetes aged 15-30 years on psychosocial and biological (A1C) outcomes. Core databases were searched for both published and grey research. Studies completed between January 1985 and October 2018 using any psychosocial intervention and meeting age and diabetes type requirements were selected if they included a control or comparison group and findings reported in such a way that effect size was calculable. Two authors independently extracted relevant data using standard data extraction templates. Six studies with 450 participants met the broad inclusion criteria. Sample-weighted pooling of 12 outcomes, six each on glycemic control and psychosocial status, suggested the preventive potential (d = 0.31, 95% CI 0.17-0.45) and homogeneity (χ2 [11] = 11.15, P = 0.43) of studied interventions. This preliminary meta-analysis provides some suggestion that psychosocial interventions, including telephone-based case management, individualized treatment modules, and small-group counseling interventions, may diminish burden, depression, and anxiety and enhance glycemic control among emerging adults with type 1 diabetes as they transition from adolescence to adulthood.
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Affiliation(s)
- Rachel R Jewell
- School of Social Work, University of Windsor, Windsor, Ontario, Canada
| | - Kevin M Gorey
- School of Social Work, University of Windsor, Windsor, Ontario, Canada
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Ramchandani N, Way N, Melkus GD, Sullivan-Bolyai S. Challenges to Diabetes Self-Management in Emerging Adults With Type 1 Diabetes. DIABETES EDUCATOR 2019; 45:484-497. [PMID: 31304878 DOI: 10.1177/0145721719861349] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of this qualitative descriptive study undergirded by Meleis's Transition Framework was to explore developmental, situational, and organizational challenges experienced by a diverse group of emerging adults (18-29 years old) with type 1 diabetes (T1DM). Their perspectives on creating a developmentally informed diabetes self-management (DSM) program that supports transitional care were also explored. METHODS A purposive sample of emerging adults with T1DM was recruited from the pediatric and adult diabetes clinics of an urban academic medical center. Those who consented participated in either a single focus group or a single interview. Self-reported demographic and clinical information was also collected. RESULTS The sample was comprised of 21 emerging adults, with an average age of 23.6 ± 2.6 years, diabetes duration of 14.7 ± 5.0 years, and 71% female. Four main themes emerged: (1) finding a balance between diabetes and life, (2) the desire to be in control of their diabetes, (3) the hidden burden of diabetes, and (4) the desire to have a connection with their diabetes provider. Use of insulin pumps and continuous glucose monitors and attendance at diabetes camp decreased some of the DSM challenges. Different groups of individuals had different perspectives on living with diabetes and different approaches to DSM. CONCLUSIONS The emerging adults in this study had a strong desire to be in good glycemic control. However, all participants described having a hard time balancing DSM with other competing life priorities. They also desired personalized patient-provider interactions with their diabetes care provider in clinical follow-up services. Even though the study sample was small, important themes emerged that warrant further exploration.
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Affiliation(s)
| | - Niobe Way
- Department of Applied Psychology, New York University Steinhardt, New York, New York
| | | | - Susan Sullivan-Bolyai
- University of Massachusetts Medical School-Graduate School of Nursing, Worcester, Massachusetts
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18
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Yassaee A, Hale D, Armitage A, Viner R. The Impact of Age of Transfer on Outcomes in the Transition From Pediatric to Adult Health Systems: A Systematic Review of Reviews. J Adolesc Health 2019; 64:709-720. [PMID: 30833120 DOI: 10.1016/j.jadohealth.2018.11.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 11/30/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE International guidance on health-care transition has existed for over a decade; however, many unanswered questions remain. This systematic review of reviews aimed to answer the question: is a later age of transfer from pediatric to adult health care associated with improved health and health service outcomes? METHODS We included systematic reviews which considered at least one long-term condition and provided outcome data from adult services. Methodology of primary studies was not an exclusion criterion. We searched multiple databases and conducted an initial search in May 2015 which was repeated in May 2017. All reviews were assessed for quality using the Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) tool. Reviews that scored less than 22 were excluded. RESULTS Initial searches identified 6,149 papers. Forty-three reviews met exclusion and inclusion criteria, and 15 reviews also met quality criteria. With one exception, primary studies from reviews which only considered quantitative evidence found that a delayed age of transfer resulted in improved outcomes. Qualitative and mixed-methods evidence supported the view that age 18 was an appropriate time of transfer. CONCLUSION We found moderate evidence that models of transition which transfer young people in late adolescence or early adulthood can improve transition outcomes and patient satisfaction.
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Affiliation(s)
- Arrash Yassaee
- General Adolescent Pediatrics Unit, Institute of Child Health, UCL, London, United Kingdom.
| | - Daniel Hale
- General Adolescent Pediatrics Unit, Institute of Child Health, UCL, London, United Kingdom
| | - Alice Armitage
- General Adolescent Pediatrics Unit, Institute of Child Health, UCL, London, United Kingdom
| | - Russell Viner
- General Adolescent Pediatrics Unit, Institute of Child Health, UCL, London, United Kingdom
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Carlsund Å, Söderberg S. Living with type 1 diabetes as experienced by young adults. Nurs Open 2019; 6:418-425. [PMID: 30918692 PMCID: PMC6419143 DOI: 10.1002/nop2.222] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 10/21/2018] [Accepted: 11/01/2018] [Indexed: 12/16/2022] Open
Abstract
AIM Describe young adults` (19-30 years) experiences of living with Type 1 Diabetes (T1D). BACKGROUND Young adulthood is characterized by adaption to adult roles, gradual separation from parental support and leaving the parental home. Living with T1D in young adulthood raises challenges and concerns. DESIGN This study has a qualitative design. METHODS Semistructured interviews with 12 young adults living with T1D for 3-14 years, analysed with qualitative content analysis. RESULTS The analysis revealed contradictory ways of handling the illness, as is illuminated in two main categories (a) and five subcategories (b). Handling the situation and dealing with different opinions (a), (b) managing daily life, emotional roller coaster and general attitudes, own views and apprehensions, ignorance and lack of motivation. Most participants were motivated, had knowledge and were in control of their long-term illness. Planning and structure were an essential part of their daily life. The participants were anxious about losing control of their bodies, the situation, die or be a burden to other people.
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Affiliation(s)
- Åsa Carlsund
- Department of Nursing SciencesMid‐Sweden UniversityÖstersundSweden
| | - Siv Söderberg
- Department of Nursing SciencesMid‐Sweden UniversityÖstersundSweden
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20
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Essaddam L, Kallali W, Jemel M, Kandara H, Kammoun I, Hsairi M, Ben Salem L, Ben Becher S. Implementation of effective transition from pediatric to adult diabetes care: epidemiological and clinical characteristics-a pioneering experience in North Africa. Acta Diabetol 2018; 55:1163-1169. [PMID: 30074090 DOI: 10.1007/s00592-018-1196-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 07/18/2018] [Indexed: 12/13/2022]
Abstract
AIMS Type 1 diabetes is increasing in children leading more T1D young adults to adult healthcare settings. This change is experienced as a tear and results in a disengagement from specialist services. This study reports on an implementation of an effective and pioneering program of transition in North Africa. METHODS A total of 65 teenagers with T1D were recruited for a structured program of transition. They attend transitional meetings involving both pediatric and adult team and were, when ready, welcomed in specialized consultations for adolescents with a special « passport ». Here we study their characteristics before and after structured transition and the benefit of this program. RESULTS 9 transition meetings took place (September 2012-December 2017). Mean age was 16.5 years. Mean age at onset of T1D was 7.5 years with average pediatric follow-up of 9 years.72% of young adults felt satisfied. After the transition meeting, 74% of patients wished to join directly adult unit. They were followed there for 28.4 ± 16.2 months. The glycaemic control improved significantly with a decrease in HbA1C of 0.93 ± 1.69% the first year of follow-up and the number of young adults achieving a HbA1C < 7.5% increased by 8%. CONCLUSION This program was beneficial for 75% of patients who demonstrated an improvement in their metabolic control the year following transition to adult care service. To our knowledge, this study is the first one in North Africa to report on the outcome of a structured transition program from pediatric to adult diabetes care.
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Affiliation(s)
- Leïla Essaddam
- Faculté de Médecine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia.
- Children Hospital Béchir Hamza de Tunis, Jebbari, 1007, Tunis, Tunisia.
- , Tunis, Tunisia.
| | - Wafa Kallali
- Faculté de Médecine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
- Children Hospital Béchir Hamza de Tunis, Jebbari, 1007, Tunis, Tunisia
| | - Manel Jemel
- Faculté de Médecine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
- Unit of Endocrinology, Diabetology and Metabolic diseases, Institut National de Nutrition de Tunis, 1007, Tunis, Tunisia
| | - Hager Kandara
- Faculté de Médecine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
- Unit of Endocrinology, Diabetology and Metabolic diseases, Institut National de Nutrition de Tunis, 1007, Tunis, Tunisia
| | - Inès Kammoun
- Faculté de Médecine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
- Unit of Endocrinology, Diabetology and Metabolic diseases, Institut National de Nutrition de Tunis, 1007, Tunis, Tunisia
| | - Mohamed Hsairi
- Faculté de Médecine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
- Department of Epidemiology, Salah Azaiez Institute of Tunis, 1007, Tunis, Tunisia
| | - Leïla Ben Salem
- Faculté de Médecine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
- Unit of Endocrinology, Diabetology and Metabolic diseases, Institut National de Nutrition de Tunis, 1007, Tunis, Tunisia
| | - Saayda Ben Becher
- Faculté de Médecine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
- Children Hospital Béchir Hamza de Tunis, Jebbari, 1007, Tunis, Tunisia
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21
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Michaud S, Dasgupta K, Bell L, Yale JF, Anjachak N, Wafa S, Nakhla M. Adult care providers' perspectives on the transition to adult care for emerging adults with Type 1 diabetes: a cross-sectional survey. Diabet Med 2018; 35:846-854. [PMID: 29577410 DOI: 10.1111/dme.13627] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2018] [Indexed: 12/23/2022]
Abstract
AIMS To assess adult diabetes care providers' current transition practices, knowledge about transition care, and perceived barriers to implementation of best practices in transition care for emerging adults with Type 1 diabetes mellitus. METHODS We administered a 38-item web-based survey to adult diabetes care providers identified through the Québec Endocrinologist Medical Association and Diabetes Québec. RESULTS Fifty-three physicians responded (35%). Fewer than half of all respondents (46%) were familiar with the American Diabetes Association's transition care position statement. Approximately one-third of respondents reported a gap of >6 months between paediatric and adult diabetes care. Most (83%) believed communication with the paediatric team was adequate; however, only 56% reported receiving a medical summary and 2% a psychosocial summary from the paediatric provider. Respondents believed that the paediatric team should improve emerging adults' preparation for transition care by developing their self-management skills and improve teaching about the differences between paediatric and adult-oriented care. Only 31% had a system for identifying emerging adults lost to follow-up in adult care. Perceived barriers included difficulty accessing psychosocial services, emerging adults' lack of motivation, and inadequate transition preparation. Most (87%) were interested in having additional resources, including a self-care management tool and a registry to track those lost to follow-up. CONCLUSIONS Our findings highlight the need to better engage adult care providers into transition care practices. Despite adult physicians' interest in transition care, implementation of transition care recommendations and resources in clinical care remains limited. Enhanced efforts are needed to improve access to mental health services within the adult healthcare setting.
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Affiliation(s)
- S Michaud
- Department of Paediatrics, Montreal Children's Hospital, McGill University
| | - K Dasgupta
- Research Institute of the McGill University Health Centre
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - L Bell
- Department of Paediatrics, Montreal Children's Hospital, McGill University
| | - J-F Yale
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - N Anjachak
- Research Institute of the McGill University Health Centre
| | - S Wafa
- Research Institute of the McGill University Health Centre
| | - M Nakhla
- Department of Paediatrics, Montreal Children's Hospital, McGill University
- Research Institute of the McGill University Health Centre
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Clement M, Filteau P, Harvey B, Jin S, Laubscher T, Mukerji G, Sherifali D. Organization of Diabetes Care. Can J Diabetes 2018; 42 Suppl 1:S27-S35. [DOI: 10.1016/j.jcjd.2017.10.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Indexed: 02/06/2023]
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23
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Wherrett DK, Ho J, Huot C, Legault L, Nakhla M, Rosolowsky E. Type 1 Diabetes in Children and Adolescents. Can J Diabetes 2018; 42 Suppl 1:S234-S246. [DOI: 10.1016/j.jcjd.2017.10.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Zoni S, Verga ME, Hauschild M, Aquarone-Vaucher MP, Gyuriga T, Ramelet AS, Dwyer AA. Patient Perspectives on Nurse-led Consultations Within a Pilot Structured Transition Program for Young Adults Moving From an Academic Tertiary Setting to Community-based Type 1 Diabetes Care. J Pediatr Nurs 2018; 38:99-105. [PMID: 29357987 DOI: 10.1016/j.pedn.2017.11.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE We aimed to evaluate patient self-management activities, patient perceptions of the therapeutic relationship and satisfaction with nurse-led consultations as part of a structured, pilot program transitioning young adults with type 1 diabetes (T1DM) to adult-oriented community-based practices. DESIGN AND METHODS A descriptive, cross-sectional study of patients receiving nurse-led consultations. Patients provided sociodemographic/health information, glycated hemoglobin (HbA1c) measures and completed questionnaires assessing self-management (Revised Self-Care Inventory) and the therapeutic relationship (Caring Nurse-Patient Interaction - short scale). HbA1c values were compared to guideline recommendations. RESULTS Twenty patients participated. HbA1c was ≤7.5% in 3/14 (21%) and 5/14 (36%) exhibited poor glycemic control (≥9.5%). The greatest concordance for self-care was in relation to insulin therapy (4.5±0.5) while patients reported the lowest adherence to diet recommendations (2.9±0.8). Overall satisfaction with nurse-led consultations was high (4±0.5 out of 5). Patients considered diabetes knowledge and technical competence as very important and were most pleased with the humanistic aspects of nursing care. Respect for privacy was deemed the most important (and most frequently observed) nursing attitude/behavior during consultations. CONCLUSIONS Young adults found the nurse-led consultations with therapeutic education to develop T1DM self-care skills are an important complement to medical management during transition. PRACTICE IMPLICATIONS Patient autonomy and privacy should be respected during this developmental period. Nurses taking a humanistic approach towards accompanying and supporting the patient can enhance the therapeutic relationship during transition and promote continuity of care. Transition nurses can use technical competence and therapeutic education to empower patients for self-management.
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Affiliation(s)
- Sandra Zoni
- University of Lausanne Institute of Higher Education and Research in Healthcare, Lausanne, Switzerland
| | - Marie-Elise Verga
- University of Lausanne Institute of Higher Education and Research in Healthcare, Lausanne, Switzerland; Haute école de santé Fribourg, Fribourg Switzerland
| | - Michael Hauschild
- Centre Hospitalier Universitaire Vaudois (CHUV) Pediatric Endocrinology, Diabetes and Metabolism Service of the Department of Maternal and Child Health, Lausanne, Switzerland
| | - Marie-Paule Aquarone-Vaucher
- Centre Hospitalier Universitaire Vaudois (CHUV) Pediatric Endocrinology, Diabetes and Metabolism Service of the Department of Maternal and Child Health, Lausanne, Switzerland
| | - Teresa Gyuriga
- Centre Hospitalier Universitaire Vaudois (CHUV) Pediatric Endocrinology, Diabetes and Metabolism Service of the Department of Maternal and Child Health, Lausanne, Switzerland
| | - Anne-Sylvie Ramelet
- University of Lausanne Institute of Higher Education and Research in Healthcare, Lausanne, Switzerland; Centre Hospitalier Universitaire Vaudois (CHUV) Department of Maternal and Child Health, Lausanne, Switzerland
| | - Andrew A Dwyer
- University of Lausanne Institute of Higher Education and Research in Healthcare, Lausanne, Switzerland; Centre Hospitalier Universitaire Vaudois (CHUV) Endocrinology, Diabetes and Metabolism Service, Lausanne, Switzerland.
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25
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Potì S, Emiliani F, Palareti L. Subjective Experience of Illness Among Adolescents and Young Adults With Diabetes: A Qualitative Research Study. J Patient Exp 2017; 5:140-146. [PMID: 29978031 PMCID: PMC6022948 DOI: 10.1177/2374373517738234] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Diabetes mellitus type 1 is a chronic illness that has its onset in childhood or adolescence. It is determined by the insufficient production of insulin. The main therapies consist of replacement of the lacking insulin, diet, exercise, and glycemic control. If treatment is managed by parents in childhood, adherence seems to be a difficult issue during adolescence. In order to understand the subjective experience of the illness and treatment, the present study aims to investigate the patients' subjective perspective by addressing a group of adolescents and young adults in pediatric care. A qualitative research design was adopted with semi-structured interviews, and later software thematic analysis was performed. Six core issues were deepened: family and health-care professional's mediation support for self-management, adherence to treatments as a boring responsibility, disclosure problems in peer relationships, difficulty in becoming autonomous in a period of socioeconomic crisis, illness as concern for the future, and seeking a normal life in daily activities. The knowledge can be useful for designing more appropriate interventions that favor the active engagement of patients.
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Affiliation(s)
- Silvia Potì
- Department of Education Studies "Giovanni Maria Bertin," University of Bologna, Bologna, Italy
| | - Francesca Emiliani
- Department of Education Studies "Giovanni Maria Bertin," University of Bologna, Bologna, Italy
| | - Laura Palareti
- Department of Education Studies "Giovanni Maria Bertin," University of Bologna, Bologna, Italy
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Interventions to improve treatment, retention and survival outcomes for adolescents with perinatal HIV-1 transitioning to adult care: moving on up. Curr Opin HIV AIDS 2017; 11:477-486. [PMID: 27272537 DOI: 10.1097/coh.0000000000000302] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW There is an increasing number of deaths among adult survivors of perinatal HIV. Multiple and complex factors drive this mortality, including problems with retention in care and adherence during adolescence, coupled with the critical period of transition from paediatric to adult care, increasing their risk of treatment failure and severe immunosuppression. We reviewed studies that evaluated the impact of service delivery interventions to improve the health of perinatally infected adolescents living with HIV (P-ALHIV) to gain insight into what might help them survive the vulnerable period of adolescence. RECENT FINDINGS Youth-focused health services and individual-level interventions may improve P-ALHIV adherence and retention in care. However, there have been few studies, many with small sample sizes and with short durations of follow-up that end before the transition period. Studies from other childhood-onset chronic diseases are similarly limited. SUMMARY Further studies are urgently needed to identify optimal intervention strategies to reduce mortality and poor outcomes as the adolescent population expands and ages into adult care. Until we have a more robust evidence base, programmes can develop transition plans based on best practice recommendations to optimize the health and longevity of ALHIV in adulthood.
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20 Things You Didn’t Know About Type 2 Diabetes in Emerging Adults. J Cardiovasc Nurs 2017; 32:317-320. [DOI: 10.1097/jcn.0000000000000385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- Cecily L Betz
- Research Director, Director of Nursing Training, USC University Center for Excellence in Developmental Disabilities, Children's Hospital Los Angeles; Professor of Clinical Pediatrics, Department of Pediatrics, Keck School of Medicine, University of Southern California.
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Acuña Mora M, Moons P, Sparud-Lundin C, Bratt EL, Goossens E. Assessing the level of evidence on transfer and transition in young people with chronic conditions: protocol of a scoping review. Syst Rev 2016; 5:166. [PMID: 27686735 PMCID: PMC5043611 DOI: 10.1186/s13643-016-0344-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 09/17/2016] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Life-long specialized care is of the utmost importance to safeguard longevity as well as the quality of life in children diagnosed with a chronic condition (CC). Provision of life-long care, however, infers transfers to different settings in line with person's development status. Young people with CC (10-25 years) will transfer care from a pediatric towards an adult-oriented care setting. As a transfer of care is associated with a change of care context, healthcare team, responsibilities, expectations, and roles, patients need to be prepared for this alteration. One type of preparatory intervention is the provision of transitional care. Transition prepares adolescents for the responsibilities associated with adult care and age through support, education, skills demonstration, and guidance. The past decades, increasing attention has been paid towards the concept of transfer and transition, both in clinical practice and research. Numerous consensus papers have been established, emphasizing the need for the establishment of a transition program for young patients with CC. To date, it remains, however, unclear what the overall level of evidence is on transfer and transition in this population. This scoping review aims to analyze and determine the level of evidence of published literature on transfer and transition of young people diagnosed with CC. METHOD MEDLINE, CINAHL, Scopus, and Web of Science databases will be searched for relevant publications. Any publication in English, Spanish, German, or French, related to transfer and/or transition in young people with CC will be included. A three-staged approach will identify relevant papers, comprising systematic database searches, application of snowball method, and citation searching. Study selection will be performed through screening of titles/abstracts followed by a full-text assessment using a standardized selection form. Data extraction will be performed by two reviewers independently using a pilot-tested, standardized form. Descriptive statistics and content analysis will be applied to present the results. Bibliometric visualization techniques will be performed with VOS viewer®. DISCUSSION Our review will map the overall level of evidence of published literature on transfer and transition in young people with CC. It will provide guidance for future research initiatives, clinical practice, and policy makers.
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Affiliation(s)
- Mariela Acuña Mora
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, Gothenburg, SE-405 30, Sweden.,Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35, box 7001, 3000, Leuven, Belgium
| | - Philip Moons
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, Gothenburg, SE-405 30, Sweden.,Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35, box 7001, 3000, Leuven, Belgium
| | - Carina Sparud-Lundin
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, Gothenburg, SE-405 30, Sweden
| | - Ewa-Lena Bratt
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, Gothenburg, SE-405 30, Sweden.,Department of Pediatric Cardiology, The Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Eva Goossens
- Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35, box 7001, 3000, Leuven, Belgium. .,Research Foundation Flanders (FWO), Brussels, Belgium.
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Monaghan M, Baumann K. Type 1 diabetes: addressing the transition from pediatric to adult-oriented health care. RESEARCH AND REPORTS IN ENDOCRINE DISORDERS 2016; 6:31-40. [PMID: 27812509 PMCID: PMC5087810 DOI: 10.2147/rred.s56609] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Adolescents and young adults with type 1 diabetes are at risk for poor health outcomes, including poor glycemic control, acute and chronic complications, and emergency department admissions. During this developmental period, adolescent and young adult patients also experience significant changes in living situation, education, and/or health care delivery, including transferring from pediatric to adult health care. In recent years, professional and advocacy organizations have proposed expert guidelines to improve the process of preparation for and transition to adult-oriented health care. However, challenges remain and evidence-based practices for preparing youth for adult health care are still emerging. Qualitative research suggests that adolescent and young adult patients rely on health care providers to guide them through the transition process and appreciate a gradual approach to preparing for adult-oriented health care, keeping parents in supportive roles into young adulthood. Patients also benefit from specific referrals and contact information for adult care providers. Promising models of transition care include provision of transition navigators, attendance at a young adult bridge clinic, or joint visits with pediatric and adult care providers. However, much of this research is in its early stages, and more rigorous trials need to be conducted to evaluate health outcomes during transition into adult health care. The purpose of this review is to provide an overview of the transition process, patient and health care provider perceptions of transition care, and emerging evidence of successful models of care for engagement in adult-oriented health care. Recommendations and resources for health care providers are also presented.
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Affiliation(s)
- Maureen Monaghan
- Center for Translational Science, Children's National Health System
- George Washington University School of Medicine, Washington, DC, USA
| | - Katherine Baumann
- George Washington University School of Medicine, Washington, DC, USA
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