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Lalji R, Koh L, Francis A, Khalid R, Guha C, Johnson DW, Wong G. Patient navigator programmes for children and adolescents with chronic diseases. Cochrane Database Syst Rev 2024; 10:CD014688. [PMID: 39382077 PMCID: PMC11462635 DOI: 10.1002/14651858.cd014688.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2024]
Abstract
BACKGROUND Despite a substantial global improvement in infant and child mortality from communicable diseases since the early 1990s there is now a growing burden of chronic disease in children and adolescents worldwide, mimicking the trend seen in the adult population. Chronic diseases in children and adolescents can affect all aspects of their well-being and function with these burdens and their health-related consequences often carried into adulthood. Up to one third of disability-adjusted life years for children and adolescents globally are a result of chronic disease. This has profound implications for the broader family unit, communities, and health systems in which these children and young people reside. Models of chronic care delivery for children and adolescents with chronic disease have traditionally been adapted from adult models. There is a growing recognition that children and adolescents with chronic diseases have a unique set of healthcare needs. Their needs extend beyond disease education and management appropriate to the developmental stage of the child, to encompass psychological well-being for the entire family and a holistic care approach focusing on the social determinants of health. It is for this reason that patient navigators have been proposed as a potential intervention to help fulfil this critical healthcare gap. Patient navigators are trained medical or non-medical personnel (e.g. lay health workers, community health workers, nurses, or people with lived experience) who provide guidance for the patients (and their primary caregivers) as they move through complex (and often bewildering) medical and social systems. The navigator may deliver education, help to co-ordinate patient care, be an advocate for the patient (and their primary caregivers), or combinations of these. Patient navigators can assist people with a chronic illness (especially those who are vulnerable or from a marginalised population, or both) to better understand their diagnoses, treatment options, and available resources. As there is considerable variation in the purpose, design, and target population of patient navigator programmes, there is a need to systematically review and summarise the existing literature on the effectiveness of navigator programmes in children and young adults with chronic disease. OBJECTIVES To assess the effectiveness of patient navigator programmes in children and adolescents with chronic diseases. SEARCH METHODS We searched the Cochrane Library and Epistemonikos up to 20 January 2023 for related systematic reviews using search terms relevant to this review. We searched CENTRAL, MEDLINE, Embase, CINAHL EBSCO, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal, and ClinicalTrials.gov for primary studies. SELECTION CRITERIA We included randomised controlled trials reporting the effect of patient navigator interventions on children and adolescents (aged 18 years or younger) with any chronic disease in hospital or community settings. Two review authors independently assessed the retrieved titles and abstracts, and where necessary, the full text to identify studies that satisfied the inclusion criteria. DATA COLLECTION AND ANALYSIS Two review authors extracted data using a standard data extraction form. We used a random-effects model to perform a quantitative synthesis of the data. We used the I² statistic to measure heterogeneity amongst the studies in each analysis. We indicated summary estimates as mean differences (MD), where studies used the same scale, or standardised mean differences (SMD), where studies used different scales, with 95% confidence intervals (CI). We used subgroup and univariate meta-regression to assess reasons for between-study differences. We used the Cochrane RoB 1 tool to assess the methodological quality of the included studies. We used GRADE to assess the certainty of the evidence. MAIN RESULTS We included 17 studies (2895 randomised participants). All studies compared patient navigators with standard care. Most studies were at unclear or high risk of bias. Meta-analysis was undertaken only for those studies that had the same duration of patient navigator intervention and follow-up/reporting of outcome measures. The evidence is very uncertain about the effects of patient navigator programmes compared with standard care on self-reported quality of life of children with chronic illness (SMD 0.63, 95% CI -0.20 to 1.47; I2 = 96%; 4 studies, 671 participants; very low-certainty evidence); parent proxy-reported quality of life (SMD 0.09, 95% CI -2.21 to 2.40; I2 = 99%; 2 studies, 309 participants; very low-certainty evidence); or parents' or caregivers' quality of life (SMD -1.98, 95% CI -4.13 to 0.17; I2 = 99%; 3 studies, 757 participants; very low-certainty evidence). It is uncertain whether duration of patient navigator intervention accounts for any of the variances in the changes in quality of life. The evidence is very uncertain about the effects of patient navigator programmes compared with standard care on the number of hospital admissions (MD -0.05, 95% CI -0.34 to 0.23; I2 = 99%; 2 studies, 381 participants; very low-certainty evidence) and the number of presentations to the emergency department (MD 0.06, 95% CI -0.23 to 0.34; I2 = 98%; 2 studies, 381 participants; very low-certainty evidence). Furthermore, it is unclear whether patient navigator programmes reduce the number of missed school days as data were sparse (2 studies, 301 participants). Four studies (629 participants) reported data on resource use. However, given the variation in units of analysis used, meta-analysis was not possible (very low-certainty evidence). All studies reported cost savings or quality-adjusted life year improvement (or both) in the patient navigation arm. No studies reported on adverse events (specifically, abuse of any type against the navigator, the patient, or their family members). AUTHORS' CONCLUSIONS There is insufficient evidence at present to support the use of patient navigator programmes for children and adolescents with chronic diseases. The current evidence is based on limited data with very low-certainty evidence. Further studies are likely to significantly change these results.
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Affiliation(s)
- Rowena Lalji
- The Centre for Kidney Research, The University of Queensland, Brisbane, Australia
- Metro South Kidney and Transplant Services, Princess Alexandra Hospital, Woolloongabba, Australia
- Queensland Children and Adolescent Renal Service (QCARS), Queensland Children's Hospital, Brisbane, Australia
| | - Lee Koh
- Department of Paediatric Nephrology, Starship Children's Hospital, Auckland, New Zealand
| | - Anna Francis
- The Centre for Kidney Research, The University of Queensland, Brisbane, Australia
- Metro South Kidney and Transplant Services, Princess Alexandra Hospital, Woolloongabba, Australia
- Queensland Children and Adolescent Renal Service (QCARS), Queensland Children's Hospital, Brisbane, Australia
| | - Rabia Khalid
- School of Public Health, The University of Sydney, Sydney, Australia
| | - Chandana Guha
- School of Public Health, The University of Sydney, Sydney, Australia
| | - David W Johnson
- Metro South Kidney and Transplant Services, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Germaine Wong
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
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Graziani V, Suprani T, Di Bartolo P, Marchetti F. From pediatric to adult care: a survey on the transition process in type 1 diabetes mellitus and the diabetes services in Italy. Acta Diabetol 2024; 61:1069-1076. [PMID: 38700547 DOI: 10.1007/s00592-024-02268-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/24/2024] [Indexed: 08/17/2024]
Abstract
AIMS The present study assessed the transitioning process of young adults with type 1 diabetes mellitus (T1D) in Italy. MATERIALS AND METHODS We asked Pediatric Diabetes Centers (PDC) and Adult Diabetes Centers (CAD) to fill in a web-based survey on the current state of services, the number of transitioning adolescents with T1D within the last year, observations on limitations, and future directions. RESULTS 93 centers (46 PDCs, 47 CADs) joined the study. The total number of subjects with T1D being followed by a PDC was 16,261 (13,779 minors and 2483 young adults), while CADs had 25,500 patients. The survey showed an uneven situation. Only some services had a dedicated diabetes team (78% of PDCs, 64% of CADs). 72% of PDCs and 58% of CADs reported a protocol dedicated to transition. The median age for transition was 19 (range 16-25 years); the time required for preparing transition, indicated by both PDCs and CADs, was 5.5 months. A high percentage of CADs (80%) confirmed receiving sufficient clinical information, mainly through paper or computerized reports. The transition process is hampered by a lack of resources, logistical facilities, and communication between services. While some services have a protocol, monitoring of results is only carried out in a few cases. Most specialists expressed the need to enhance integration and continuity of treatment. CONCLUSIONS The current situation could be improved. Applying standard guidelines, taking into consideration both clinicians' and patients' necessities, would lead to a more successful transition process.
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Affiliation(s)
- Vanna Graziani
- Department of Pediatrics, Romagna Local Health Authority, Santa Maria delle Croci Hospital, Viale Randi 5, AUSL della Romagna, Ravenna, Italy.
| | - Tosca Suprani
- Department of Pediatrics, Romagna Local Health Authority, Santa Maria delle Croci Hospital, Viale Randi 5, AUSL della Romagna, Ravenna, Italy
| | - Paolo Di Bartolo
- Diabetes Clinic, Romagna Local Health Authority, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Federico Marchetti
- Department of Pediatrics, Romagna Local Health Authority, Santa Maria delle Croci Hospital, Viale Randi 5, AUSL della Romagna, Ravenna, Italy
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Demirok A, Benninga MA, Diamanti A, El Khatib M, Guz-Mark A, Hilberath J, Lambe C, Norsa L, Pironi L, Sanchez AA, Serlie M, Tabbers MM. Transition from pediatric to adult care in patients with chronic intestinal failure on home parenteral nutrition: How to do it right? Clin Nutr 2024; 43:1844-1851. [PMID: 38959661 DOI: 10.1016/j.clnu.2024.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/30/2024] [Accepted: 06/14/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Life expectancy of children with chronic intestinal failure (CIF) on home parenteral nutrition has greatly improved. Children are now able to grow into adulthood which requires transfer from pediatric to adult health care. A guideline for structured transition is lacking and the demand for a more standardized care for this patient group is necessary. Therefore, we investigated the perceptions of health care professionals from various disciplines working in this specific field, concerning effective interventions regarding transition to adult health care. AIM To create a standardized protocol which provides practical guidance for health care professionals in order to bridge the gap between pediatric and adult health care and to facilitate successful transition of children with chronic intestinal failure. METHODS A survey consisting of 20 interventions for transition was sent out to members of the Intestinal Failure working group of European Reference Network for Rare Inherited Congenital (gastrointestinal and digestive) Anomalies (ERNICA) and the Network of Intestinal Failure and Intestinal Transplant in Europe (NITE) group - European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) healthcare professionals in 48 medical centers in various countries. Next to 20 interventions, an open-ended question to fill in any other suggestion with respect to most effective intervention was included. Interventions scoring higher than 80% by the participants were included in the protocol. Interventions scoring between 50% and 80% and other own suggestions were discussed during a consensus meeting and included when consensus, defined as unanimous agreement, was reached. Interventions scoring as effective by < 50% of participants were excluded directly. RESULTS A total of 80 healthcare professionals from 33 medical centers (participation rate 69%) participated. The protocol consisted of modifiable components expected to be targets of interventions. The most important key outcomes of the survey were: 1) assessment of patient's transition readiness and provision of knowledge to the patient by the pediatric team, 2) involvement of parents in the transition process, and 3) collaboration between the pediatric and adult chronic intestinal failure team. In addition it is advised that the transition process should start 1-2 years before transfer. A nurse specialist working in both services should form a bridge. All interventions must be tailor-made and based on the maturity of the patient. CONCLUSION This study provides a protocol describing transition of children with chronic intestinal failure from pediatric to adult care. This international protocol will serve as practical guidance for pediatric chronic intestinal failure which will provide a more structured, optimal transition process. It is advised to use this protocol as a formal checklist that can be placed in the patient's chart to review and track the transition process by CIF team members. Future research investigating transition readiness of CIF patients is needed.
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Affiliation(s)
- Aysenur Demirok
- Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
| | - Marc A Benninga
- Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Myriam El Khatib
- Department of Gastroenterology and Nutrition Support, APHP Beaujon Hospital, Clichy, France
| | - Anat Guz-Mark
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva, Israel and Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Johannes Hilberath
- Paediatric Gastroenterology and Hepatology, University Children's Hospital Tübingen, Tübingen, Germany
| | - Cécile Lambe
- Department of Pediatric Gastroenterology-Hepatology-Nutrition, Hôpital Necker-Enfants Malades, Université Paris Descartes, Paris, France
| | - Lorenzo Norsa
- Department of Pediatric Hepatology, Gastroenterology and Transplantation, ASST Papa Giovanni XXIIII, Bergamo, Italy
| | - Loris Pironi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy and Centre for Chronic Intestinal Failure, Bologna, Italy; Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy
| | - Alida A Sanchez
- Pediatric Gastroenterology, Intestinal Rehabilitation Unit, La Paz University Hospital, Madrid, Spain
| | - Mireille Serlie
- Department of Endocrinology and Metabolism, Laboratory of Endocrinology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Merit M Tabbers
- Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Reproduction and Development and Amsterdam Gastroenterology Endocrinology Metabolism Research Institutes, Amsterdam, the Netherlands
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Zenno A, Huang A, Roberts AJ, Pihoker C. Health-Care Utilization and Outcomes in Young Adults With Type 1 and Type 2 Diabetes. J Endocr Soc 2024; 8:bvae115. [PMID: 38939833 PMCID: PMC11210301 DOI: 10.1210/jendso/bvae115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Indexed: 06/29/2024] Open
Abstract
Young adulthood can be a challenging time for individuals with diabetes mellitus (DM) as they experience increasing independence and life transitions, which can make it difficult to engage in DM self care. Compared to older adults, young adults are more likely to have higher glycated hemoglobin A1c (HbA1c). They also often have lower adherence to standards of care in DM, and higher utilization of emergency department (ED) visits and hospitalizations for diabetic ketoacidosis. This review describes health-care utilization and explores factors that may contribute to high HbA1c among young adults with DM. In addition, it discusses the unique health-care needs of young adults with DM, examines the role of technology in their DM care, and analyzes the effects of social determinants of health on their health-care utilization.
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Affiliation(s)
- Anna Zenno
- Department of Pediatrics, University of Washington, Seattle, WA 98105, USA
- Department of Medicine, University of Washington, Seattle, WA 98105, USA
| | - Alyssa Huang
- Department of Pediatrics, University of Washington, Seattle, WA 98105, USA
| | - Alissa J Roberts
- Department of Pediatrics, University of Washington, Seattle, WA 98105, USA
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington, Seattle, WA 98105, USA
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Berot A, Morsa M, De Andrade V, Gagnayre R, Bihan H. Lack of consideration of socioeconomic factors in transition programme of adolescents with type 1 diabetes: A systematic review. Diabet Med 2024; 41:e15225. [PMID: 37714193 DOI: 10.1111/dme.15225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/05/2023] [Accepted: 09/10/2023] [Indexed: 09/17/2023]
Abstract
The transition of adolescents with type 1 diabetes should be organized such that loss of follow-up and deterioration of patients' metabolic control are minimized. OBJECTIVE Our study aimed to ascertain whether socioeconomic status is featured in the characteristics of adolescents with type 1 diabetes in transition programmes and their inclusion in transition programmes. RESEARCH DESIGN AND METHODS A systematic review of the literature was performed according to PRISMA recommendations. All articles published between 2010 and 2023 were considered. Studies that described a transition programme for adolescents or young adults with T1DM were included. RESULTS After screening, 18 studies were included. Different transition programmes were proposed (exchanges between professionals, coordinators, and transition clinics). Nine articles described socio-economic factors. The educational level was the most frequently reported. Only three studies evaluated the impact of one parameter on transition success: a lower education level was associated with more hospital visits for hyperglycaemia, and the other did not report any socioeconomic factor associated with clinic attendance. CONCLUSIONS The socioeconomic status of type 1 diabetes is poorly described in transition programmes, and the few that do make mention of it, offer little information about patient management.
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Affiliation(s)
- Aurelie Berot
- CHU Reims - American Memorial Hospital - Pediatrics, Reims, France
- University Sorbonne Paris Nord, Laboratoire Éducations et Promotion de la Santé, LEPS, Villetaneuse, France
| | - Maxime Morsa
- University Sorbonne Paris Nord, Laboratoire Éducations et Promotion de la Santé, LEPS, Villetaneuse, France
| | - Vincent De Andrade
- University Sorbonne Paris Nord, Laboratoire Éducations et Promotion de la Santé, LEPS, Villetaneuse, France
| | - Remi Gagnayre
- University Sorbonne Paris Nord, Laboratoire Éducations et Promotion de la Santé, LEPS, Villetaneuse, France
| | - Hélène Bihan
- University Sorbonne Paris Nord, Laboratoire Éducations et Promotion de la Santé, LEPS, Villetaneuse, France
- Endocrinology, Diabetology, Nutrition, Avicenne Hospital, APHP, Bobigny, France
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ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 14. Children and Adolescents: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S258-S281. [PMID: 38078582 PMCID: PMC10725814 DOI: 10.2337/dc24-s014] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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West M, Sidhaye A, Thivierge M, Wolf RM. Development and implementation of a workshop for young adults with diabetes entering college and the workforce. Front Endocrinol (Lausanne) 2023; 14:1288215. [PMID: 37886638 PMCID: PMC10598457 DOI: 10.3389/fendo.2023.1288215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/14/2023] [Indexed: 10/28/2023] Open
Abstract
The process of transitioning from pediatric to adult diabetes care for adolescents and young adults is challenging. This transition period may include many life changes, and can be fraught with worsening glycemic control leading to increased risk for diabetes-related hospitalizations and complications. Research has demonstrated that increased support during this period can help maintain engagement in diabetes care. Transition guidelines highlight the importance of preparation and readiness for transition. In this article, we discuss the development, implementation and content of a workshop for patients and parents/caregivers preparing for the transition to college, the workforce and adult diabetes care.
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Affiliation(s)
- Margaret West
- Department of Pediatrics, Division of Endocrinology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Aniket Sidhaye
- Department of Medicine, Division of Endocrinology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Meredith Thivierge
- Center for Diabetes and Endocrinology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Risa M. Wolf
- Department of Pediatrics, Division of Endocrinology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Konnyu KJ, Yogasingam S, Lépine J, Sullivan K, Alabousi M, Edwards A, Hillmer M, Karunananthan S, Lavis JN, Linklater S, Manns BJ, Moher D, Mortazhejri S, Nazarali S, Paprica PA, Ramsay T, Ryan PM, Sargious P, Shojania KG, Straus SE, Tonelli M, Tricco A, Vachon B, Yu CH, Zahradnik M, Trikalinos TA, Grimshaw JM, Ivers N. Quality improvement strategies for diabetes care: Effects on outcomes for adults living with diabetes. Cochrane Database Syst Rev 2023; 5:CD014513. [PMID: 37254718 PMCID: PMC10233616 DOI: 10.1002/14651858.cd014513] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND There is a large body of evidence evaluating quality improvement (QI) programmes to improve care for adults living with diabetes. These programmes are often comprised of multiple QI strategies, which may be implemented in various combinations. Decision-makers planning to implement or evaluate a new QI programme, or both, need reliable evidence on the relative effectiveness of different QI strategies (individually and in combination) for different patient populations. OBJECTIVES To update existing systematic reviews of diabetes QI programmes and apply novel meta-analytical techniques to estimate the effectiveness of QI strategies (individually and in combination) on diabetes quality of care. SEARCH METHODS We searched databases (CENTRAL, MEDLINE, Embase and CINAHL) and trials registers (ClinicalTrials.gov and WHO ICTRP) to 4 June 2019. We conducted a top-up search to 23 September 2021; we screened these search results and 42 studies meeting our eligibility criteria are available in the awaiting classification section. SELECTION CRITERIA We included randomised trials that assessed a QI programme to improve care in outpatient settings for people living with diabetes. QI programmes needed to evaluate at least one system- or provider-targeted QI strategy alone or in combination with a patient-targeted strategy. - System-targeted: case management (CM); team changes (TC); electronic patient registry (EPR); facilitated relay of clinical information (FR); continuous quality improvement (CQI). - Provider-targeted: audit and feedback (AF); clinician education (CE); clinician reminders (CR); financial incentives (FI). - Patient-targeted: patient education (PE); promotion of self-management (PSM); patient reminders (PR). Patient-targeted QI strategies needed to occur with a minimum of one provider or system-targeted strategy. DATA COLLECTION AND ANALYSIS We dual-screened search results and abstracted data on study design, study population and QI strategies. We assessed the impact of the programmes on 13 measures of diabetes care, including: glycaemic control (e.g. mean glycated haemoglobin (HbA1c)); cardiovascular risk factor management (e.g. mean systolic blood pressure (SBP), low-density lipoprotein cholesterol (LDL-C), proportion of people living with diabetes that quit smoking or receiving cardiovascular medications); and screening/prevention of microvascular complications (e.g. proportion of patients receiving retinopathy or foot screening); and harms (e.g. proportion of patients experiencing adverse hypoglycaemia or hyperglycaemia). We modelled the association of each QI strategy with outcomes using a series of hierarchical multivariable meta-regression models in a Bayesian framework. The previous version of this review identified that different strategies were more or less effective depending on baseline levels of outcomes. To explore this further, we extended the main additive model for continuous outcomes (HbA1c, SBP and LDL-C) to include an interaction term between each strategy and average baseline risk for each study (baseline thresholds were based on a data-driven approach; we used the median of all baseline values reported in the trials). Based on model diagnostics, the baseline interaction models for HbA1c, SBP and LDL-C performed better than the main model and are therefore presented as the primary analyses for these outcomes. Based on the model results, we qualitatively ordered each QI strategy within three tiers (Top, Middle, Bottom) based on its magnitude of effect relative to the other QI strategies, where 'Top' indicates that the QI strategy was likely one of the most effective strategies for that specific outcome. Secondary analyses explored the sensitivity of results to choices in model specification and priors. Additional information about the methods and results of the review are available as Appendices in an online repository. This review will be maintained as a living systematic review; we will update our syntheses as more data become available. MAIN RESULTS We identified 553 trials (428 patient-randomised and 125 cluster-randomised trials), including a total of 412,161 participants. Of the included studies, 66% involved people living with type 2 diabetes only. Participants were 50% female and the median age of participants was 58.4 years. The mean duration of follow-up was 12.5 months. HbA1c was the commonest reported outcome; screening outcomes and outcomes related to cardiovascular medications, smoking and harms were reported infrequently. The most frequently evaluated QI strategies across all study arms were PE, PSM and CM, while the least frequently evaluated QI strategies included AF, FI and CQI. Our confidence in the evidence is limited due to a lack of information on how studies were conducted. Four QI strategies (CM, TC, PE, PSM) were consistently identified as 'Top' across the majority of outcomes. All QI strategies were ranked as 'Top' for at least one key outcome. The majority of effects of individual QI strategies were modest, but when used in combination could result in meaningful population-level improvements across the majority of outcomes. The median number of QI strategies in multicomponent QI programmes was three. Combinations of the three most effective QI strategies were estimated to lead to the below effects: - PR + PSM + CE: decrease in HbA1c by 0.41% (credibility interval (CrI) -0.61 to -0.22) when baseline HbA1c < 8.3%; - CM + PE + EPR: decrease in HbA1c by 0.62% (CrI -0.84 to -0.39) when baseline HbA1c > 8.3%; - PE + TC + PSM: reduction in SBP by 2.14 mmHg (CrI -3.80 to -0.52) when baseline SBP < 136 mmHg; - CM + TC + PSM: reduction in SBP by 4.39 mmHg (CrI -6.20 to -2.56) when baseline SBP > 136 mmHg; - TC + PE + CM: LDL-C lowering of 5.73 mg/dL (CrI -7.93 to -3.61) when baseline LDL < 107 mg/dL; - TC + CM + CR: LDL-C lowering by 5.52 mg/dL (CrI -9.24 to -1.89) when baseline LDL > 107 mg/dL. Assuming a baseline screening rate of 50%, the three most effective QI strategies were estimated to lead to an absolute improvement of 33% in retinopathy screening (PE + PR + TC) and 38% absolute increase in foot screening (PE + TC + Other). AUTHORS' CONCLUSIONS There is a significant body of evidence about QI programmes to improve the management of diabetes. Multicomponent QI programmes for diabetes care (comprised of effective QI strategies) may achieve meaningful population-level improvements across the majority of outcomes. For health system decision-makers, the evidence summarised in this review can be used to identify strategies to include in QI programmes. For researchers, this synthesis identifies higher-priority QI strategies to examine in further research regarding how to optimise their evaluation and effects. We will maintain this as a living systematic review.
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Affiliation(s)
- Kristin J Konnyu
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Sharlini Yogasingam
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Johanie Lépine
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Katrina Sullivan
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Alun Edwards
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Michael Hillmer
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Sathya Karunananthan
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - John N Lavis
- McMaster Health Forum, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Stefanie Linklater
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Braden J Manns
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Canada
| | - David Moher
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Sameh Mortazhejri
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Samir Nazarali
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Canada
| | - P Alison Paprica
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Timothy Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Peter Sargious
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Kaveh G Shojania
- University of Toronto Centre for Patient Safety, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital and University of Toronto, Toronto, Canada
| | - Marcello Tonelli
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Canada
| | - Andrea Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital and University of Toronto, Toronto, Canada
- Epidemiology Division and Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Queen's University, Kingston, Canada
| | - Brigitte Vachon
- School of Rehabilitation, Occupational Therapy Program, University of Montreal, Montreal, Canada
| | - Catherine Hy Yu
- Department of Medicine, St. Michael's Hospital, Toronto, Canada
| | - Michael Zahradnik
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Thomas A Trikalinos
- Departments of Health Services, Policy, and Practice and Biostatistics, Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Noah Ivers
- Department of Family and Community Medicine, Women's College Hospital, Toronto, Canada
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9
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Grasemann C, Höppner J, Burgard P, Schündeln MM, Matar N, Müller G, Krude H, Berner R, Lee-Kirsch MA, Hauck F, Wainwright K, Baumgarten S, Atinga J, Bauer JJ, Manka E, Körholz J, Kiewert C, Heinen A, Kretschmer T, Kurth T, Mittnacht J, Schramm C, Klein C, Graessner H, Hiort O, Muntau AC, Grüters A, Hoffmann GF, Choukair D. Transition for adolescents with a rare disease: results of a nationwide German project. Orphanet J Rare Dis 2023; 18:93. [PMID: 37098531 PMCID: PMC10131406 DOI: 10.1186/s13023-023-02698-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 04/06/2023] [Indexed: 04/27/2023] Open
Abstract
PURPOSE The transition process from paediatric/adolescent to adult medical care settings is of utmost importance for the future health of adolescents with chronic diseases and poses even more difficulties in the context of rare diseases (RDs). Paediatric care teams are challenged to deliver adolescent-appropriate information and structures. Here we present a structured transition pathway which is patient-focused and adoptable for different RDs. METHODS The transition pathway for adolescents 16 years and older was developed and implemented as part of a multi-centre study in 10 university hospitals in Germany. Key elements of the pathway included: assessment of patients' disease-related knowledge and needs, training/educational and counselling sessions, a structured epicrisis and a transfer appointment jointly with the paediatric and adult specialist. Specific care coordinators from the participating university hospitals were in charge of organization and coordination of the transition process. RESULTS Of a total of 292 patients, 286 completed the pathway. Deficits in disease-specific knowledge were present in more than 90% of participants. A need for genetic or socio-legal counselling was indicated by > 60%. A mean of 2.1 training sessions per patient were provided over a period of almost 1 year, followed by the transfer to adult care in 267 cases. Twelve patients remained in paediatric care as no adult health care specialist could be identified. Targeted training and counselling resulted in improved disease-specific knowledge and contributed to empowering of patients. CONCLUSION The described transition pathway succeeds to improve health literacy in adolescents with RDs and can be implemented by paediatric care teams in any RD specialty. Patient empowerment was mainly achieved by individualized training and counselling.
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Affiliation(s)
- Corinna Grasemann
- Division of Rare Diseases, Department of Paediatrics, St. Josef-Hospital Bochum, Ruhr-University Bochum, Alexandrinenstraße 5, 44791, Bochum, Germany.
- Centre for Rare Diseases Ruhr CeSER, Ruhr-University Bochum and Witten/Herdecke University, Bochum, Germany.
| | - Jakob Höppner
- Division of Rare Diseases, Department of Paediatrics, St. Josef-Hospital Bochum, Ruhr-University Bochum, Alexandrinenstraße 5, 44791, Bochum, Germany
| | - Peter Burgard
- Centre for Child and Adolescent Medicine and and Centre for Rare Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Michael M Schündeln
- Department of Paediatrics III, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Nora Matar
- Division of Rare Diseases, Department of Paediatrics, St. Josef-Hospital Bochum, Ruhr-University Bochum, Alexandrinenstraße 5, 44791, Bochum, Germany
- Centre for Rare Diseases Ruhr CeSER, Ruhr-University Bochum and Witten/Herdecke University, Bochum, Germany
| | - Gabriele Müller
- Centre for Evidence-Based Healthcare, Carl Gustav Carus Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Heiko Krude
- Institute for Experimental Paediatric Endocrinology and Centre for Rare Diseases, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Reinhard Berner
- Children's Department and University Centre for Rare Diseases (USE), University Hospital Dresden, Dresden, Germany
| | - Min Ae Lee-Kirsch
- Children's Department and University Centre for Rare Diseases (USE), University Hospital Dresden, Dresden, Germany
| | - Fabian Hauck
- Dr von Hauner Children's Hospital, University Hospital and Munich Centre for Rare Diseases (M-ZSELMU), Ludwig-Maximilians-University Munich, Munich, Germany
| | - Kerstin Wainwright
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sylvana Baumgarten
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Janet Atinga
- Division of Rare Diseases, Department of Paediatrics, St. Josef-Hospital Bochum, Ruhr-University Bochum, Alexandrinenstraße 5, 44791, Bochum, Germany
- Centre for Rare Diseases Ruhr CeSER, Ruhr-University Bochum and Witten/Herdecke University, Bochum, Germany
| | - Jens J Bauer
- Division of Rare Diseases, Department of Paediatrics, St. Josef-Hospital Bochum, Ruhr-University Bochum, Alexandrinenstraße 5, 44791, Bochum, Germany
- Centre for Rare Diseases Ruhr CeSER, Ruhr-University Bochum and Witten/Herdecke University, Bochum, Germany
| | - Eva Manka
- Department of Paediatrics II and Essener Centre for Rare Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Julia Körholz
- Children's Department and University Centre for Rare Diseases (USE), University Hospital Dresden, Dresden, Germany
| | - Cordula Kiewert
- Department of Paediatrics II and Essener Centre for Rare Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - André Heinen
- Children's Department and University Centre for Rare Diseases (USE), University Hospital Dresden, Dresden, Germany
| | - Tanita Kretschmer
- Children's Department and University Centre for Rare Diseases (USE), University Hospital Dresden, Dresden, Germany
| | - Tobias Kurth
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Janna Mittnacht
- Centre for Child and Adolescent Medicine and and Centre for Rare Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Christoph Schramm
- Martin Zeitz Centre for Rare Diseases, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Klein
- Dr von Hauner Children's Hospital, University Hospital and Munich Centre for Rare Diseases (M-ZSELMU), Ludwig-Maximilians-University Munich, Munich, Germany
| | - Holm Graessner
- Institute for Medical Genetics and Applied Genomics, University of Tuebingen, Tübingen, Germany
| | - Olaf Hiort
- Departments of Paediatrics, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Ania C Muntau
- University Children's Hospital, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Annette Grüters
- Institute for Experimental Paediatric Endocrinology and Centre for Rare Diseases, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Georg F Hoffmann
- Centre for Child and Adolescent Medicine and and Centre for Rare Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Daniela Choukair
- Centre for Child and Adolescent Medicine and and Centre for Rare Diseases, University Hospital Heidelberg, Heidelberg, Germany
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10
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Hornung RJ, Reed PW, Gunn AJ, Albert B, Hofman PL, Farrant B, Jefferies C. Transition from paediatric to adult care in young people with diabetes; A structured programme from a regional diabetes service, Auckland, New Zealand. Diabet Med 2023; 40:e15011. [PMID: 36398457 DOI: 10.1111/dme.15011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 10/26/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022]
Abstract
AIM To assess participation with a structured transition programme for adolescents with diabetes. METHODS Data from a regional cohort aged less than 16 years of age with type 1 (T1) and type 2 diabetes (T2D) in Auckland, New Zealand (2006-2016). Participation was defined as opting into a structured transition programme. RESULTS Five hundrend and twelve adolescents who were to be transferred to adult care (476 type 1 (T1D) and 36 type 2 (T2D)), overall participation rate of 83%, 86% (408/476) with T1D compared to 47% (17/36) with T2D. Within the cohort of T1D, participation rates for Māori and Pacific were lower (74% and 77%, respectively) than New Zealand Europeans (88%, p = 0.020 and p = 0.039, respectively). Lower socio-economic status was associated with reduced participation (77%) compared to higher socio-economic status (90%, p = 0.002). Of the 476 T1D who participated, 408 (96%) subsequently attended at least one adult service clinic ("capture"). 42% attended an adult clinic within the planned 3 months, 87% at 6 months and retention in adult clinics over 5 years of follow-up was 78%. By contrast, the 68 young people with T1D who did not participate in the structured transition had a capture rate of 78% (p < 0.001) and retention of 63% (p = 0.036). CONCLUSIONS In adolescents with diabetes, a formal transition from a paediatric service was associated with high rates of adult capture and subsequent retention in adult care over a 5-year follow-up period. Low socio-economic status, Māori or Pacific ethnicity and T2D were associated with reduced participation in the structured transition programme.
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Affiliation(s)
- Rosalie J Hornung
- Starship Children's Health, Paediatric Diabetes and Endocrinology Service, Auckland District Health Board, Auckland, New Zealand
| | - Peter W Reed
- Starship Children's Health Children's Research Centre, Auckland District Health Board, Auckland, New Zealand
| | - Alistair J Gunn
- Starship Children's Health, Paediatric Diabetes and Endocrinology Service, Auckland District Health Board, Auckland, New Zealand
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Ben Albert
- Starship Children's Health, Paediatric Diabetes and Endocrinology Service, Auckland District Health Board, Auckland, New Zealand
| | - Paul L Hofman
- Starship Children's Health, Paediatric Diabetes and Endocrinology Service, Auckland District Health Board, Auckland, New Zealand
- The Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Bridget Farrant
- Centre for Youth Health, Counties Manukau District Health Board, Auckland, New Zealand
| | - Craig Jefferies
- Starship Children's Health, Paediatric Diabetes and Endocrinology Service, Auckland District Health Board, Auckland, New Zealand
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11
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ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Gabbay RA, on behalf of the American Diabetes Association. 14. Children and Adolescents: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S230-S253. [PMID: 36507640 PMCID: PMC9810473 DOI: 10.2337/dc23-s014] [Citation(s) in RCA: 84] [Impact Index Per Article: 84.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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12
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Peeters MAC, de Haan HG, Bal RA, van Staa A, Sattoe JNT. Active involvement of young people with T1DM during outpatient hospital consultations: Opportunities and challenges in transitional care services. PATIENT EDUCATION AND COUNSELING 2022; 105:1510-1517. [PMID: 34649751 DOI: 10.1016/j.pec.2021.09.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/23/2021] [Accepted: 09/27/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Little is known about active involvement of young people (YP) with type 1 diabetes (T1DM) in transitional care. This study aims to gain insight into patient-provider interactions during outpatient hospital consultations. METHODS Semi-structured observations (n = 61) of outpatient consultations with YP with T1DM (15-25 years) treated in 12 hospitals in the Netherlands. The consultations concerned pediatric care (n = 23), adult care (n = 17), and joint consultations (n = 21). Thematic data analysis focused on whether professionals engaged in open, in-depth conversations; used motivational interviewing techniques; involved YP in shared decision-making; and addressed non-medical topics. RESULTS Apart from some good examples, the healthcare professionals generally had difficulty interacting adequately with YP. They paid little attention to the YP's individual attitudes and priorities regarding disease management; non-medical topics remained generally underexposed. Conversations about daily life often remained shallow, as YP's cues were not taken up. Furthermore, decisions about personal and health-related goals were often not made together. CONCLUSION By adopting a more person-centered approach, professionals could empower YP to take an active role in their diabetes management. PRACTICE IMPLICATIONS Using a structured conversation model combined with a tool to encourage YP's agenda-setting and shared decision-making is recommended for more person-centered transitional care in T1DM.
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Affiliation(s)
- Mariëlle A C Peeters
- Research Centre (American English) Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Hielke G de Haan
- Nutrition and Dietetics, Hanze University of Applied Sciences, Groningen, The Netherlands.
| | - Roland A Bal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - AnneLoes van Staa
- Research Centre (American English) Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Jane N T Sattoe
- Research Centre (American English) Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
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13
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Toschi E, Leblanc J, Hafida S, Mehta S, Ritholz M, Gabbay R, Laffel L. Caring for Young Adults With Diabetes in the Adult Care Setting: Summary of a Multidisciplinary Roundtable. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:830183. [PMID: 36992759 PMCID: PMC10012109 DOI: 10.3389/fcdhc.2022.830183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/31/2022] [Indexed: 01/09/2023]
Abstract
Aims A multidisciplinary team of clinicians and researchers, patients and family members, and representative from national advocacy groups and research organization met to review the literature, highlight gaps, and identify best practices to improve adult care delivery for young adults (YA) with diabetes. Methods The participants prepared presentations in advance, rotated through sessions, and contributed to group discussions in three areas: physical health, mental health, and quality of life (QoL). Session moderators and scribes used thematic analysis to summarize discussions for each topic. Results Thematic analysis revealed four foci for addressing physical health, mental health and QoL: 1) best practices to facilitate the process of transfer; 2) age-specific curricula and guidelines for prevention and management of comorbidities and complications; 3) collaboration with behavioral health clinicians to address diabetes distress and mental health disorders; and 4) research on the impact of diabetes on QoL in YA. Conclusion There was substantial interest and need among adult clinicians to work in concert with pediatric and mental health professionals to identify best practices and future directions to improve healthcare process and diabetes-related outcome measures in YA with diabetes.
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Affiliation(s)
- Elena Toschi
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
- Section on Clinical, Behavioral, and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
| | - Jennifer Leblanc
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
| | - Samar Hafida
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
| | - Sanjeev Mehta
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
| | - Marilyn Ritholz
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
| | - Robert Gabbay
- American Diabetes Association, Alexandria, VA, United States
| | - Lori Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
- Section on Clinical, Behavioral, and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States
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14
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Pape L, Ernst G. Health care transition from pediatric to adult care: an evidence-based guideline. Eur J Pediatr 2022; 181:1951-1958. [PMID: 35084548 PMCID: PMC9056438 DOI: 10.1007/s00431-022-04385-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 12/01/2022]
Abstract
For consistent quality of treatment of young people with chronic health care needs, a structured health care transition (HCT) from pediatric medicine to adult medical care is essential. Currently, most countries have no guidelines on HCT based on systematic evidence research. To close this gap, guidance to support HCT was developed in Germany. Twenty-two experts in the management of adolescents and young adults with different chronic conditions and three patient representatives were invited to take part in the guideline group. Based on a systematic literature search recommendations for HCT were drafted. Where evidence was lacking, recommendations were developed using collective expert consensus. The consensus process was independently moderated using a Delphi approach. The final draft was reviewed and endorsed by all major German medical societies. The clinical recommendations provide guidance for all chronic somatic diseases. After assessment of HCT readiness, an individualized plan for HCT should be drawn up. Key elements here are a responsible coordinator, age-adapted patient education, involvement of caregivers, web-based interventions, joint visits, and a structured summary for the receiving physician. The aim is the gradual transfer of responsibility for disease management to the young person themselves. Conclusion: As only a few randomized controlled studies on HCT are available, evidence-based statements are possible for some but not all areas of HCT. However, this guideline may help to develop globally accepted standards. These standards should be established and implemented. The aim should be a reimbursement by individual national health systems to allow appropriate support for young people. What is Known: • Health care transition from pediatric to adult care is primarily organized in local settings, partly based on disease-specific guidelines. •There have been no national guidelines in Germany until now. What is New: • Here we present the general evidence-based guidelines of the German Association of Scientific Medical Societies for health care transition. • These might serve as a blueprint for further national or international health care transition guidelines.
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Affiliation(s)
- Lars Pape
- Society for Transition Medicine, Hannover, Germany
- Children’s Clinic II, Essen University Hospital, Univ. of Duisburg-Essen, Essen, Germany
| | - Gundula Ernst
- Society for Transition Medicine, Hannover, Germany
- Research and Teaching Unit Medical Psychology, Hannover Medical School, Hannover, Germany
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15
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Ebrahimi F, Kutz A, Christ ER, Szinnai G. Lifetime risk and health-care burden of diabetic ketoacidosis: A population-based study. Front Endocrinol (Lausanne) 2022; 13:940990. [PMID: 36093075 PMCID: PMC9449722 DOI: 10.3389/fendo.2022.940990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Diabetic ketoacidosis (DKA) is a life-threatening complication of both type 1 and type 2 diabetes. We aimed to assess population-based rates, trends and outcomes of patients with DKA. DESIGN AND METHODS This is a nationwide cohort study using hospital discharge claims data from 2010 to 2018 in Switzerland. Incidence rates and in-hospital outcomes of DKA were analyzed throughout lifetime for children (0-9 years), adolescents (10-19 years), and adults (20-29, 30-59, and 60-90 years). Analyses were stratified for type of diabetes mellitus and sex. RESULTS In total, 5,544 hospitalizations with DKA were identified, of whom 3,847 were seen in patients with type 1 diabetes and 1,697 in type 2 diabetes. Incidence rates of DKA among patients with type 1 diabetes were highest during adolescence with 17.67 (girls) and 13.87 (boys) events per 100,000 person-years (incidence rate difference [IRD]: -3.80 [95% CI, -5.59 to -2.02]) and decreased with age in both sexes thereafter. Incidence rates of DKA in patients with type 2 diabetes were low up to an age of 40 years and rose to 5.26 (females) and 6.82 (males) per 100,000 person-years in adults aged 60-90 years. Diabetic ketoacidosis was associated with relevant health-care burden independent of age, sex, or type of diabetes. The population-based incidence rate of DKA increased over time from 7.22 per 100,000 person-years in 2010 to 9.49 per 100,000 person-years in 2018. CONCLUSIONS In type 1 diabetes highest incidence rates of DKA hospitalizations were observed among adolescent females. In comparison, in patients with type 2 diabetes the risk for DKA steadily increased with age with higher rates in adult males. Over the 9 year study period, incidence rates of DKA were increasing irrespective of type of diabetes. DKA was associated with a high burden of disease reflected by high rates of intensive care unit admission, prolonged hospital stay and high mortality rates, especially in elderly.
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Affiliation(s)
- Fahim Ebrahimi
- University Center for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital, Basel, Switzerland
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University Basel, Basel, Switzerland
| | - Alexander Kutz
- Division of Endocrinology, Diabetes, and Metabolism, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
- Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Emanuel Remigius Christ
- Division of Endocrinology, Diabetes, and Metabolism, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, University Basel, Basel, Switzerland
| | - Gabor Szinnai
- Department of Clinical Research, University Hospital Basel, University Basel, Basel, Switzerland
- pt?> Pediatric Endocrinology and Diabetology, University Children's Hospital Basel, University of Basel, Basel, Switzerland
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16
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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17
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White M, O'Connell M, Steinbeck K, Lingam R, Cameron F. Increasing evidence of the benefits of a transition coordinator in type 1 diabetes. Diabetologia 2021; 64:2348-2351. [PMID: 34390366 DOI: 10.1007/s00125-021-05536-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/04/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Mary White
- Department of Endocrinology & Diabetes, The Royal Children's Hospital, Melbourne, Australia.
- Murdoch Children's Research Institute, Melbourne, Australia.
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.
| | - Michele O'Connell
- Department of Endocrinology & Diabetes, The Royal Children's Hospital, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Katharine Steinbeck
- Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Westmead, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Raghu Lingam
- Population Child Health Research Group, School of Women's and Children's Health, University of New South Wales, Sydney, Australia
- Department of Community Paediatrics, Sydney Children's Hospital, Sydney, Australia
| | - Fergus Cameron
- Department of Endocrinology & Diabetes, The Royal Children's Hospital, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
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18
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Kim JH, Yoo JH. A national survey of transition from pediatric to adult healthcare providers for adolescents and young adults with type 1 diabetes: perspectives of pediatric endocrinologists in Korea. Ann Pediatr Endocrinol Metab 2021; 26:112-117. [PMID: 33626630 PMCID: PMC8255862 DOI: 10.6065/apem.2040194.097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/06/2020] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Transition from pediatric to adult healthcare for adolescents and young adults with type 1 diabetes (T1D) increases the risk for poor outcomes. This study aimed to describe the circumstances and clinical practice patterns associated with this transition of care based on a nationwide survey of pediatric endocrinologists in Korea. METHODS An electronic survey regarding the healthcare transition of T1D patients was administered to 143 pediatric endocrinologists registered in the Korean Society of Pediatric Endocrinology. RESULTS The response rate was 50.2% (n=72). Among responders, 58.3% (n=42) were females, and 70.8% (n=51) worked in academic medical centers. The main reasons for transfer to adult care were request from a patient or family (69.6%) and age ≥18 years (42.0%). Impediments to transition were a long-lasting therapeutic relationship (72.9%) and lack of adult specialists in T1D care (62.9%). Communication between pediatric and adult endocrinologists was via nonstructured patient summary (68.6%) and telephone or email (27.1%). Responders reported that successful transition requires development of transition protocols (79.2%) and a multidisciplinary team approach for transition care (52.8%). CONCLUSION Transition care of T1D patients is a challenge to pediatric endocrinologists in Korea. Development of transition care protocols for healthcare providers and improvement of diabetes self-management skills for patients are needed.
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Affiliation(s)
- Jae Hyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Ho Yoo
- Department of Pediatrics, Dong-A University College of Medicine, Busan, Korea,Address for correspondence: Jae-Ho Yoo Department of Pediatrics, Dong-A University College of Medicine, 32 Daesingongwon-ro, Seo-gu, Busan 49201, Korea
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Butalia S, Crawford SG, McGuire KA, Dyjur DK, Mercer JR, Pacaud D. Improved transition to adult care in youth with type 1 diabetes: a pragmatic clinical trial. Diabetologia 2021; 64:758-766. [PMID: 33439284 DOI: 10.1007/s00125-020-05368-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/04/2020] [Indexed: 10/22/2022]
Abstract
AIMS/HYPOTHESIS Youth with type 1 diabetes are at high risk for loss to follow-up during the transition from paediatric to adult diabetes care. Our aim was to assess the effect of a communication technology enhanced transition coordinator intervention compared with usual care on clinic attendance among transitioning youth with type 1 diabetes. METHODS In this open label, pragmatic clinical trial of youth with type 1 diabetes, aged 17-18 years, transitioning from paediatric to adult diabetes care, the intervention group received support from a transition coordinator who used communication technology and the control group received usual care. The primary outcome was the proportion of individuals that did not attend at least one routine clinic visit in adult diabetes care within 1 year after transfer. Secondary outcomes included diabetes-related clinical outcomes and quality of life measures. RESULTS There were no baseline differences in age, sex, HbA1c and number of follow-up visits, emergency department visits and diabetic ketoacidosis admissions in the 1 year prior to transition between the usual care (n = 101) and intervention (n = 102) groups. In the year following transfer, 47.1% in the usual care group vs 11.9% in the intervention group did not attend any outpatient diabetes appointments (p < 0.01). There were no differences in glycaemic control or diabetic ketoacidosis post transfer. CONCLUSIONS/INTERPRETATION Our intervention was successful in improving clinic attendance among transitioning youth with type 1 diabetes. Importantly, this programme used simple, readily accessible communication technologies, which increases the sustainability and transferability of this strategy. TRIAL REGISTRATION isrctn.org ISRCTN13459962.
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Affiliation(s)
- Sonia Butalia
- Division of Endocrinology and Metabolism, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | | | - K Ashlee McGuire
- Provincial Primary Health Care, Alberta Health Services, Calgary, AB, Canada
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - David K Dyjur
- Diabetes Centre Calgary, Alberta Health Services, Calgary, AB, Canada
| | - Julia R Mercer
- Alberta Children's Hospital, Diabetes Clinic, Alberta Health Services, Calgary, AB, Canada
| | - Danièle Pacaud
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc21-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Ladha S, Fox D, Bone JN, Amed S. An Analysis of Self-Reported Barriers to Type 1 Diabetes Care in a Pediatric Population in British Columbia, Canada. Can J Diabetes 2020; 45:383-389. [PMID: 33358268 DOI: 10.1016/j.jcjd.2020.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/22/2020] [Accepted: 10/24/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Our aim in this study was to identify patient-level barriers to attending pediatric type 1 diabetes mellitus (T1DM) clinic and to better understand the demographic and clinical characteristics of these reporting barriers. METHODS Patients were recruited from pediatric T1DM clinics throughout British Columbia. Barriers to attending clinic were identified through a survey. Demographic and clinical characteristics of patients who reported difficulty attending clinic appointments were compared with those who did not. RESULTS Of the 197 study participants, 31% reported difficulty attending appointments. Commonly reported barriers were distance to clinic and missing work. Younger child age and residing in northern regions increased the odds of reporting a barrier, whereas residing on Vancouver Island decreased odds of reporting a barrier. There were no differences in glycated hemoglobin levels between the 2 groups. CONCLUSIONS Approximately 1 in 3 patients identified challenges in attending T1DM appointments in British Columbia. Further research is needed to determine whether similar challenges exist in other provinces.
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Affiliation(s)
- Safia Ladha
- Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Danya Fox
- Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Jeffrey N Bone
- Department of Obstetrics and Gynecology, University of British Columbia, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Shazhan Amed
- Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada.
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Ravens E, Becker J, Pape L, Ernst G. Psychosocial benefit and adherence of adolescents with chronic diseases participating in transition programs: a systematic review. JOURNAL OF TRANSITION MEDICINE 2020. [DOI: 10.1515/jtm-2020-0009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
AbstractChronically ill young people must transition to the adult health care service after their 18th birthday. The transition from child centred paediatric care to the adult health care service is not simply limited to the change from familiar structures to something unknown, but includes the entire process of growing up, of individuals becoming independent from their parents and taking responsibility for their own disease management. Young people are at particular risk of losing the connection to medical care during this phase and the transition of young people with chronic conditions is associated with a high risk of declining adherence and worsening health status. Studies suggest that transition programs might be helpful, yet there is no evidence as to whether risks can be reduced or which intervention components are particularly conducive to better outcome. This study aimed to identify transition-specific interventions and evaluate their effect on the improvement of psychosocial parameters, such as health related quality of life and adherence of patients. A systematic literature review was conducted. Electronic databases (Cochrane, Embase, Pubmed, Web of Science) were searched by two independent reviewers for intervention studies aiming to improve transition. Grey literature was also searched. Studies were included if they evaluated transition-specific interventions aiming to improve psychosocial or adherence parameters of participants aged 12 years and older suffering from a chronic condition. Both controlled trials and studies with measurements before an after the intervention were included. The GRADE approach was used to assess the quality of evidence. The inclusion criteria was met by forty studies. Patients suffered from different chronic conditions, such as inflammatory bowel disease, type 1 diabetes or juvenile idiopathic arthritis. Transition interventions used several program components, such as transition coordinators, patient education programs or web-based interventions. Outcomes included quality of life, transition-specific knowledge, adherence and loss to follow up. Thirty-eight studies showed beneficial effects in the intervention group, respectively after intervention. The overall study quality was low. A large number of studies evaluating transition-specific interventions was included. Transition-specific interventions seem to have beneficial effects on psychosocial outcomes and adherence. The promotion of health literacy, appointment arrangement service and the use of technical elements (websites, SMS) seem to be particularly helpful in the transition process. As the patient population was diverse, the results can be transferred to other diseases. Even though the overall study quality was poor, it is possible to draw some conclusions. Future studies should aim to include large numbers of patients over extended periods of time in order to assess long-term outcomes.
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Affiliation(s)
- Esther Ravens
- Institute of Medical Psychology, Hannover Medical School, Hannover, Germany
- Departement of Paediatric Nephrology, Hannover Medical School, Hannover, Germany
| | - Johanna Becker
- Institute of Medical Psychology, Hannover Medical School, Hannover, Germany
- Departement of Paediatric Nephrology, Hannover Medical School, Hannover, Germany
| | - Lars Pape
- Departement of Paediatric Nephrology, Hannover Medical School, Hannover, Germany
| | - Gundula Ernst
- Institute of Medical Psychology, Hannover Medical School, Hannover, Germany
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Brewster S, Bartholomew J, Holt RIG, Price H. Non-attendance at diabetes outpatient appointments: a systematic review. Diabet Med 2020; 37:1427-1442. [PMID: 31968127 DOI: 10.1111/dme.14241] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Non-attendance at diabetes outpatient appointments is a sizeable problem worldwide and has been associated with suboptimal health outcomes. We aimed to describe the characteristics, health outcomes and reasons given for non-attendance at doctor- or nurse-led diabetes appointments, and interventions to improve attendance. METHODS PubMed, EMBASE, CINAHL and PsychInfo were searched from database inception to February 2019. Included articles were peer-reviewed, published in English, related to adults or young people with type 1 or type 2 diabetes, and addressed one of the above aspects of non-attendance. Studies were excluded if reporting on other types of diabetes or reviewing attendance at structured education, retinal screening, paediatric, antenatal, podiatry or dietetic clinics. RESULTS Thirty-four studies of varied designs were identified (15 observational, 1 randomized control trial, 9 qualitative, 5 surveys, 4 service improvements). The definition of non-attendance varied. Younger adults, smokers and those with financial pressures were less likely to attend. Non-attendance was associated with higher HbA1c ; other outcomes were varied but typically worse in non-attenders. Reasons for non-attendance in qualitative studies fell into three categories: balancing the costs and benefits of attendance, coping strategies, and the relationships between the person with diabetes and healthcare professionals. Interventions included appointment management strategies, service improvements, patient navigators and WebCam appointments. CONCLUSIONS Non-attendance is only partially explained by logistical issues. Qualitative studies suggest complex psychosocial factors are involved. Interventions have progressed from simple appointment reminders in an attempt to address some of the psycho-social determinants, but more work is needed to improve attendance.
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Affiliation(s)
- S Brewster
- Research and Development Tom Rudd Unit, Moorgreen Hospital, Southern Health NHS Foundation Trust, Southampton, UK
| | - J Bartholomew
- CRN Wessex, NIHR Clinical Research Network (CRN), University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - R I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - H Price
- Research and Development Tom Rudd Unit, Moorgreen Hospital, Southern Health NHS Foundation Trust, Southampton, UK
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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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25
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White M, O'Connell MA, Colman PG, Cameron FJ. Successful post-transition engagement can be predicted at the time of transition in type 1 diabetes. Diabetes Res Clin Pract 2020; 163:108023. [PMID: 31954750 DOI: 10.1016/j.diabres.2020.108023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 01/13/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Mary White
- Department of Endocrinology & Diabetes, Murdoch Children's Research Institute at The Royal Children's Hospital, 50 Flemington Road, Parkville, Melbourne, VIC 3052, Australia; Department of Paediatric Endocrinology & Diabetes, Monash Children's Hospital, Clayton, VIC 3168, Australia.
| | - Michele A O'Connell
- Department of Endocrinology & Diabetes, Murdoch Children's Research Institute at The Royal Children's Hospital, 50 Flemington Road, Parkville, Melbourne, VIC 3052, Australia.
| | - Peter G Colman
- Department of Endocrinology and Diabetes, Royal Melbourne Hospital, Grattan Street, Parkville, Melbourne, VIC 3051, Australia.
| | - Fergus J Cameron
- Department of Endocrinology & Diabetes, Murdoch Children's Research Institute at The Royal Children's Hospital, 50 Flemington Road, Parkville, Melbourne, VIC 3052, Australia.
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Becker J, Ravens E, Pape L, Ernst G. Somatic outcomes of young people with chronic diseases participating in transition programs: a systematic review. JOURNAL OF TRANSITION MEDICINE 2020. [DOI: 10.1515/jtm-2020-0003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractIntroductionThere is growing evidence that the health of young people with chronic health conditions deteriorates during the transfer from child-centred to adult-oriented health care. Risks include not only the deterioration of health status in general but also the occurrence of secondary diseases and adverse events. Transition programs have been implemented. However, there is a lack of evidence about whether they reduce these risks and which interventions should be principally included. Evidence-based guidelines for the transition of young people should be introduced. In this study we therefore aim to summarise actual evidence on somatic outcomes during the transition period.MethodsA systematic literature review was conducted. Two independent reviewers searched in electronic databases (Cochrane, Embase, PubMed, Web of Science) for intervention studies that aimed to improve transition. Last update of search was October 31st 2018. Grey literature was also searched. Studies were included if they examined participants aged 11 years or older suffering from a chronic health condition and evaluated interventions aimed to improve somatic outcomes after transition. Controlled trials or studies with a measurement before and after intervention were considered. The certainty of evidence was assessed using the GRADE approach. Additionally, each study was graded using a modified grading scale based on GRADE.Results28 studies met the inclusion criteria. Patients suffered from different chronic conditions such as type 1 diabetes, solid organ transplantation, inflammatory bowel disease or cystic fibrosis. Interventions had different components such as transition checklists, workshops, web-based interventions, transition plans, joint visits or transition coordinators. Outcomes included mortality and morbidity. They varied according to chronic condition. Thirteen studies showed beneficial effects in the intervention group or in post-intervention measurements. The certainty of evidence was very low.ConclusionA considerable number of studies evaluating transition interventions was identified. Transition interventions had some beneficial effects. Workshops, joint visits and longer or multidisciplinary appointments may be particularly effective components. Transition guidelines could be based on these results. However, due to the limitations of the included studies it is difficult to draw firm conclusions. More research is needed to further evaluate the effectiveness of transition interventions. It should address the deficits identified from prior studies, such as poor study design, short follow-up time or small sample sizes.
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Affiliation(s)
- Johanna Becker
- Department of Paediatric Nephrology, Hannover Medical School, Hannover, Germany
- Institute of Medical Psychology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany, Phone: +49 511 532-4439
| | - Esther Ravens
- Department of Paediatric Nephrology, Hannover Medical School, Hannover, Germany
- Institute of Medical Psychology, Hannover Medical School, Hannover, Germany
| | - Lars Pape
- Department of Paediatric Nephrology, Hannover Medical School, Hannover, Germany
| | - Gundula Ernst
- Institute of Medical Psychology, Hannover Medical School, Hannover, Germany
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27
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Schmidt A, Ilango SM, McManus MA, Rogers KK, White PH. Outcomes of Pediatric to Adult Health Care Transition Interventions: An Updated Systematic Review. J Pediatr Nurs 2020; 51:92-107. [PMID: 31981969 DOI: 10.1016/j.pedn.2020.01.002] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/31/2019] [Accepted: 01/03/2020] [Indexed: 02/07/2023]
Abstract
PROBLEM A previous systematic review found that health care transition (HCT) interventions result in positive outcomes related to population health, patient experience of care, and utilization. Since its publication, new national statistics, updated professional guidance, and a growing body of published literature on HCT have prompted the need for an updated systematic review that aims to examine outcomes of the latest pediatric-to-adult HCT interventions. ELIGIBILITY CRITERIA Eligible studies were published in English between May 2016 and December 2018, described HCT interventions for youth moving from pediatric to adult outpatient health care, quantitative in design, and peer-reviewed. SAMPLE Nineteen articles from a literature search of CINAHL, OVID Medline, PubMed, Scopus, Web of Science were included in this review. RESULTS All included studies examined youth with special health care needs. Most of the positive outcomes identified were related to population health, followed by improvements in utilization. All studies mentioned transfer assistance, most described transition planning supports, and almost half reported on integration into adult care. CONCLUSIONS This review strengthens the evidence that a structured HCT process for youth with special health care needs can show improvements in adherence to care, disease-specific measures, quality of life, self-care skills, satisfaction with care, health care utilization, and HCT process of care. IMPLICATIONS Future research studies should utilize interventions that incorporate all HCT components (planning, transfer, and integration) and assess provider experience of care as well as cost of care.
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Affiliation(s)
- Annie Schmidt
- The National Alliance to Advance Adolescent Health/Got Transition, ®Washington, D.C., United States of America.
| | - Samhita M Ilango
- The National Alliance to Advance Adolescent Health/Got Transition, ®Washington, D.C., United States of America
| | - Margaret A McManus
- The National Alliance to Advance Adolescent Health/Got Transition, ®Washington, D.C., United States of America
| | - Katherine K Rogers
- Independent Research Consultant, Washington, D.C., United States of America
| | - Patience H White
- The National Alliance to Advance Adolescent Health/Got Transition, ®Washington, D.C., United States of America
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28
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Wong SKW, Smith HE, Chua JJS, Griva K, Cartwright EJ, Soong AJ, Dalan R, Tudor Car L. Effectiveness of self-management interventions in young adults with type 1 and 2 diabetes: a systematic review and meta-analysis. Diabet Med 2020; 37:229-241. [PMID: 31769532 DOI: 10.1111/dme.14190] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2019] [Indexed: 12/27/2022]
Abstract
AIM Diabetes in young adulthood has been associated with poor outcomes. Self-management is fundamental to good diabetes care, and self-management interventions have been found to improve outcomes in older adults. We performed a systematic review and meta-analysis to assess the effectiveness of self-management interventions in young adults (aged 15-39 years) with type 1 or type 2 diabetes. METHODS We searched five databases and two clinical trial registries from 2003 to February 2019, without language restrictions. We included randomized controlled trials (RCTs) comparing the effectiveness of self-management interventions with usual care or enhanced usual care in young adults. Outcomes of interest included clinical outcomes, psychological health, self-care behaviours, diabetes knowledge and self-efficacy. Pairwise meta-analysis was conducted using a random effects model and quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria. We followed Cochrane gold standard systematic review methodology and reported this systematic review according to PRISMA guidelines. The protocol was registered with PROSEPRO (CRD42018110868). RESULTS In total, 13 studies (1002 participants) were included. Meta-analysis showed no difference between self-management interventions and controls in post-intervention HbA1c levels, BMI, depression, diabetes-related distress, overall self-care, diabetes knowledge and self-efficacy. Quality of evidence ranged from very low to moderate due to study limitations, inconsistency and imprecision. CONCLUSIONS Current self-management interventions did not improve outcomes in young adults with diabetes. Our findings, which contrast with those from systematic reviews in older adults, highlight the need for the development of more effective interventions for young adults with diabetes.
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Affiliation(s)
- S K W Wong
- Lee Kong Chian School of Medicine, Singapore
- National Healthcare Group Polyclinics, Singapore
| | - H E Smith
- Lee Kong Chian School of Medicine, Singapore
| | - J J S Chua
- Lee Kong Chian School of Medicine, Singapore
| | - K Griva
- Lee Kong Chian School of Medicine, Singapore
| | | | - A J Soong
- Lee Kong Chian School of Medicine, Singapore
| | - R Dalan
- Lee Kong Chian School of Medicine, Singapore
- Tan Tock Seng Hospital, Singapore
| | - L Tudor Car
- Lee Kong Chian School of Medicine, Singapore
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29
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc20-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc20-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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30
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Kearney CA, Gonzálvez C, Graczyk PA, Fornander MJ. Reconciling Contemporary Approaches to School Attendance and School Absenteeism: Toward Promotion and Nimble Response, Global Policy Review and Implementation, and Future Adaptability (Part 2). Front Psychol 2019; 10:2605. [PMID: 31849743 PMCID: PMC6895679 DOI: 10.3389/fpsyg.2019.02605] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/04/2019] [Indexed: 01/08/2023] Open
Abstract
As noted in Part 1 of this two-part review, school attendance is an important foundational competency for children and adolescents, and school absenteeism has been linked to myriad short- and long-term negative consequences, even into adulthood. Categorical and dimensional approaches for this population have been developed. This article (Part 2 of a two-part review) discusses compatibilities of categorical and dimensional approaches for school attendance and school absenteeism and how these approaches can inform one another. The article also poses a multidimensional multi-tiered system of supports pyramid model as a mechanism for reconciling these approaches, promoting school attendance (and/or prevention of school absenteeism), establishing early warning systems for nimble response to school attendance problems, assisting with global policy review and dissemination and implementation, and adapting to future changes in education and technology.
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Affiliation(s)
| | - Carolina Gonzálvez
- Department of Developmental Psychology and Teaching, Universidad de Alicante, San Vicente del Raspeig, Spain
| | - Patricia A. Graczyk
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - Mirae J. Fornander
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, United States
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Sandler CN, Garvey KC. A Practice in Maturation: Current Perspectives on the Transition from Pediatric to Adult Care for Young Adults with Diabetes. Curr Diab Rep 2019; 19:126. [PMID: 31728765 DOI: 10.1007/s11892-019-1247-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE OF REVIEW This review of available literature and resources highlights the challenges in transition from pediatric to adult care for young adults with diabetes, summarizes practical recommendations for facilitating the process, and identifies areas for improvement in current transition practice. RECENT FINDINGS Observational studies highlight suboptimal transition preparation counseling, gaps between pediatric and adult care, and increased post-transition hemoglobin A1c and acute care utilization. Studies showing improved outcomes with later age at transition allows for an extended focus on transition preparation with an eye toward developmental maturity. Interventional studies suggest varying benefits of transition coordinators and support programs. The period of transition from pediatric to adult care is a time of in which patients are at high risk for adverse outcomes and loss to follow-up; however, careful attention to planning the process and tracking patient readiness along with skilled care coordination can contribute to transition success. The durability of interventional models, as well as generalizability to varied clinical settings, must be further tested.
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Affiliation(s)
- Courtney N Sandler
- Division of Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA.
- Boston Children's Hospital, 333 Longwood Avenue, Boston, MA, 02115, USA.
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32
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Abstract
PURPOSE OF REVIEW The transition of patients from pediatric to adult centered care represents not only the means to transfer medical care to a group of providers who specialize in adult care but also is part of the process of the transfer of healthcare responsibility from the family to a patient. The intent of this review is to provide a summary of some of the important studies published in the past 2 years that advance this knowledge. RECENT FINDINGS Progress has been made in the recognition of the process of transition, including developing tools to assess transition readiness, improving routes of communication along with patient education. Other studies provided information on patients' preferences for information seeking, types of family interactions, and factors that improved transition success. SUMMARY In general, reported clinics and programs did demonstrate improvements in adherence, clinic retention, and even quality of life. Further studies should focus on clinical outcomes of transition programs and risk assessment for transitioning patients.
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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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Spaic T, Robinson T, Goldbloom E, Gallego P, Hramiak I, Lawson ML, Malcolm J, Mahon J, Morrison D, Parikh A, Simone A, Stein R, Uvarov A, Clarson C. Closing the Gap: Results of the Multicenter Canadian Randomized Controlled Trial of Structured Transition in Young Adults With Type 1 Diabetes. Diabetes Care 2019; 42:1018-1026. [PMID: 31010873 DOI: 10.2337/dc18-2187] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 03/08/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine if a structured transition program for young adults with type 1 diabetes improves clinic attendance, glycemic control, diabetes-related distress, quality of life, and satisfaction with care. RESEARCH DESIGN AND METHODS In this multicenter randomized controlled trial, young adults (17-20 years) with type 1 diabetes were randomly assigned to a transition program with a transition coordinator or to standard care. The intervention lasted 18 months (6 in pediatric and 12 in adult care). The primary outcome was the proportion of participants who failed to attend at least one adult diabetes clinic visit during the 12-month follow-up after completion of the intervention. RESULTS We randomized 205 participants, 104 to the transition program and 101 to standard care. Clinic attendance was improved in the transition program (mean [SD] number of visits 4.1 [1.1] vs. 3.6 [1.2], P = 0.002), and there was greater satisfaction with care (mean [SD] score 29.0 [2.7] vs. 27.9 [3.4], P = 0.032) and less diabetes-related distress (mean [SD] score 1.9 [0.8] vs. 2.1 [0.8], P = 0.049) reported than in standard care. There was a trend toward improvement in mean HbA1c (8.33% [68 mmol/mol] vs. 8.80% [73 mmol/mol], P = 0.057). During the 12-month follow-up, there was no difference in those failing to attend at least one clinic visit (P = 0.846), and the mean change in HbA1c did not differ between the groups (P = 0.073). At completion of follow-up, the groups did not differ with respect to satisfaction with care or diabetes-related distress and quality of life. CONCLUSIONS Transition support during this 18-month intervention was associated with increased clinic attendance, improved satisfaction with care, and decreased diabetes-related distress, but these benefits were not sustained 12 months after completion of the intervention.
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Affiliation(s)
- Tamara Spaic
- Division of Endocrinology and Metabolism, St. Joseph's Health Care London, London, Ontario, Canada .,Department of Medicine, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Tracy Robinson
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Ellen Goldbloom
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
| | - Patricia Gallego
- Lawson Health Research Institute, London, Ontario, Canada.,Children's Hospital, London Health Sciences Centre, London, Ontario, Canada.,Department of Paediatrics, Western University, London, Ontario, Canada
| | - Irene Hramiak
- Division of Endocrinology and Metabolism, St. Joseph's Health Care London, London, Ontario, Canada.,Department of Medicine, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Margaret L Lawson
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,University of Ottawa, Ottawa, Ontario, Canada
| | - Janine Malcolm
- University of Ottawa, Ottawa, Ontario, Canada.,The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Jeffrey Mahon
- Division of Endocrinology and Metabolism, St. Joseph's Health Care London, London, Ontario, Canada.,Department of Medicine, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Deric Morrison
- Division of Endocrinology and Metabolism, St. Joseph's Health Care London, London, Ontario, Canada.,Department of Medicine, Western University, London, Ontario, Canada
| | - Amish Parikh
- Trillium Health Partners, Mississauga, Ontario, Canada
| | - Angelo Simone
- Trillium Health Partners, Mississauga, Ontario, Canada
| | - Robert Stein
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada.,Department of Paediatrics, Western University, London, Ontario, Canada
| | - Artem Uvarov
- Department of Medicine, Western University, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
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Aldiss S, Rose L, McCutcheon D, Cass H, Ellis J, Gibson F. Gathering expert opinion to inform benchmarks to support transitional care. J Child Health Care 2019; 23:131-146. [PMID: 29911431 DOI: 10.1177/1367493518780486] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to (1) explore views of known experts leading on transition, (2) gather insights on the essential features of transitional care models and (3) highlight opportunities for and barriers to change: to inform core elements of benchmarks for transitional care. We held three workshops ( n = 20) and used a telephone interview ( n = 1) with health and social care professionals with expertise working with young people with a range of health conditions and disabilities. The workshops included individual brainstorming and group discussion. Data were analysed using qualitative content analysis. The general consensus from stakeholders' discussions about transition was that 'things have become stuck'. Themes included: professionals' attitudes towards and knowledge about young people and transition, organizational barriers and 'lack of joined-up thinking' between services. Our work offers further insight into experts' perceptions of transition services within the United Kingdom. It is clear that there is still much to be done to improve transition, to better meet the needs of young people and parents and begin to offer equitable access to transitional care programmes. The benchmarks offer a starting point for professionals seeking to improve transition through enabling the identification of gaps in services and providing a platform to share successful practice initiatives.
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Affiliation(s)
- Susie Aldiss
- 1 School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Laura Rose
- 2 University College London Hospital NHS Foundation Trust, London, UK
| | - Dominic McCutcheon
- 3 Department of Nursing and Midwifery, University of the West of England, Bristol, UK
| | - Hilary Cass
- 4 Evelina London Children's Hospital, St Thomas' Hospital, Westminster Bridge Road, London, UK
| | - Judith Ellis
- 5 Royal College of Paediatrics and Child Health, London, UK
| | - Faith Gibson
- 1 School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.,6 Centre for Outcomes and Experiences Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Cameron FJ, Garvey K, Hood KK, Acerini CL, Codner E. ISPAD Clinical Practice Consensus Guidelines 2018: Diabetes in adolescence. Pediatr Diabetes 2018; 19 Suppl 27:250-261. [PMID: 29900653 DOI: 10.1111/pedi.12702] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/28/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Fergus J Cameron
- Royal Children's Hospital, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Katharine Garvey
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts
| | - Korey K Hood
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Ethel Codner
- Instituto de Investigaciones Materno Infantil, Facultad de Medicina, University of Chile, Santiago, Chile
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Clarke J, Proudfoot J, Vatiliotis V, Verge C, Holmes‐Walker DJ, Campbell L, Wilhelm K, Moravac C, Indu PS, Bridgett M. Attitudes towards mental health, mental health research and digital interventions by young adults with type 1 diabetes: A qualitative analysis. Health Expect 2018; 21:668-677. [PMID: 29319923 PMCID: PMC5980506 DOI: 10.1111/hex.12662] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Young people with type 1 diabetes are at increased risk of mental disorders. Whereas treatment need is high, difficulty recruiting young people with type 1 diabetes into psychosocial studies complicates development, testing and dissemination of these interventions. OBJECTIVE Interviews with young adults with type 1 diabetes were conducted to examine attitudes towards mental health and mental health research, including barriers and motivators to participation in mental health studies and preferred sources of mental health support. The interviews were audio-taped, transcribed and evaluated via thematic analysis. SETTING AND PARTICIPANTS Young adults with type 1 diabetes were recruited via social media channels of 3 advocacy organizations. A total of 31 young adults (26 females and 5 males) with an average age of 22 years were interviewed between October 2015 and January 2016. RESULTS Participants were largely unaware of their increased vulnerability to common mental health problems and knew little about mental health research. Major barriers to participation included perceived stigma and lifestyle issues and low levels of trust in researchers. Opportunities to connect with peers and help others were described as key motivators. Psychological distress was considered normal within the context of diabetes. A need for some level of human contact in receiving psychosocial support was expressed. DISCUSSION AND CONCLUSION Findings provide valuable insights into the complex dynamics of engaging young adults with type 1 diabetes in mental health studies. Interviewees provided practical suggestions to assist investigation and delivery of psychosocial interventions for this vulnerable group.
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Affiliation(s)
- Janine Clarke
- Black Dog InstituteRandwick, SydneyNSWAustralia
- UNSW AustraliaSydneyNSWAustralia
| | - Judy Proudfoot
- Black Dog InstituteRandwick, SydneyNSWAustralia
- UNSW AustraliaSydneyNSWAustralia
| | | | - Charles Verge
- Sydney Children's HospitalSydneyNSWAustralia
- School of Women's and Children's HealthUNSW AustraliaSydneyNSWAustralia
| | | | - Lesley Campbell
- Department of EndocrinologySt Vincent's HospitalSydneyNSWAustralia
| | - Kay Wilhelm
- Urban Mental Research InstituteSt Vincent's HospitalSydneyNSWAustralia
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Kordonouri O. Transition of care for young adults with chronic diseases. THE LANCET CHILD & ADOLESCENT HEALTH 2017; 1:251-253. [PMID: 30169176 DOI: 10.1016/s2352-4642(17)30102-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 09/26/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Olga Kordonouri
- Diabetes Center for Children and Adolescents, Kinder und Jugendkrankenhaus Auf der Bult, Hannover, 30173, Germany.
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