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Momplaisir F, McGlonn K, Grabill M, Moahi K, Nkwihoreze H, Knowles K, Laguerre R, Dowshen N, Hussen SA, Tanner AE, Lowenthal ED. Strategies to improve outcomes of youth experiencing healthcare transition from pediatric to adult HIV care in a large U.S. city. Arch Public Health 2023; 81:49. [PMID: 37004125 PMCID: PMC10064608 DOI: 10.1186/s13690-023-01057-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 03/08/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND The healthcare transition (HCT) from pediatric to adult HIV care can be disruptive to HIV care engagement and viral suppression for youth living with HIV (YLH). METHODS We performed qualitative interviews with 20 YLH who experienced HCT and with 20 multidisciplinary pediatric and adult HIV clinicians to assess and rank barriers and facilitators to HCT and obtain their perspectives on strategies to improve the HCT process. We used the Exploration Preparation Implementation Sustainment Framework to guide this qualitative inquiry. RESULTS The most impactful barriers identified by YLH and clinicians focused on issues affecting the patient-clinician relationship, including building trust, and accessibility of clinicians. Both groups reported that having to leave the pediatric team was a significant barrier (ranked #1 for clinicians and #2 for YLH). The most impactful facilitator included having a social worker or case manager to navigate the HCT (listed #1 by clinicians and #2 by YLH); case managers were also identified as the individual most suited to support HCT. While YLH reported difficulty building trust with their new clinician as their #1 barrier, they also ranked the trust they ultimately built with a new clinician as their #1 facilitator. Factors reported to bridge pediatric and adult care included providing a warm handoff, medical record transfer, developing relationships between pediatric clinics and a network of youth-friendly adult clinics, and having the pediatric case manager attend the first adult appointment. Longer new patient visits, increased health communication between YLH and clinicians and sharing vetted clinician profiles with YLH were identified as innovative strategies. CONCLUSION In this multi-disciplinary contextual inquiry, we have identified several determinants that may be targeted to improve HCT for YLH.
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Affiliation(s)
- Florence Momplaisir
- Department of Medicine, Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, 1201 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19102, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
| | - Kassandra McGlonn
- Institute of Public Health, Epidemiology & Biostatistics, Florida A&M University, Tallahassee, FL, USA
| | - Megan Grabill
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Kaelo Moahi
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Hervette Nkwihoreze
- Department of Medicine, Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, 1201 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19102, USA
| | - Kayla Knowles
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Roberta Laguerre
- Department of Pediatrics, St Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Nadia Dowshen
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sophia A Hussen
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Amanda E Tanner
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Elizabeth D Lowenthal
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Fegran L, Westergren T, Hall EOC, Aagaard H, Ludvigsen MS. Nurses' and Doctors' Experiences of Transferring Adolescents or Young Adults With Long-Term Health Conditions From Pediatric to Adult Care: A Metasynthesis. Glob Qual Nurs Res 2023; 10:23333936231189568. [PMID: 37561016 PMCID: PMC10408318 DOI: 10.1177/23333936231189568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 06/26/2023] [Accepted: 07/07/2023] [Indexed: 08/11/2023] Open
Abstract
The transfer of adolescents and young adults (AYA) with long-term health conditions from pediatric to adult care is a multidisciplinary enterprise where nurses and doctors play an important role. This review aimed to identify and synthesize evidence from qualitative primary reports on how nurses and doctors experience the transfer of AYA aged 13 to 24 years with long-term health conditions to an adult hospital setting. We systematically searched seven electronic databases for reports published between January 2005 and November 2021 and reporting nurses' and doctors' experiences. We meta-summarized data from 13 reports derived from 11 studies published worldwide. Using qualitative content analysis, we metasynthesized nurses' and doctors' experiences into the theme "being boosters." Boosting AYA's transfer was characterized by supporting AYA's and their parents' changing roles, smoothening AYA's transition from pediatric to adult care, and handling AYA's encounters with a different care culture.
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Affiliation(s)
- Liv Fegran
- University of Agder, Kristiansand, Norway
| | - Thomas Westergren
- University of Agder, Kristiansand, Norway
- University of Stavanger, Norway
| | | | - Hanne Aagaard
- Lovisenberg diaconal University College, Oslo, Norway
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Lemon TL, Tassiopoulos K, Tsai AC, Cantos K, Escudero D, Quinn MK, Kacanek D, Berman C, Salomon L, Nichols S, Chadwick EG, Seage GR, Williams PL. Health Insurance Coverage, Clinical Outcomes, and Health-Related Quality of Life Among Youth Born to Women Living With HIV. J Acquir Immune Defic Syndr 2023; 92:6-16. [PMID: 36150048 PMCID: PMC9742193 DOI: 10.1097/qai.0000000000003100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 07/25/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Although sustained access to health care is essential, little is known about the relationship between insurance coverage and health among people born to women living with HIV (WLHIV). SETTING Prospective cohort studies of youth and young adults born to WLHIV from 2007 to 2019. METHODS We used adjusted generalized estimating equation models to estimate mean differences in, and relative risks (RRs) of, health-related quality of life (HR-QoL) and HIV disease measures over time by insurance status. HR-QoL scales with limited variability were dichotomized. Modified Poisson models were used to estimate RRs. RESULTS Six hundred sixty-nine Adolescent Master Protocol (AMP) youth [66% living with perinatally-acquired HIV (PHIV), 72% Black] and 939 AMP Up/AMP Up Lite young adults (89% PHIV, 68% Black) reported insurance. Most were publicly insured (87% youth, 67% young adults). Privately insured young adults living with PHIV had lower risk of antiretroviral therapy nonadherence [adjusted RR (aRR): 0.82, 95% CI: 0.70 to 0.97] than those with public insurance. There was a lower risk of suboptimal role functioning for young adults with private insurance (aRR: 0.58, 95% CI: 0.35 to 0.97) and those unaware of their coverage (aRR: 0.41, 95% CI: 0.21 to 0.78). Young adults with private insurance had higher health perception scores than those with public insurance (adjusted mean difference: 3.87, 95% CI: 0.37 to 7.38). For youth, we observed no differences in HR-QOL and HIV disease measures by insurance. CONCLUSION These findings suggest meaningful differences in antiretroviral therapy adherence and some HR-QoL outcomes by health insurance coverage among young adults born to WLHIV.
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Affiliation(s)
- Tiffany L Lemon
- Center for Global Health, Massachusetts General Hospital, Boston, MA
| | | | - Alexander C Tsai
- Center for Global Health, Massachusetts General Hospital, Boston, MA
- Mongan Institute, Massachusetts General Hospital, Boston, MA
- Department of Psychiatry Harvard Medical School, Boston, MA
| | - Krystal Cantos
- Center for Global Health, Massachusetts General Hospital, Boston, MA
- IQVIA Epidemiology & Drug Safety, Cambridge, MA
| | - Dan Escudero
- Center for Global Health, Massachusetts General Hospital, Boston, MA
| | - M K Quinn
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Deborah Kacanek
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Claire Berman
- Center for Global Health, Massachusetts General Hospital, Boston, MA
| | - Liz Salomon
- Center for Global Health, Massachusetts General Hospital, Boston, MA
| | - Sharon Nichols
- Department of Neurosciences, University of California, San Diego San Diego, CA; and
| | - Ellen G Chadwick
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - George R Seage
- Center for Global Health, Massachusetts General Hospital, Boston, MA
| | - Paige L Williams
- Center for Global Health, Massachusetts General Hospital, Boston, MA
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA
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Barr EA, Raybin JL, Dunlevy H, Abuogi L, Jones J. Transition From Pediatric and Adolescent HIV Care to Adult HIV Care and the Patient-Provider Relationship: A Qualitative Metasynthesis. J Assoc Nurses AIDS Care 2022; 33:132-154. [PMID: 33654006 DOI: 10.1097/jnc.0000000000000239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Approximately 5 million adolescents (ages 15-24 years) living with HIV will transition to adult care in the next decade. Only half are engaged in care 12 months post-transition. This qualitative metasynthesis aimed to answer: What effect did the patient-provider relationship (PPR) have on adolescent living with HIV transition? What strategies were suggested to develop trusting relationships to promote engagement and retention in care? Primary qualitative studies from PubMed, CINAHL, and EBSCO (January 2008 to December 2019) were identified. Data were analyzed using team-based thematic synthesis techniques and international standards. Fourteen articles with 478 participants from eight countries were included. Four themes emerged: the familial nature of the PPR, stigma as a bond and barrier, the provider knowing the patient and getting to know new providers, and recommendations supporting transition. The PPR is integral. Collaborative strategies used to build new relationships will support autonomy, decrease stigma, and facilitate trust.
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Affiliation(s)
- Emily A Barr
- Emily A. Barr, MSN, RN, CPNP, CNM, is an Assistant Professor, Division of Infectious Diseases, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA. Jennifer L. Raybin, MSN, RN, CPNP, is an Associate Professor, Department of Pediatrics, Palliative Care Program Leader, Children's Hospital Colorado, University of Colorado School of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA. Hillary Dunlevy, MD, MPH, is an Assistant Professor, Division of Infectious Diseases, Department of Medicine, University of Colorado School of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA. Lisa Abuogi, MD, MSc, is an Associate Professor, Division of Infectious Diseases, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA. Jacqueline Jones, PhD, RN, FAAN, is a Professor at the College of Nursing, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, USA
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Alwadiy F, Mok E, Dasgupta K, Rahme E, Frei J, Nakhla M. Association of Self-Efficacy, Transition Readiness and Diabetes Distress With Glycemic Control in Adolescents With Type 1 Diabetes Preparing to Transition to Adult Care. Can J Diabetes 2021; 45:490-495. [PMID: 34176613 DOI: 10.1016/j.jcjd.2021.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 03/25/2021] [Accepted: 05/12/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Adolescence and emerging adulthood are associated with inadequate medical follow up, suboptimal glycemic control and higher risk for adverse outcomes. Our aim in this study was to determine whether self-efficacy, transition readiness or diabetes distress is associated with glycemic control (glycated hemoglobin [A1C]) among adolescents with type 1 diabetes (T1D) preparing to transition to adult care. METHODS We conducted a cross-sectional study of adolescents (age 17 years) with T1D followed at the Montreal Children's Hospital Diabetes Clinic 1 year before transferring to adult care. Participants completed validated questionnaires on self-efficacy (Self-Efficacy for Diabetes Self-Management Measure [SEDM], score 1 to 10), transition readiness (Am I ON TRAC? For Adult Care questionnaire [TRAC], score ≥8 indicates readiness) and diabetes distress (Diabetes Distress Scale for Adults with Type 1 Diabetes [T1-DDS], score ≥3 indicates distress). The primary outcome was A1C (%) 1 year before transfer. We examined associations of self-efficacy, transition readiness and diabetes distress with A1C using multivariate linear and logistic regression models adjusted for sex, age at diagnosis and socioeconomic status. RESULTS Of 74 adolescents with T1D (29 males, 39.1%), 27 (36.4%) had suboptimal glycemic control (A1C ≥9.0%). Less than half were transition-ready (TRAC questionnaire score ≥8) and 14% had diabetes distress (T1-DDS score ≥3). SEDM was not associated with A1C. Adolescents considered ready for transition were less likely to have suboptimal glycemic control (odds ratio, 0.30; 95% confidence interval, 0.09 to 0.99), whereas adolescents with diabetes distress were more likely to have suboptimal glycemic control (odds ratio, 6.24; 95% confidence interval, 1.06 to 36.75). CONCLUSIONS Improving health-care transition within pediatric care should focus on both transition readiness and diabetes distress to help improve adolescents' glycemic control and prepare them for adult care.
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Affiliation(s)
- Faisal Alwadiy
- Division of Endocrinology, Department of Pediatrics, McGill University Health Centre, Montreal, Québec, Canada
| | - Elise Mok
- Center of Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Kaberi Dasgupta
- Center of Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada; Division of Clinical Epidemiology, Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Elham Rahme
- Center of Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada; Division of Clinical Epidemiology, Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Jennifer Frei
- Center of Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Meranda Nakhla
- Division of Endocrinology, Department of Pediatrics, McGill University Health Centre, Montreal, Québec, Canada; Center of Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada.
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Abstract
Because of effective treatment and prolonged survival, thousands of young adult people living with HIV will need to transfer their health care to adult care providers. However, many lack basic essential skills and are not prepared for this transition. Many providers do not assess transition readiness on a regular basis. Validated transition readiness assessment tools can help providers guide interventions based on identified skill and knowledge deficits. Our purpose was to describe the impact of incorporating a validated Transition Readiness Assessment Questionnaire (TRAQ) into clinical practice. A retrospective chart review of 48 patients with HIV, ages 22-24 years, showed that the use of the TRAQ significantly affected provider interventions in the area of medication management (odds ratio: 0.02). Overall, the use of the TRAQ did not increase clinical interventions; however, it enabled providers to identify knowledge or skill deficits not previously addressed and to plan future clinical interventions to meet individual patient needs.
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Disabato JA, Mannino JE, Betz CL. Pediatric Nurses' Role in Health Care Transition Planning: National Survey Findings and Practice Implications. J Pediatr Nurs 2019; 49:60-66. [PMID: 31494347 DOI: 10.1016/j.pedn.2019.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 08/04/2019] [Accepted: 08/06/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE Youth and young adults (YYA) with chronic illness and/or disability (CID) face numerous challenges in transition from pediatric to adult health care. Established evidence supports interdisciplinary team approaches to preparing youth and families for transition and transfer. The purpose of this national survey was to address a gap in current knowledge specific to pediatric nursing professionals' roles and responsibilities in health care transition planning (HCTP). METHODOLOGY A quantitative descriptive study using a survey questionnaire validated by experts in the field investigated respondents' role in HCTP, inclusion of HCTP in job description, levels of HCTP knowledge, and ratings of importance of HCTP elements. A volunteer sample of 1814 respondents was drawn from two professional organizations. RESULTS Over 64% of respondents performed HCTP activities related to complex chronic illness management. Only 18% reported specialized training in HCTP. The highest-ranking items in regard to perceived importance were educating and supporting disease self-management and speaking with families about complex needs. Predictors of perceived importance were role, inclusion of transition planning in a job description, percentage of time in direct care, caring for those aged 14 years and older, and level of knowledge about HCTP. CONCLUSIONS The findings highlight key aspects of the pediatric nurse role in HCTP and identify specific elements that can be addressed to support future HCTP role development. PRACTICE IMPLICATIONS Pediatric nurses perform a vital role in HCTP for YYA with CID that may be enhanced with the inclusion of HCTP activities in job descriptions and specialized interdisciplinary HCTP training related to this emerging and growing population.
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Affiliation(s)
- Jennifer A Disabato
- College of Nursing & School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America.
| | - Jennifer E Mannino
- Barbara H. Hagan School of Nursing, Molloy College, Rockville Center, NY, United States of America
| | - Cecily L Betz
- Clinical Pediatrics, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
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Lindmark U, Bülow PH, Mårtensson J, Rönning H. The use of the concept of transition in different disciplines within health and social welfare: An integrative literature review. Nurs Open 2019; 6:664-675. [PMID: 31367388 PMCID: PMC6650790 DOI: 10.1002/nop2.249] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 12/03/2018] [Accepted: 01/15/2019] [Indexed: 11/20/2022] Open
Abstract
AIMS To continuing the quest of the concept of transition in nursing research and to explore how the concept of transition is used in occupational therapy, oral health and social work as well as in interdisciplinary studies in health and welfare, between 2003-2013. DESIGN An integrative literature review. METHODS PubMed, CINAHL, PsycINFO, DOSS, SocIndex, Social Science Citation Index and AMED databases from 2003-2013 were used. Identification of 350 articles including the concept of transition in relation to disciplines included. Assessment of articles are in accordance to Meleis' typologies of transition by experts in each discipline. Chosen key factors were entered into Statistical Package for the Social Sciences (SPSS). RESULTS Meleis' four typologies were found in all studied disciplines, except development in oral health. The health-illness type was the most commonly explored, whereas in social work and in occupation therapy, situational transitions dominated.
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Affiliation(s)
- Ulrika Lindmark
- Department of Natural Science and Bio Medicine, Center for Oral Health, School of Health and WelfareJönköping UniversityJönköpingSweden
| | - Pia H. Bülow
- Department of Social Work, School of Health and WelfareJönköping UniversityJönköpingSweden
- Department of Social WorkUniversity of the Free StateBloemfonteinSouth Africa
| | - Jan Mårtensson
- Department of Nursing, School of Health and WelfareJönköping UniversityJönköpingSweden
| | - Helén Rönning
- School of Health and WelfareJönköping UniversityJönköpingSweden
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Straub DM, Tanner AE. Health-care transition from adolescent to adult services for young people with HIV. THE LANCET CHILD & ADOLESCENT HEALTH 2018; 2:214-222. [PMID: 30169256 DOI: 10.1016/s2352-4642(18)30005-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 10/27/2017] [Accepted: 10/31/2017] [Indexed: 12/17/2022]
Abstract
HIV-related care and treatment engagement are crucial steps to improve individual and population-level health; yet, many young people (18-25 years old) with HIV are not maintained in, or disengage from, care. Health-care transition and the transfer to adult care are particularly vulnerable points in the care and treatment of young people with HIV. In this Review, we explore barriers and facilitators to health-care transition, evaluate existing health-care transition programmes, and identify best practices for the improvement of health-care transition outcomes and health. Although we examine health-care transition across a range of geographical regions, most examples are from the settings in which the most research has been done-the USA and western Europe.
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Affiliation(s)
- Diane M Straub
- Pediatrics Department, University of South Florida, Tampa, FL, USA.
| | - Amanda E Tanner
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC, USA
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Mitchell AG, Belton S, Johnston V, Ralph AP. Transition to adult care for Aboriginal children with rheumatic fever: a review informed by a focussed ethnography in northern Australia. Aust J Prim Health 2018; 24:9-13. [DOI: 10.1071/py17069] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 09/28/2017] [Indexed: 11/23/2022]
Abstract
Aboriginal children in northern Australia have high rates of rheumatic fever and rheumatic heart disease, which are chronic conditions because of the need for long-term treatment and monitoring. This article critically reviews the literature on transition to adult care for children with chronic conditions and considers applicability to the care of these children. The review was merged with findings from a focussed ethnography conducted in four remote Aboriginal communities with young people who have these conditions. Transition care aims to support adolescents on a healthcare trajectory to facilitate best long-term health and personal outcomes. Characteristics of the two medical conditions, the children and their local health services in northern Australia were generalised and merged with principles from the transition care literature, including policies governing transition clinics in urban locations. In this setting, the challenge is to transition Aboriginal children safely through to adulthood without rheumatic heart damage rather than to a separate health service on reaching adulthood. Recommended tailoring of transition care involves engaging and valuing local navigators who can address language and cultural barriers to provide a sustainable alternative to transition coordinators in mainstream programs. This has potential to improve care without further burdening overstretched clinical resources.
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A review of transition experiences in perinatally and behaviourally acquired HIV-1 infection; same, same but different? J Int AIDS Soc 2017; 20:21506. [PMID: 28530044 PMCID: PMC5577725 DOI: 10.7448/ias.20.4.21506] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Introduction: Despite sharing common psychosocial and developmental experiences, adolescents living with perinatally and behaviourally acquired HIV-1 infection are different in terms of timing of HIV infection and developmental stage at infection. Therefore, it is of interest to identify similarities and differences between these two groups of adolescents living with HIV in their experiences, facilitators and barriers during the transition process. Methods: A detailed literature search of peer-reviewed published papers was conducted on PubMed to identify relevant original research or viewpoints published up to September 2016. Conference abstracts and other unpublished data sources were not included. Results: Existing published literature, mainly using qualitative methods, explores the transition from paediatric to adult healthcare provision, as experienced by these two groups of young people. Reports highlight the variation and similarities in their experiences and challenges of transition. Findings from the USA and Europe predominate, while experience from Africa and Asia is lacking, despite the importance of these regions in the global epidemic. Conclusions: Published transition data remain limited, and there are few studies focusing on behaviourally infected adolescents and key population groups (e.g. adolescents who use drugs, lesbian/gay/transgender individuals). Robust definitions of the transition process and standardized outcome measures are required to facilitate cross-study and geographic comparisons.
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The Happy Teen programme: a holistic outpatient clinic-based approach to prepare HIV-infected youth for the transition from paediatric to adult medical care services in Thailand. J Int AIDS Soc 2017; 20:21500. [PMID: 28530043 PMCID: PMC5704900 DOI: 10.7448/ias.20.4.21500] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Introduction: We developed an 18‐month Happy Teen 2 (HT2) programme comprised of a one‐day workshop, two half‐day sessions, and three individual sessions to prepare HIV‐infected youth for the transition from paediatric to adult HIV care services. We describe the programme and evaluate the change in youth's knowledge scores. Methods: We implemented the HT2 programme among HIV‐infected Thai youth aged 14–22 years who were aware of their HIV status and receiving care at two hospitals in Bangkok (Siriraj Hospital, Queen Sirikit National Institute of Child Health [QSNICH]). Staff interviewed youth using a standardized questionnaire to assess HIV and health‐related knowledge at baseline and at 12 and 18 months while they participated in the programme. We examined factors associated with a composite knowledge score ≥95% at month 18 using logistic regression. Results: During March 2014–July 2016, 192 of 245 (78%) eligible youth were interviewed at baseline. Of these, 161 (84%) returned for interviews at 12 and 18 months. Among the 161 youth, the median age was 17 years, 74 (46%) were female, and 99% were receiving antiretroviral treatment. The median composite score was 45% at baseline and increased to 82% at 12 months and 95% at 18 months (P < 0.001). The range of median knowledge scores for antiretroviral management, HIV monitoring, HIV services, and family planning significantly increased from baseline (range 0–75%) to (range 67–100%) at 12 months and to 100% at 18 months (P < 0.001). Almost all youth were able to describe education and career goals at 12 and 18 months compared to 75% at baseline. In multivariable analysis, a composite knowledge score at 18 months >95% was associated with education level >high school (aOR: 2.15, 95%CI, 1.03–4.48) and receipt care at QSNICH (aOR: 2.43, 95%CI, 1.18–4.98). Youth whose mother and father had died were less likely to have score ≥95% (aOR: 0.22, 95%CI, 0.07–0.67) than those with living parents. Conclusions: Knowledge useful for a successful transition from paediatric to adult HIV care increased among youth participating in the HT2 programme. Youth follow‐up will continue to assess the impact of improved knowledge on outcomes following the transition to adult care services.
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Transition from children's to adult services for young adults with life-limiting conditions: A realist review of the literature. Int J Nurs Stud 2017; 76:1-27. [PMID: 28898740 DOI: 10.1016/j.ijnurstu.2017.06.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 04/16/2017] [Accepted: 06/21/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Improvements in care and treatment have led to more young adults with life-limiting conditions living beyond childhood, which means they must make the transition from children's to adult services. This has proved a challenging process for both young adults and service providers, with complex transition interventions interacting in unpredictable ways with local contexts. OBJECTIVES To explain how intervention processes interact with contextual factors to help transition from children's to adult services for young adults with life-limiting conditions. DESIGN Systematic realist review of the literature. DATA SOURCES Literature was sourced from four electronic databases: Embase, MEDLINE, Science Direct and Cochrane Library from January 1995 to April 2016. This was supplemented with a search in Google Scholar and articles sourced from reference lists of included papers. REVIEW METHODS Data were extracted using an adapted standardised data extraction tool which included identifying information related to interventions, mechanisms, contextual influences and outcomes. Two reviewers assessed the relevance of papers based on the inclusion criteria. Methodological rigor was assessed using the relevant Critical Appraisal Skills Programme tools. RESULTS 78 articles were included in the review. Six interventions were identified related to an effective transition to adult services. Contextual factors include the need for children's service providers to collaborate with adult service providers to prepare an environment with knowledgeable staff and adequate resources. Mechanisms triggered by the interventions include a sense of empowerment and agency amongst all stakeholders. CONCLUSIONS Early planning, collaboration between children's and adult service providers, and a focus on increasing the young adults' confidence in decision-making and engaging with adult services, are vital to a successful transition. Interventions should be tailored to their context and focused not only on organisational procedures but on equipping young adults, parents/carers and staff to engage with each other effectively.
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Philbin MM, Tanner AE, Chambers BD, Ma A, Ware S, Lee S, Fortenberry JD, The Adolescent Trials Network. Transitioning HIV-infected adolescents to adult care at 14 clinics across the United States: using adolescent and adult providers' insights to create multi-level solutions to address transition barriers. AIDS Care 2017; 29:1227-1234. [PMID: 28599596 DOI: 10.1080/09540121.2017.1338655] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
HIV-infected adolescents have disproportionately low rates of care retention and viral suppression. Approximately half disengage from care while transitioning to adult clinics, in part due to fragmented care systems and lack of streamlined protocols. We conducted 58 qualitative interviews with social service and health care providers across 14 Adolescent Trials Network clinics (n = 28) and 20 adult clinics that receive transitioning adolescents (n = 30) from August 2015-June 2016. We used the constant comparative approach to examine processes, barriers, and facilitators of adult care transition. Transition barriers coalesced around three levels. Structural: insurance eligibility, transportation, and HIV-related stigma; Clinical: inter-clinic communication, differences in care cultures, and resource/personnel limitations; and Individual: adolescents' transition readiness and developmental capacity. Staff-initiated solutions (e.g., grant-funded transportation) were often unsustainable and applied individual-level solutions to structural-level barriers. Comprehensive initiatives, which develop collaborative policies and protocols that support providers' ability to match the solution and barrier level (i.e., structural-to-structural), are sorely needed. These initiatives should also support local systematic planning to facilitate inter-clinic structures and communication. Such approaches will help HIV-infected adolescents transition to adult care and improve long-term health outcomes.
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Affiliation(s)
- Morgan M Philbin
- a Department of Sociomedical Sciences , Columbia University Mailman School of Public Health , New York , NY , USA
| | - Amanda E Tanner
- b Department of Public Health Education , University of North Carolina Greensboro , Greensboro , NC , USA
| | - Brittany D Chambers
- b Department of Public Health Education , University of North Carolina Greensboro , Greensboro , NC , USA
| | - Alice Ma
- b Department of Public Health Education , University of North Carolina Greensboro , Greensboro , NC , USA
| | - Samuella Ware
- b Department of Public Health Education , University of North Carolina Greensboro , Greensboro , NC , USA
| | - Sonia Lee
- c Maternal and Pediatric Infectious Disease Branch , Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health , Bethesda , MD , USA
| | - J Dennis Fortenberry
- d Department of Pediatrics , Indiana University School of Medicine , Indianapolis , IN , USA
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Tepper V, Zaner S, Ryscavage P. HIV healthcare transition outcomes among youth in North America and Europe: a review. J Int AIDS Soc 2017; 20:21490. [PMID: 28530041 PMCID: PMC5577703 DOI: 10.7448/ias.20.4.21490] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 02/14/2016] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION The transition from paediatric to adult care poses risks to the health of young adults living with HIV if unsuccessful, including interruptions in care and poor health outcomes. Evolving best practices in HIV healthcare transition should ideally be informed by real-world qualitative and quantitative clinical healthcare transition outcomes. There has been a recent proliferation of HIV healthcare transition outcome research, largely from Europe and North America. METHODS A literature search was undertaken using the online databases PubMed, Web of Science, and Google Scholar. Medical subject and text word searches were combined for terms relating to HIV, paediatric transition outcomes, and internal and external factors were used to identify peer-reviewed articles. RESULTS In this paper, we review data on HIV healthcare transition outcomes in North America and Europe. Internal and external factors which may impact the success of HIV healthcare transition are examined. We describe ongoing research efforts to capture transition outcomes in the North America and Europe. Clinical, operational, and implementation science research gaps that exist to date are highlighted. Efforts to improve HIV healthcare transition research through country-level surveillance networks and large multicentre cohorts, including data integration and linkage between paediatric and adult cohorts are discussed. CONCLUSIONS We identified the need for a comprehensive approach to implementing empirically supported protocols to support healthcare transition for ALHIV. While there is limited prospective longitudinal cohort data available at this time, cohorts linking the paediatric and adolescent with ongoing surveillance into adulthood are being developed. Through a review of existing qualitative and quantitative healthcare transition outcomes studies, we identify emerging areas of consensus surrounding healthcare transition research implementation. Successful healthcare transition programmes in Europe and North America often share several characteristics, including implementation of a youth friendly multidisciplinary approach, consistent communication and integration between paediatric and adult care teams, and an individualized approach which is attuned the adolescent's transition readiness. Moving forward, the voices of youth and young adults living with HIV should be included in the development and evaluation of healthcare transition protocols to ensure that the definition of successful transition reflects all of the stakeholders in the transition process.
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Affiliation(s)
- Vicki Tepper
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Stefanie Zaner
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Patrick Ryscavage
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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16
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Abstract
Remarkable advances have been made in the treatment of HIV. Despite progress in reducing perinatal HIV transmission, there is a growing number of adolescents and emerging adults with HIV who will require transfer of care from pediatric to adult providers. Adolescents with HIV have poorer retention in care and viral suppression compared to other age groups with HIV. Barriers to successful care of youth with HIV include mental health disorders, poor medication adherence, socioeconomic instability, and HIV-related stigma. Transfer of care to adult providers is often met with reluctance on the part of the adolescent. Recommendations for effective transfer of care include clear communication between adult and pediatric providers, early initiation of a transition planning discussion, a multidisciplinary team approach, and meeting the adult provider prior to the transfer of care. Adult HIV care may be more fragmented than adolescents are familiar with, but thoughtful transition approaches can foster development of health and life skills among youth with HIV. [Pediatr Ann. 2017;46(5):e198-e202.].
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17
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Sainz T, Navarro ML. HIV-Infected Youths: Transition in Spain Compared to the Netherlands. Clin Infect Dis 2016; 64:230. [DOI: 10.1093/cid/ciw702] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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18
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Kakkar F, Van der Linden D, Valois S, Maurice F, Onnorouille M, Lapointe N, Soudeyns H, Lamarre V. Health outcomes and the transition experience of HIV-infected adolescents after transfer to adult care in Québec, Canada. BMC Pediatr 2016; 16:109. [PMID: 27457719 PMCID: PMC4960665 DOI: 10.1186/s12887-016-0644-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 07/15/2016] [Indexed: 11/24/2022] Open
Abstract
Background Little is known on outcomes after transition to adult care among adolescents with perinatal HIV infection. Though there is data from other chronic pediatric diseases suggesting increased morbidity and mortality following transfer to adult care, this has not well been studied among the first wave of survivors of perinatal HIV infection. The primary objective of this study was to determine outcomes after transition to adult care among a cohort of HIV-infected adolescents in Québec, Canada. Secondary objectives were to document participant experiences with the transition process, identify barriers to successful transition, and potential changes to improve the transition process. Methods Clinic records were reviewed to identify all perinatally-infected youth who transitioned from the Centre Maternel et Infantile sur le Sida pediatric HIV clinic (Montreal) at age 18 to an adult care provider between 1999 and 2012. Transitioned patients were contacted using last available patient or parental listed phone number on hospital record, internet based telephone directory, or social media. A standardized questionnaire was administered by telephone or in-person interview, and copies of current medical records obtained from treating physicians. Results Forty-five patients were transferred between 1999 and 2012, among whom 25 consented to the study, eight were lost to follow-up, eight refused participation, and four were deceased. Overall 76 % of patients remained engaged in care, defined by at least one physician visit within 6 months of the interview. Over 50 % reported difficulty with adherence to their current drug regimens. At one-year post-transfer, there was a decrease in the proportion of patients with CD4 count >500 cells/mm3 from 64 to 29 %, and a statistically significant decrease in absolute CD4 count (mean 370 vs 524 cells/mm3, p = 0.04.). The majority (92 %) of participants felt that 18 was too young an age to transfer to adult care, and provided suggestions for improving the transition process. Conclusions This group of perinatally-infected youth remained engaged in care after transition, however difficulties with adherence and assuming responsibility for their own care were identified as issues in their post-transition care. The high rate of mortality among them and the changes to their health status post-transition suggest that further work is necessary to document the health outcomes of this group in larger, more diverse cohort settings.
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Affiliation(s)
- Fatima Kakkar
- Division of Infectious Diseases, CHU Sainte-Justine, 3175 Côte Sainte-Catherine, Montréal, Québec, H3T 1C5, Canada. .,Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montréal, Canada. .,Centre Maternel et Infantile sur le SIDA, CHU Sainte-Justine, Montréal, Canada.
| | - Dimitri Van der Linden
- Cliniques universitaires Saint-Luc, Maladies Infectieuses Pédiatriques, Service de Pédiatrie Générale, Bruxelles, Belgium
| | - Silvie Valois
- Centre Maternel et Infantile sur le SIDA, CHU Sainte-Justine, Montréal, Canada
| | - Francois Maurice
- Centre Maternel et Infantile sur le SIDA, CHU Sainte-Justine, Montréal, Canada
| | - Marion Onnorouille
- Centre Maternel et Infantile sur le SIDA, CHU Sainte-Justine, Montréal, Canada
| | - Normand Lapointe
- Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montréal, Canada.,Centre Maternel et Infantile sur le SIDA, CHU Sainte-Justine, Montréal, Canada
| | - Hugo Soudeyns
- Centre Maternel et Infantile sur le SIDA, CHU Sainte-Justine, Montréal, Canada.,Unité d'immunopathologie virale, Centre de recherche du CHU Sainte-Justine, Montréal, Canada.,Department of Microbiology, Infectious Diseases and Immunology, Faculty of Medicine, Université de Montréal, Montréal, Canada
| | - Valerie Lamarre
- Division of Infectious Diseases, CHU Sainte-Justine, 3175 Côte Sainte-Catherine, Montréal, Québec, H3T 1C5, Canada.,Department of Pediatrics, Faculty of Medicine, Université de Montréal, Montréal, Canada.,Centre Maternel et Infantile sur le SIDA, CHU Sainte-Justine, Montréal, Canada
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19
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Weijsenfeld AM, Smit C, Cohen S, Wit FWNM, Mutschelknauss M, van der Knaap LC, van Zonneveld LM, Zomer BJ, Nauta N, Patist JC, Kuipers-Jansen MHJ, Smit EP, Blokhuis C, Pajkrt D, Weijsenfeld AM, Cohen S, Blokhuis C, van der Plas A, Scherpbier HJ, Mutschelknauss M, Nellen FJB, Prins JM, Pajkrt D, Smit C, Wit FWNM, Reiss P, van der Knaap L, Visser E, van Zonneveld LM, Vriesde ME, Bassant NY, van der Ende ME, van Rossum AMC, Driessen GJA, Fraaij PLA, Smit JV, Smit EP, Kastelijns MPW, den Hollander JG, Pogány K, Moons C, Kroon FP, Oude Geerdink E, van der Meche IB, Schouten WEM, Brinkman K, Ter Beest G, Gisolf EH, Richter C, Zomer BJ, Strik-Albers R, van der Flier M, Henriet SS, Koopmans PP, Patist JC, Nauta N, Geelen SPM, Wolfs TFW, Hoepelman IM, Mudrikova T, van der Meulen PA, de Jonge H, Scholvink EH, Bierman WFW, van den Berg JF, Bouwhuis JW, Faber S, van Vonderen M, Schippers JA, Lowe SH, Kuipers-Jansen MHJ, van Kasteren MEE, Brouwer AE, Pronk DC, Kortmann W. Virological and Social Outcomes of HIV-Infected Adolescents and Young Adults in The Netherlands Before and After Transition to Adult Care. Clin Infect Dis 2016; 63:1105-1112. [PMID: 27439528 DOI: 10.1093/cid/ciw487] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 07/06/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND As a result of effective combination antiretroviral therapy (cART) and advanced supportive healthcare, a growing number of human immunodeficiency virus (HIV)-infected children survive into adulthood. The period of transition to adult care is often associated with impaired adherence to treatment and discontinuity of care. We aimed to evaluate virological and social outcomes of HIV-infected adolescents and young adults (AYAs) before and after transition, and explore which factors are associated with virological failure. METHODS We included 59 HIV-infected AYAs from the Netherlands who had entered into pediatric care and transitioned from pediatric to adult healthcare. We used HIV RNA load and cART data from the Dutch Stichting HIV Monitoring database (1996-2014), and collected social and treatment data from patients' medical records from all Dutch pediatric HIV treatment centers and 14 Dutch adult treatment centers involved. We evaluated risk factors for virological failure (VF) in a logistic regression model adjusted for repeated measurements. RESULTS HIV VF occurred frequently during the study period (14%-36%). During the transition period (from 18 to 19 years of age) there was a significant increase in VF compared with the reference group of children aged 12-13 years (odds ratio, 4.26 [95% confidence interval, 1.12-16.28]; P = .03). Characteristics significantly associated with VF were low educational attainment and lack of autonomy regarding medication adherence at transition. CONCLUSIONS HIV-infected AYAs are vulnerable to VF, especially during the transition period. Identification of HIV-infected adolescents at high risk for VF might help to improve treatment success in this group.
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Affiliation(s)
- Annouschka M Weijsenfeld
- Department of Pediatric Infectious Diseases, Emma Children's Hospital, Academic Medical Centre AMC
| | | | - Sophie Cohen
- Department of Pediatric Infectious Diseases, Emma Children's Hospital, Academic Medical Centre AMC
| | - Ferdinand W N M Wit
- HIV Monitoring Foundation.,Department of Infectious Diseases, Academic Medical Center AMC, Amsterdam
| | | | - Linda C van der Knaap
- Department of Pediatrics, Division of Infectious Diseases and Immunology, Erasmus Medical Centre-Sophia Children's Hospital
| | | | - Bert J Zomer
- Department of Infectious Diseases, Radboud University Medical Centre, Nijmegen
| | - Nike Nauta
- Department of Pediatric Infectious Diseases, Wilhelmina Children's Hospital
| | - Joke C Patist
- Department of Internal Medicine and Infectious Diseases, University Medical Centre UMC, Utrecht
| | | | - Esther P Smit
- Department of Infectious Diseases, Maasstad Hospital, Rotterdam, The Netherlands
| | - Charlotte Blokhuis
- Department of Pediatric Infectious Diseases, Emma Children's Hospital, Academic Medical Centre AMC
| | - Dasja Pajkrt
- Department of Pediatric Infectious Diseases, Emma Children's Hospital, Academic Medical Centre AMC
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20
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Kahana SY, Jenkins RA, Bruce D, Fernandez MI, Hightow-Weidman LB, Bauermeister JA. Structural Determinants of Antiretroviral Therapy Use, HIV Care Attendance, and Viral Suppression among Adolescents and Young Adults Living with HIV. PLoS One 2016; 11:e0151106. [PMID: 27035905 PMCID: PMC4817971 DOI: 10.1371/journal.pone.0151106] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 02/22/2016] [Indexed: 11/18/2022] Open
Abstract
Background The authors examined associations between structural characteristics and HIV disease management among a geographically diverse sample of behaviorally and perinatally HIV-infected adolescents and young adults in the United States. Methods The sample included 1891 adolescents and young adults living with HIV (27.8% perinatally infected; 72.2% behaviorally infected) who were linked to care through 20 Adolescent Medicine Trials Network for HIV/AIDS Interventions Units. All completed audio computer–assisted self-interview surveys. Chart abstraction or blood draw provided viral load data. Geographic-level variables were extracted from the United States Census Bureau (e.g., socioeconomic disadvantage, percent of Black and Latino households, percent rural) and Esri Crime (e.g., global crime index) databases as Zip Code Tabulation Areas. AIDSVu data (e.g., prevalence of HIV among youth) were extracted at the county-level. Using HLM v.7, the authors conducted means-as-outcomes random effects multi-level models to examine the association between structural-level and individual-level factors and (1) being on antiretroviral therapy (ART) currently; (2) being on ART for at least 6 months; (3) missed HIV care appointments (not having missed any vs. having missed one or more appointments) over the past 12 months; and (4) viral suppression (defined by the corresponding assay cutoff for the lower limit of viral load at each participating site which denoted nondetectability vs. detectability). Results Frequencies for the 4 primary outcomes were as follows: current ART use (n = 1120, 59.23%); ART use for ≥6 months (n = 861, 45.53%); at least one missed HIV care appointment (n = 936, 49.50); and viral suppression (n = 577, 30.51%). After adjusting for individual-level factors, youth living in more disadvantaged areas (defined by a composite score derived from 2010 Census indicators including percent poverty, percent receiving public assistance, percent of female, single-headed households, percent unemployment, and percent of people with less than a high school degree) were less likely to report current ART use (OR: 0.85, 95% CI: 0.72–1.00, p = .05). Among current ART users, living in more disadvantaged areas was associated with greater likelihood of having used ART for ≥6 months. Participants living in counties with greater HIV prevalence among 13–24 year olds were more likely to report current ART use (OR: 1.32, 95% CI: 1.05–1.65, p = .02), ≥6 months ART use (OR: 1.32, 95% CI: 1.05–1.65, p = .02), and to be virally suppressed (OR: 1.50, 95% CI: 1.20–1.87, p = .001); however, youth in these areas were also more likely to report missed medical appointments (OR: 1.32, 95% CI: 1.07–1.63, p = .008). Conclusions The findings underscore the multi-level and structural factors associated with ART use, missed HIV care appointments, and viral suppression for adolescents and young adults in the United States. Consideration of these factors is strongly recommended in future intervention, clinical practice, and policy research that seek to understand the contextual influences on individuals’ health behaviors.
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Affiliation(s)
- Shoshana Y. Kahana
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse/National Institutes of Health, Bethesda, MD, United States of America
- * E-mail:
| | - Richard A. Jenkins
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse/National Institutes of Health, Bethesda, MD, United States of America
| | - Douglas Bruce
- Department of Health Sciences, DePaul University, Chicago, IL, United States of America
| | - Maria I. Fernandez
- Department of Preventive Medicine and Department of Public Health Program, College of Osteopathic Medicine, Nova Southeastern University, Ft. Lauderdale, FL, United States of America
| | - Lisa B. Hightow-Weidman
- Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Jose A. Bauermeister
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States of America
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21
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Newman CE, Persson A, Miller A, Brown RJ. "Just take your medicine and everything will be fine": Responsibilisation narratives in accounts of transitioning young people with HIV into adult care services in Australia. AIDS Care 2015; 28:131-6. [PMID: 26477602 DOI: 10.1080/09540121.2015.1069790] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Young people who have grown up with perinatally acquired HIV in wealthy nations are increasingly transitioning into adult care settings which expect more independence and self-regulation than paediatric care. Drawing on the first qualitative study on growing up with HIV in Australia, this paper examines "responsibilisation" narratives in semi-structured interviews conducted with young people with HIV and their paediatric and adult care providers. Three dominant narratives were identified: responsibilisation as imperative, practice and contest. This suggests that while young people growing up with HIV in an advanced liberal setting such as Australia may value the independence of adult care, and appreciate the need to take responsibility for their health, the practices involved in becoming a responsible health citizen are shaped by individual histories and circumstances, and in some cases, can lead to serious contestation and conflict with care providers. Placing a stronger emphasis on what young people can gain from taking an active role in managing their health may more successfully foster responsibilisation, rather than focusing on what they will lose. Clinicians could benefit from greater support regarding how to engage young people with the elements of responsibilisation likely to resonate more meaningfully at different points in their lives.
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Affiliation(s)
- Christy E Newman
- a Centre for Social Research in Health , UNSW Australia , Sydney , Australia
| | - Asha Persson
- a Centre for Social Research in Health , UNSW Australia , Sydney , Australia
| | - Angela Miller
- b Short St Centre Sexual Health Service , South East Sydney Local Health District , Sydney , Australia.,c Paediatric HIV Service , Sydney Children's Hospital , Sydney , Australia
| | - Rebecca J Brown
- a Centre for Social Research in Health , UNSW Australia , Sydney , Australia
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22
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Fair CD, Goldstein B, Dizney R. Congruence of Transition Perspectives Between Adolescents With Perinatally-Acquired HIV and Their Guardians: An Exploratory Qualitative Study. J Pediatr Nurs 2015; 30:684-90. [PMID: 26117807 DOI: 10.1016/j.pedn.2015.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 05/31/2015] [Accepted: 06/07/2015] [Indexed: 11/29/2022]
Abstract
Youth with perinatally-acquired HIV infection (PHIV) routinely survive into adulthood requiring transition to adult care. Research underscores the importance of assessing transition perspective congruence between adolescents and guardians. Interviews focused on transition decisions were conducted with 18 adolescents with PHIV and their guardians recruited from a southeastern US pediatric infectious disease clinic. Transcribed responses were coded as congruent or divergent. Adolescents and guardians held congruent views that the transition process had not started. Fewer dyads agreed upon the level of adolescent and guardian involvement in transition decisions. Providers should assess congruence of adolescent and guardian perspectives regarding transition-related decisions.
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Affiliation(s)
| | | | - Rachel Dizney
- Pediatric Infectious Disease, University Medical Center, NC
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23
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Nehring WM, Betz CL, Lobo ML. Uncharted Territory: Systematic Review of Providers' Roles, Understanding, and Views Pertaining to Health Care Transition. J Pediatr Nurs 2015; 30:732-47. [PMID: 26228310 DOI: 10.1016/j.pedn.2015.05.030] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 05/21/2015] [Accepted: 05/22/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Health care transition (HCT) for adolescents and emerging adults (AEA) with special health care needs is an emerging field of interdisciplinary field of practice and research that is based upon an intergenerational approach involving care coordination between pediatric and adult systems of health care. Informed understanding of the state of the HCT science pertaining to this group of providers is needed in order to develop and implement service programs that will meet the comprehensive needs of AEA with special health care needs. METHODS The authors conducted a systematic review of the literature on the transition from child to adult care for adolescents and emerging adults (AEA) with special health care needs from 2004 to 2013. Fifty-five articles were selected for this review. An adaptation of the PRISMA guidelines was applied because all studies in this review used descriptive designs. RESULTS Findings revealed lack of evidence due to the limitations of the research designs and methodology of the studies included in this systematic review. Study findings were categorized the following four types: adult provider competency, provider perspectives, provider attitudes, and HCT service models. The discipline of medicine was predominant; interdisciplinary frameworks based upon integrated care were not reported. Few studies included samples of adult providers. CONCLUSIONS Empirical-based data are lacking pertaining to the role of providers involved in this specialty area of practice. Evidence is hampered by the limitations of the lack of rigorous research designs and methodology.
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Affiliation(s)
| | - Cecily L Betz
- Clinical Pediatrics, USC Keck School of Medicine, Department of Pediatrics, University of Southern California University Center of Excellence for Developmental Disabilities at Children's Hospital Los Angeles
| | - Marie L Lobo
- University of New Mexico, College of Nursing, Albuquerque, NM
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24
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Moynihan M, Saewyc E, Whitehouse S, Paone M, McPherson G. Assessing readiness for transition from paediatric to adult health care: Revision and psychometric evaluation of the Am I ON TRAC for Adult Care questionnaire. J Adv Nurs 2015; 71:1324-35. [PMID: 25616006 PMCID: PMC4690724 DOI: 10.1111/jan.12617] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2014] [Indexed: 11/27/2022]
Abstract
AIM To refine and psychometrically test the Am I ON TRAC for Adult Care questionnaire. BACKGROUND Inadequate transition to adult care for adolescents with special healthcare needs has been associated with greater risk of treatment non-adherence, lack of medical follow-up, increased morbidity and mortality. Presently, there are no well-validated measures assessing adolescents' readiness to transition from paediatric to adult medical care. DESIGN Descriptive cross-sectional study. METHODS The Am I ON TRAC for Adult Care questionnaire was refined to improve the instrument's methodological soundness. A literature review informed the revisions. A convenience sample of 200 adolescents, 12-19 years, was recruited from four outpatient clinics at a paediatric hospital in Western Canada between April-June 2012. Construct validity was evaluated by Exploratory Factory Analysis; concurrent validity was assessed using the Psychosocial Maturity Index. Internal consistency was evaluated by computing Cronbach's alpha estimates. RESULTS Factor analysis of the knowledge items identified a 14-item unidimensional scale. Knowledge and behaviour sub-scale scores increased with age, with a stronger relationship between knowledge and age. Psychosocial maturity correlated with both sub-scale scores, but had a stronger association with behaviour. Psychosocial maturity and age had a weak but significant correlation suggesting age is a loose proxy for maturity. Only 27% of 17-year olds, but 62% 18-year olds, scored above the behaviour cut-off for transition readiness. CONCLUSION The revised Am I ON TRAC for Adult Care questionnaire is a psychometrically sound measure that has potential to be used as a readiness assessment tool in both clinical practice and research.
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Affiliation(s)
- Melissa Moynihan
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Elizabeth Saewyc
- School of Nursing and Division of Adolescent Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sandra Whitehouse
- Department of Paediatrics, Division of Adolescent Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Youth Transitions Initiative, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Mary Paone
- Division of Adolescent Health, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Gladys McPherson
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
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25
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Hussen SA, Chahroudi A, Boylan A, Camacho-Gonzalez AF, Hackett S, Chakraborty R. Transition of youth living with HIV from pediatric to adult-oriented healthcare: a review of the literature. Future Virol 2015; 9:921-929. [PMID: 25983853 PMCID: PMC4433446 DOI: 10.2217/fvl.14.73] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Due to advances in antiretroviral therapy, most HIV-infected children and youth now survive into adulthood. Many experts and professional societies have expressed concern about potential disruptions to care when youth living with HIV transition from pediatric to adult-oriented medical care. However, original research focused on this transition process is rare. The existing literature can be organized into the following categories: pre-transition assessments of anticipated barriers and concerns; studies describing provider practices during the transition period; and post-transition retrospective analyses after transition to adult care. Most studies had small sample sizes and focused on vertically infected youth. Further work is needed to document clinical outcomes after transition and to evaluate transition protocols that are in place at some institutions.
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Affiliation(s)
- Sophia A Hussen
- Hubert Department of Global Health, Rollins School of Public Health, Atlanta, GA 30322, USA
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA 30322, USA
- Ponce Family & Youth Clinic, Grady Infectious Diseases Program, Grady Health Systems, Atlanta, GA 30303, USA
| | - Ann Chahroudi
- Ponce Family & Youth Clinic, Grady Infectious Diseases Program, Grady Health Systems, Atlanta, GA 30303, USA
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Emory University School of Medicine, Atlanta, GA 30342, USA
| | - Ashley Boylan
- Ponce Family & Youth Clinic, Grady Infectious Diseases Program, Grady Health Systems, Atlanta, GA 30303, USA
| | - Andres F Camacho-Gonzalez
- Ponce Family & Youth Clinic, Grady Infectious Diseases Program, Grady Health Systems, Atlanta, GA 30303, USA
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Emory University School of Medicine, Atlanta, GA 30342, USA
| | - Stephanie Hackett
- Ponce Family & Youth Clinic, Grady Infectious Diseases Program, Grady Health Systems, Atlanta, GA 30303, USA
| | - Rana Chakraborty
- Ponce Family & Youth Clinic, Grady Infectious Diseases Program, Grady Health Systems, Atlanta, GA 30303, USA
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Emory University School of Medicine, Atlanta, GA 30342, USA
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Newman C, Persson A, Miller A, Cama E. Bridging worlds, breaking rules: Clinician perspectives on transitioning young people with perinatally acquired HIV into adult care in a low prevalence setting. AIDS Patient Care STDS 2014; 28:381-93. [PMID: 24749770 DOI: 10.1089/apc.2013.0346] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The first generation of young people with perinatally acquired HIV is moving into adulthood, precipitating a transition from pediatric to adult care. As the first research appraisal of Australian clinician perspectives on this process, this article makes a unique contribution by examining the particular challenges associated with transitioning this population into adult care in regions of low HIV prevalence among young people. Qualitative interviews were conducted with twelve pediatric and adult care clinicians and analyzed for dominant and diverging themes. Clinicians anticipated significant client vulnerabilities during transition and worked beyond the boundaries of their roles and service parameters to keep clients engaged as they moved between pediatric and adult care. Strategies to strengthen the transition process focused on communication and teamwork, informed by and responsive to the needs of individual young people and their families. Clinicians working in settings with very small numbers of young people with HIV must advocate for a hidden minority with little potential for gaining large scale recognition or system changes. New conversations are needed to design a stronger and more sustainable transition process for both young people living with HIV, and their clinicians who care for them, in low prevalence settings.
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Affiliation(s)
- Christy Newman
- Centre for Social Research in Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Asha Persson
- Centre for Social Research in Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Angela Miller
- Paediatric HIV Service, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Elena Cama
- Centre for Social Research in Health, The University of New South Wales, Sydney, New South Wales, Australia
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Greifinger R, Batchelor M, Fair C. Improving Engagement and Retention in Adult Care Settings for Lesbian, Gay, Bisexual, Transgender and Questioning (LGBTQ) Youth Living with HIV: Recommendations for Health Care Providers. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2013. [DOI: 10.1080/19359705.2013.739533] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Fair CD, Sullivan K, Dizney R, Stackpole A. "It's like losing a part of my family": transition expectations of adolescents living with perinatally acquired HIV and their guardians. AIDS Patient Care STDS 2012; 26:423-9. [PMID: 22686235 DOI: 10.1089/apc.2012.0041] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The increased life expectancy of perinatally HIV-infected adolescents necessitates the transition from pediatric to adult infectious disease care. Significant differences exist between pediatric and adult HIV clinic models, and adequate preparation is critical for successful transition. The expectations of youth on the cusp of this transition and their guardians have not previously been explored. Semistructured interviews were conducted with 40 perinatally infected adolescents (mean age, 17.3 years; 90% African American; 57.5% female; 57.5% in high school) currently receiving care in a pediatric infectious disease clinic in the southeast United States and 17 guardians about their expectations related to the pending transition to adult care. Interviews were transcribed and coded for emergent themes. Many adolescents had difficulty articulating expectations of their transition to an adult clinic, reporting they did not know what to expect. Others looked forward to increased responsibility and control, while some expressed concerns over leaving their current providers and having to establish new relationships. Most guardians viewed the transition to adult care as a tool to facilitate maturity. Several indicated they had not discussed transition with their child and were waiting for their child to initiate a conversation about it. Given the importance providers place on preparing youth for transition, it is surprising that many adolescents had no expectations about this impending change. This indicates a need for improved communication between providers and adolescents to enhance preparation and ultimately transition success. Additionally, guardians play an important role in the transition process and may need support to discuss this process with their child.
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Affiliation(s)
- Cynthia D. Fair
- Human Service Studies, Elon University, Elon, North Carolina
| | | | - Rachel Dizney
- Duke Pediatric Infectious Disease, Duke University Medical Center, Durham, North Carolina
| | - Avra Stackpole
- Advance Associate for the Executive Office of the President, McLean, Virginia
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Huang JS, Gottschalk M, Pian M, Dillon L, Barajas D, Bartholomew LK. Transition to adult care: systematic assessment of adolescents with chronic illnesses and their medical teams. J Pediatr 2011; 159:994-8.e2. [PMID: 21784450 PMCID: PMC3215794 DOI: 10.1016/j.jpeds.2011.05.038] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Revised: 04/29/2011] [Accepted: 05/19/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine the process of transition from pediatric to adult health care services from the perspectives of young adults with chronic disease and both pediatric and adult health care providers. STUDY DESIGN A qualitative approach using focus-group interviews was performed to investigate transition experiences. Novel games were also used to generate data. Content and narrative analyses of interview transcripts were performed. RESULTS We conducted 6 focus groups with 10 young adults who had chronic disease and with 24 health care providers. Content analysis yielded 3 content domains: (1) transition experiences in the context of relationships among patients, parents, and health care providers; (2) differences between pediatric and adult-oriented medicine and how these differences inhibit or facilitate transition; and (3) identification of transition services that should be provided to young patients who have chronic disease. CONCLUSION This study demonstrates the need for gradual transfer of disease management from parent to child and the need for better communication between adult and pediatric services during the transition process. Pediatric medicine and adult medicine represent different subcultures; acknowledging these differences may improve cooperation during transition from pediatric to adult providers. Young-adult patients with chronic disease embrace the use of technology for specific interventions to improve the transition experience.
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Affiliation(s)
- Jeannie S Huang
- Department of Pediatrics, University of California, San Diego, La Jolla, CA 92103, USA.
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