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Coyne I, Sleath B, Surdey J, Pembroke S, Hilliard C, Chechalk K, Rafferty S, Rogerson S, Hughes M M, Murphy M, Cody D, Roche E. Intervention to promote adolescents' communication and engagement in diabetes clinic encounters: A pilot randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2024; 126:108322. [PMID: 38772095 DOI: 10.1016/j.pec.2024.108322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 04/26/2024] [Accepted: 05/13/2024] [Indexed: 05/23/2024]
Abstract
AIM To conduct a pilot randomized trial of an intervention to improve adolescent question-asking and provider education during paediatric diabetes visits. METHODS Adolescents aged 11 to 17 with type 1 diabetes and their parents were enrolled from two urban tertiary paediatric clinics. Adolescents were randomised to the intervention group or control group. Adolescent consultations were audio-recorded, their HbA1c level was recorded, and they completed surveys after three clinic appointments. The intervention group completed a question prompt list and watched a video on a tablet with their parents before meeting their doctor and completed a short evaluation after each visit. RESULTS Six consultant endocrinologists and ninety-nine adolescents and their parents participated. The intervention increased adolescents' question asking and provider education in diabetes encounters. Total patient question-asking across the 3 consultations and a higher baseline HbA1c at time one was significantly associated with HbA1c at time three. CONCLUSIONS Question prompt lists and an educational video are useful tools to increase adolescents' question-asking and communication between adolescents and their providers. PRACTICE IMPLICATIONS Interventions that encourage adolescents' question-asking in healthcare encounters may lead to more meaningful providers-adolescents' communication and tailored education. Interventions to improve professionals' listening, communication and educational skills are also required.
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Affiliation(s)
- I Coyne
- Trinity College Dublin, School of Nursing and Midwifery, Dublin 2, Ireland.
| | - B Sleath
- University of North Carolina at Chapel Hill, Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Chapel Hill, NC, United States
| | - J Surdey
- Trinity College Dublin, School of Nursing and Midwifery, Dublin 2, Ireland
| | - S Pembroke
- Trinity College Dublin, School of Nursing and Midwifery, Dublin 2, Ireland
| | - C Hilliard
- Children's Health Ireland, Dublin 8, Ireland
| | - K Chechalk
- Trinity College Dublin, School of Medicine, Dublin 2, Ireland
| | - S Rafferty
- Trinity College Dublin, School of Nursing and Midwifery, Dublin 2, Ireland
| | - S Rogerson
- Trinity College Dublin, School of Nursing and Midwifery, Dublin 2, Ireland
| | - M Hughes M
- Trinity College Dublin, School of Nursing and Midwifery, Dublin 2, Ireland
| | - M Murphy
- Trinity College Dublin, School of Nursing and Midwifery, Dublin 2, Ireland
| | - D Cody
- Children's Health Ireland, Department of Diabetes and Endocrinology, Crumlin, Dublin 12, Ireland
| | - E Roche
- Trinity College Dublin, School of Medicine, Dublin 2, Ireland; Children's Health Ireland, Department of Endocrinology and Diabetes, Tallaght, Dublin 24, Ireland
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Siegel A, Lockridge R, Struemph KL, Toledo-Tamula MA, Little P, Wolters PL, Dufek A, Tibery C, Baker M, Wideman BC, Martin S. Perceived transition readiness among adolescents and young adults with neurofibromatosis type 1 and plexiform neurofibromas: a cross-sectional descriptive study. J Pediatr Psychol 2024; 49:383-391. [PMID: 38366576 PMCID: PMC11175589 DOI: 10.1093/jpepsy/jsae006] [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: 08/07/2023] [Revised: 01/14/2024] [Accepted: 01/16/2024] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVES Neurofibromatosis type 1 (NF1) is a genetic cancer predisposition syndrome that can impact multiple organ systems and is associated with plexiform neurofibroma tumors, requiring care from birth through adulthood. Adolescents and young adults (AYAs) with NF1 face several barriers to transition from pediatric to adult care. This cross-sectional study aimed to assess transition readiness in this population and to evaluate relationships between specific NF1 symptoms and transition readiness. METHODS AYAs (aged 16-24) enrolled in existing studies related to NF1 were eligible. AYAs and their parents completed measures of transition readiness (Transition Readiness Assessment Questionnaire version 4 [TRAQ-4]), and AYAs also completed a transition readiness interview (UNC TRxANSITION). RESULTS Thirty-eight AYAs (mean age = 19.95 ± 2.68 years) participated in the study. Average TRAQ scores indicated that AYAs were still learning Self-Management skills (M = 3.37, SD = 1.08) and Self-Advocacy skills (M = 3.98, SD = 0.67). Older AYAs had higher TRAQ scores for Self-Management (r = 0.70, p < .001) and Self-Advocacy (r = 0.41, p = .011) than younger AYAs. Parents and AYAs had similar TRAQ scores. About one third of AYAs (37.8%, n = 14) expressed uncertainty about how NF1 might affect them in the future. The remaining AYAs mostly expressed concerns regarding tumor growth, pain, or cancer. CONCLUSIONS In this small study, preliminary findings suggest that AYAs with NF1 express confidence in many areas of transition readiness but continue to require support, particularly with Self-Management skills. Given the gaps in understanding of future health risks, AYAs with NF1 would benefit from early assessment, psychoeducation, and support for transition readiness to adult care.
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Affiliation(s)
- Atara Siegel
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Robin Lockridge
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Kari L Struemph
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Mary Anne Toledo-Tamula
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Paige Little
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Pamela L Wolters
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Anne Dufek
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Cecilia Tibery
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Melissa Baker
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Brigitte C Wideman
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Staci Martin
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
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Perry L, Dunbabin J, Xu X, James S, Lowe J, Acharya S, Steinbeck KS. Service use and glycaemic control of young people with type 1 diabetes transitioning from paediatric to adult care: a 5-year study. Intern Med J 2024. [PMID: 38573020 DOI: 10.1111/imj.16387] [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: 11/05/2023] [Accepted: 02/08/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Regular contact with specialist care has been linked to better diabetes outcomes for young people with type 1 diabetes (YPwT1D), but evidence is limited to population-based service usage and outcomes. AIMS This observational 5-year study sought to capture YPwT1D living in the study catchment area (covering metropolitan, regional and rural Australia) as they transitioned to adult-based diabetes healthcare services and to describe their glycaemic control and complication rates, service usage and associated factors. METHODS Records between 2010 and 2014 in a public healthcare specialist diabetes database were extracted, care processes and outcomes were described, and associations were sought between episodes of care (EOC) and potentially predictive variables. RESULTS Annual cohort numbers increased yearly, but without significant differences in demographic characteristics. Each year around 40% had no reported planned specialist care, and the average number of planned EOC decreased significantly year on year. Overall, mean HbA1c levels also reduced significantly, but with higher values recorded for those living in non-metropolitan than metropolitan areas (achieving significance in 3 out of 5 years). Diabetes complication assessments were only reported in 37-46%, indicating one in five with retinopathy and hypertension affecting one in three to five young people. CONCLUSIONS Findings highlight the importance of investment to address the specific needs of adolescents and young adults and demonstrate the need for better support during these vulnerable early years, particularly for non-metropolitan residents. This will entail changes to funding mechanisms, the health workforce and infrastructure, and new models of care to provide equity of access and quality of specialist care.
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Affiliation(s)
- Lin Perry
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
- South Eastern Sydney Local Health District, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Janet Dunbabin
- Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Xiaoyue Xu
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
- Medicine and Health, University of New South Wales, Kensington, New South Wales, Australia
| | - Steven James
- School of Health, University of the Sunshine Coast, Petrie, Queensland, Australia
| | - Julia Lowe
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Shamasunder Acharya
- Hunter New England Local Health District, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Katharine S Steinbeck
- Discipline of Paediatrics and Child Health, University of Sydney, Camperdown, New South Wales, Australia
- The Sydney Children's Hospital Network, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
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Kubilay E, Trawley S, Ward GM, Fourlanos S, Colman PG, McAuley SA. Real-world lived experience of older adults with type 1 diabetes after an automated insulin delivery trial. Diabet Med 2024; 41:e15264. [PMID: 38073128 DOI: 10.1111/dme.15264] [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: 06/22/2023] [Accepted: 11/20/2023] [Indexed: 03/16/2024]
Abstract
AIMS First-generation closed-loop automated insulin delivery improves glycaemia and psychosocial outcomes among older adults with type 1 diabetes in clinical trials. However, no study has previously assessed real-world lived experience of older adults using closed-loop therapy outside a trial environment. METHODS Semi-structured interviews were conducted with older adults who were pre-existing insulin pump users and previously completed the OldeR Adult Closed-Loop (ORACL) randomised trial. Interviews focused on perceptions of diabetes technology use, and factors influencing decisions regarding continuation. RESULTS Twenty-eight participants, mean age 70 years (SD 5), were interviewed at median 650 days (IQR 608-694) after their final ORACL trial visit. At interview, 23 participants (82%) were still using a commercial closed-loop system (requiring manual input for prandial insulin bolus doses). Themes discussed in interviews relating to closed-loop system use included sustained psychosocial benefits, cost and retirement considerations and usability frustrations relating to sensor accuracy and system alarms. Of the five participants who had discontinued, reasons included cost, continuous glucose monitoring-associated difficulties and usability frustrations. Cost was the largest consideration regarding continued use; most participants considered the increased ease of diabetes management to be worth the associated costs, though cost was prohibitive for some. CONCLUSIONS Almost 2 years after completing a closed-loop clinical trial, closed-loop automated insulin delivery remains the preferred type 1 diabetes therapy for the majority of older adult participants. Chronological age is not a barrier to real-world successful use of diabetes technology. Identifying age-related barriers, and solutions, to diabetes technology use among older adults is warranted.
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Affiliation(s)
- Erin Kubilay
- Department of Psychology, The Cairnmillar Institute, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Steven Trawley
- Department of Psychology, The Cairnmillar Institute, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Glenn M Ward
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Spiros Fourlanos
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Australian Centre for Accelerating Diabetes Innovations, The University of Melbourne, Melbourne, Victoria, Australia
| | - Peter G Colman
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Sybil A McAuley
- Department of Psychology, The Cairnmillar Institute, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
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Housni A, Cianci R, Shulman R, Nakhla M, Cafazzo JA, Corathers SD, Yi-Frazier JP, Kichler JC, Brazeau AS. Online Educational Resources for Youth Living With Type 1 Diabetes Transitioning to Adult Care: An Environmental Scan of Canadian Content. Can J Diabetes 2024; 48:179-187.e3. [PMID: 38176453 DOI: 10.1016/j.jcjd.2023.12.008] [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: 07/12/2023] [Revised: 12/06/2023] [Accepted: 12/22/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVES There are many educational resources for adolescents and young adults living with type 1 diabetes; however, it is unknown whether they address the breadth of topics related to transition to adult care. Our aim in this study was to collect educational resources relevant to Canadian youth and assess their quality and comprehensiveness in addressing the knowledge necessary for youth to prepare for interdependent management of their diabetes. METHODS We conducted an environmental scan, a systematic assessment and analysis, of online education resources in English and French relevant to Canadian youth living with type 1 diabetes. Resources were screened using an open education resource evaluation grid and relevant resources were mapped to the Readiness for Emerging Adults with Diabetes Diagnosed in Youth, a validated diabetes transition readiness assessment tool. RESULTS From 44 different sources, 1,245 resources were identified and, of these, 760 were retained for analysis. The majority were webpages (50.1%) and downloadable PDFs (42.4%), and 12.1% were interactive. Most resources covered Diabetes Knowledge (46.0%), Health Behaviour (23.8%), Insulin and Insulin Pump Management (11.8% and 8.6%, respectively), and Health-care System Navigation (9.7%). Topic areas with the fewest resources were disability accommodations (n=5), sexual health/function (n=4), and locating trustworthy diabetes resources (n=3). CONCLUSIONS There are many resources available for those living with type 1 diabetes preparing to transition to adult care, with the majority pertaining to diabetes knowledge and the least for navigation of the health system. Few resources were available on the topics of substance use, sexual health, and reproductive health. An interactive presentation of these resources, as well as a central repository to house these resources, would improve access for youth and diabetes care providers during transition preparation.
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Affiliation(s)
- Asmaa Housni
- School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, Quebec H9X 3V9, Canada
| | - Rosemarie Cianci
- School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, Quebec H9X 3V9, Canada
| | - Rayzel Shulman
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Meranda Nakhla
- Division of Endocrinology, Montreal Children's Hospital, Research Institute of McGill University Health Centre, Montréal, Québec, Canada
| | - Joseph A Cafazzo
- Centre for Digital Therapeutics, Techna Institute, University Health Network, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; Department of Computer Science, University of Toronto, Toronto, Ontario, Canada
| | - Sarah D Corathers
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Joyce P Yi-Frazier
- Seattle Children's Research Institute, Seattle, Washington, United States
| | - Jessica C Kichler
- Department of Psychology, University of Windsor, Windsor, Ontario, Canada
| | - Anne-Sophie Brazeau
- School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, Quebec H9X 3V9, Canada.
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Sirrianni J, Hanks C, Rust S, Hart LC. Continuation of Pediatric Care after Transfer to Adult Care Among Autistic Youth Overlap of Pediatric and Adult Care. J Autism Dev Disord 2024:10.1007/s10803-024-06314-5. [PMID: 38520586 DOI: 10.1007/s10803-024-06314-5] [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] [Accepted: 03/03/2024] [Indexed: 03/25/2024]
Abstract
The transition from pediatric to adult health care is a vulnerable time period for autistic adolescents and young adults (AYA) and for some autistic AYA may include a period of receiving care in both the pediatric and adult health systems. We sought to assess the proportion of autistic AYA who continued to use pediatric health services after their first adult primary care appointment and to identify factors associated with continued pediatric contact. We analyzed electronic medical record (EMR) data from a cohort of autistic AYA seen in a primary-care-based program for autistic people. Using logistic and linear regression, we assessed the relationship between eight patient characteristics and (1) the odds of a patient having ANY pediatric visits after their first adult appointment and (2) the number of pediatric visits among those with at least one pediatric visit. The cohort included 230 autistic AYA, who were mostly white (68%), mostly male (82%), with a mean age of 19.4 years at the time of their last pediatric visit before entering adult care. The majority (n = 149; 65%) had pediatric contact after the first adult visit. Younger age at the time of the first adult visit and more pediatric visits prior to the first adult visit were associated with continued pediatric contact. In this cohort of autistic AYA, most patients had contact with the pediatric system after their first adult primary care appointment.
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Affiliation(s)
- Joseph Sirrianni
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | | | - Steve Rust
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Laura C Hart
- Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
- The Ohio State University College of Medicine, Columbus, OH, USA.
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Casanovas‐Marsal J, Civitani Monzón E, Ferrer Duce MP, González de la Cuesta D, Yelmo Valverde R, Pérez Repiso V, Goicoechea Manterola I, de Arriba Muñoz A. Study protocol of translation into Spanish and cross-cultural adaptation and validation of the problem areas in diabetes-Pediatric version (PAID-Peds) survey. Nurs Open 2024; 11:e2128. [PMID: 38429883 PMCID: PMC10907615 DOI: 10.1002/nop2.2128] [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: 08/08/2023] [Revised: 02/05/2024] [Accepted: 02/08/2024] [Indexed: 03/03/2024] Open
Abstract
AIM The metabolic and psychological management of paediatric type 1 diabetes mellitus (T1DM) can be challenging over time given that T1DM may cause a negative emotional burden and, consequently, result in poor metabolic control of the disease. The objectives of this study are to translate the Problem Area in Diabetes Survey-Pediatric version (PAID-Peds) into Spanish, adapt it culturally and validate it. DESIGN Multicenter cross sectional study. METHODS 636 patients aged 8-17 years, diagnosed with T1DM, under treatment with insulin and follow-up at the Miguel Servet University Hospital in Zaragoza (Aragón, Spain), the Ramón y Cajal University Clinical Hospital in Madrid (Spain) and at the Sant Joan de Déu Hospital in Barcelona (Catalonia, Spain) between 1 January 2023 and 31 December 2024 will be included. This study will consist of two phases: (1) Translation and cultural adaptation of the original PAID-Peds® survey into Spanish following eight steps; (2) Validation of the Spanish version of the PAIS-Peds® survey. The statistical analysis will be performed using Jamovi® 2.1.23. The reliability or internal consistency will be calculated using Cronbach's alpha index (considering an index higher than 0.8 to be good) and the test-retest will be evaluated using the intraclass correlation coefficient. For validity, confirmatory factor analysis will be calculated. This study has been approved by the ethics and research committees at each centre. RESULTS The translation and validation into Spanish language of the Problem Area in Diabetes Survey-Pediatric version will be feasible, valid and reliable to detecting the youth-perceived burden of T1DM. Therapeutic education in diabetes-recommended by the WHO and the Diabetes Education Study Group-has shown encouraging results in glycaemia and psychosocial and behavioural factors in T1DM.
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Affiliation(s)
- Josep‐Oriol Casanovas‐Marsal
- Instituto Investigación Sanitaria Aragón, Avenida San Juan BoscoZaragozaSpain
- Miguel Servet University HospitalZaragozaSpain
| | - Elisa Civitani Monzón
- Instituto Investigación Sanitaria Aragón, Avenida San Juan BoscoZaragozaSpain
- Miguel Servet University HospitalZaragozaSpain
| | - María Pilar Ferrer Duce
- Instituto Investigación Sanitaria Aragón, Avenida San Juan BoscoZaragozaSpain
- Miguel Servet University HospitalZaragozaSpain
| | - Delia González de la Cuesta
- Instituto Investigación Sanitaria Aragón, Avenida San Juan BoscoZaragozaSpain
- Miguel Servet University HospitalZaragozaSpain
| | | | | | | | - Antonio de Arriba Muñoz
- Instituto Investigación Sanitaria Aragón, Avenida San Juan BoscoZaragozaSpain
- Miguel Servet University HospitalZaragozaSpain
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Wisk LE, Garvey KC, Fu C, Landrum MB, Beaulieu ND, Chien AT. Diabetes-Focused Health Care Utilization Among Adolescents and Young Adults With Type 1 Diabetes. Acad Pediatr 2024; 24:59-67. [PMID: 37148967 DOI: 10.1016/j.acap.2023.05.001] [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: 04/08/2022] [Revised: 04/27/2023] [Accepted: 05/01/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To describe the current rates of health services use with various types of providers among adolescents and young adults (AYA) with type 1 diabetes (T1D) and evaluate which patient factors are associated with rates of service use from different provider types. METHODS Using 2012-16 claims data from a national commercial insurer, we identified 18,927 person-years of AYA with T1D aged 13 to 26 years and evaluated the frequency at which: 1) AYA skipped diabetes care for a year despite being insured; 2) received care from pediatric or non-pediatric generalists or endocrinologists if care was sought; and 3) received annual hemoglobin A1c (HbA1c) testing as recommended for AYA. We used descriptive statistics and multivariable regression to examine patient, insurance, and physician characteristics associated with utilization and quality outcomes. RESULTS Between ages 13 and 26, the percentage of AYA with: any diabetes-focused visits declined from 95.3% to 90.3%; the mean annual number of diabetes-focused visits, if any, decreased from 3.5 to 3.0; receipt of ≥2 HbA1c tests annually decreased from 82.3% to 60.6%. Endocrinologists were the majority providers of diabetes care across ages, yet the relative proportion of AYA whose diabetes care was endocrinologist-dominated decreased from 67.3% to 52.7% while diabetes care dominated by primary care providers increased from 19.9% to 38.2%. The strongest predictors of diabetes care utilization were younger age and use of diabetes technology (pumps and continuous glucose monitors). CONCLUSIONS Several provider types are involved in the care of AYA with T1D, though predominate provider type and care quality changes substantially across age in a commercially-insured population.
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Affiliation(s)
- Lauren E Wisk
- Division of General Internal Medicine and Health Services Research (LE Wisk), David Geffen School of Medicine at the University of California, Los Angeles (UCLA); Department of Health Policy and Management (LE Wisk), Fielding School of Public Health at UCLA, Los Angeles, Calif.
| | | | - Christina Fu
- Department of Health Care Policy (C Fu, MB Landrum, and ND Beaulieu), Harvard Medical School, Boston, Mass
| | - Mary Beth Landrum
- Department of Health Care Policy (C Fu, MB Landrum, and ND Beaulieu), Harvard Medical School, Boston, Mass
| | - Nancy D Beaulieu
- Department of Health Care Policy (C Fu, MB Landrum, and ND Beaulieu), Harvard Medical School, Boston, Mass
| | - Alyna T Chien
- Department of Pediatrics (AT Chien), Harvard Medical School, Boston, Mass; Division of General Pediatrics (AT Chien), Boston Children's Hospital, Mass
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9
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Coyne I, Pembroke S, Sleath B, Brenner M, Roche EF, Hilliard C, Cody D. Adolescents, parents, and providers' experiences of triadic encounters in paediatric diabetes clinics: A qualitative study. Health Expect 2023; 27:e13916. [PMID: 37984806 PMCID: PMC10726266 DOI: 10.1111/hex.13916] [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: 07/14/2023] [Revised: 09/19/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023] Open
Abstract
INTRODUCTION Adolescents with Type 1 diabetes are a cohort whose self-management of their diabetes care often declines during adolescence which can lead to adverse health outcomes. Research indicates that providers find it challenging to engage adolescents in communication exchanges during triadic encounters in diabetes clinics. Our study aimed to explore adolescents, parents, and providers' experiences of clinic encounters. METHODS A qualitative study was conducted with a convenience sample of 13 adolescents with Type 1 diabetes (aged 11-17), 14 parents, and seven providers. Participants were recruited from two outpatient diabetes clinics in two urban children's hospitals, Ireland. Data were obtained using a combination of interviews and focus groups. Data were analysed thematically. RESULTS Adolescents and their parents appeared to hold both positive and negative experiences of diabetes clinic encounters. Providers reported challenges associated with engaging adolescents in communication exchanges. The structure, focus and style of clinic encounters created barriers that potentially led to suboptimal adolescent participation and impaired provider-adolescent communication during clinic visits. CONCLUSIONS The findings provide insights into the challenges associated with adolescents' engagement in communication encounters in diabetes clinics. Healthcare providers could encourage adolescents to be more actively involved in their diabetes management, by taking an adolescent-centred approach and creating a nonjudgemental milieu. Focusing on adolescent's agenda could lead to more meaningful and relevant discussions between providers and adolescents and ensure more tailored education in the time available. Adolescence is a risky period for nonadherence and adverse health complications; therefore, it is critical that providers make every contact count in diabetes clinic encounters. PATIENT OR PUBLIC INVOLVEMENT The study's design and delivery were guided by two advisory groups, comprising (1) five adolescents living with Type 1 diabetes (T1D) and (2) five parents of an adolescent with T1D.
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Affiliation(s)
- Imelda Coyne
- Trinity College DublinThe University of DublinDublinIreland
| | | | - Betsy Sleath
- University of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | | | - Edna F. Roche
- Trinity College Dublin, Children's Health Ireland Tallaght University HospitalThe University of DublinDublinIreland
| | - Carol Hilliard
- Children's Health IrelandUniversity College DublinDublinIreland
| | - Declan Cody
- Children's Health Ireland at CrumlinDublinIreland
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Vaillancourt M, Mok E, Frei J, Dasgupta K, Rahme E, Bell L, Da Costa D, Nakhla M. Qualitative study exploring the perspectives of emerging adults with type 1 diabetes after transfer to adult care from a paediatric diabetes centre in Montreal, Canada. BMJ Open 2023; 13:e076524. [PMID: 37879699 PMCID: PMC10603410 DOI: 10.1136/bmjopen-2023-076524] [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: 06/09/2023] [Accepted: 09/27/2023] [Indexed: 10/27/2023] Open
Abstract
INTRODUCTION Among youth living with type 1 diabetes (T1D), the increasing demands to diabetes self-care and medical follow-up during the transition from paediatric to adult care has been associated with greater morbidity and mortality. Inadequate healthcare support for youth during the transition care period could exacerbate psychosocial risks and difficulties that are common during emerging adulthood. The current investigation sought to explore the post-transfer perceptions of emerging adults living with T1D relating to their transition to adult care. RESEARCH DESIGN AND METHODS Thirty-three emerging adults living with T1D were recruited during paediatric care and contacted for a semistructured interview post-transfer to adult care (16.2±4.2 months post-transfer) in Montreal, Canada. We analysed data using thematic analysis. RESULTS We identified four key themes: (1) varied perceptions of the transition process from being quick and abrupt with minimal advice or information from paediatric healthcare providers (HCP) to more positive including a greater motivation for self-management and the transition being concurrent with the developmental period; (2) facilitators to the transition process included informational and tangible social support from HCPs and family or friends, a positive relationship with adult HCP and a greater ease in communicating with the adult care clinic or adult HCP; (3) barriers to adequate transition included lack of advice or information from paediatric HCPs, loss of support from HCPs and friends or family, the separation of healthcare services and greater difficulty in making appointments with adult clinic or HCP and (4) participants recommendations for improving the transition included increasing the length and frequency of appointments in adult care, having access to educational information, and better transition preparation from paediatric HCPs. CONCLUSIONS The experiences and perceptions of emerging adults are invaluable to guide the ongoing development and improvement of transition programmes for childhood-onset chronic illnesses.
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Affiliation(s)
| | - Elise Mok
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Jennifer Frei
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Kaberi Dasgupta
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Elham Rahme
- Department of Medicine, McGill University, Montreal, Québec, Canada
- Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Lorraine Bell
- Department of Pediatrics, McGill University, Montreal, Québec, Canada
| | - Deborah Da Costa
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Meranda Nakhla
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Department of Pediatrics, McGill University, Montreal, Québec, Canada
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11
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Allende-Richter S, Benitez AD, Ramirez M, Rivera W, Liu S, Gray KP, Bourgeois F. A Patient Portal Intervention to Promote Adolescent and Young Adult Self-Management Skills. Acad Pediatr 2023; 23:1252-1258. [PMID: 36764579 DOI: 10.1016/j.acap.2023.02.003] [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: 09/10/2022] [Revised: 01/31/2023] [Accepted: 02/04/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVE Failure to transfer care to adult medicine is associated with gaps in health care access and poor health outcomes among young adults. We examined whether a patient portal educational intervention is acceptable and can improve adolescent and young adult (AYA) self-management skills toward transition readiness to adult care. METHODS We conducted a single site feasibility study using a mixed research method consisting of 1) a patient portal one-on-one educational intervention with pre- and postsurveys adapted from the Transition Readiness Assessment Questionnaire to assess participant self-management skills and portal user activity; 2) portal user experience was assessed through semistructured interviews until thematic saturation was reached. Study participants were 13 to 25 years old and received care at an academic-affiliated community pediatric clinic. Descriptive statistics were used to describe participant characteristics, paired t tests, or Wilcoxon signed-rank tests to assess outcomes of survey response changes pre- versus postintervention. RESULTS Sixty percent of enrolled participants (N = 78) completed the surveys. Following the educational intervention, we observed an increase in participants self-reporting knowing how to access their protected health information P < .0001, (95%, confidence interval [CI], 1-2) and in the proportion of participants self-reporting to strongly agree to know their medication P = .025 (95%, CI 0-1). We also observed an increase in portal user access at 3 weeks; the median number of logins was 2 per participant (range 1-36, P < .0001). The Portal user experience was strongly positive. CONCLUSION Our patient portal educational intervention suggests that AYAs welcome a patient portal to access protected health information and is associated with an increase in the proportion of participants self-reporting to strongly agree with knowing their medication. While these results are encouraging, this is a quasiexperimental study designed on the frame of feasibility. Our study was not adequately powered, limiting our findings' significance. Future interventions would benefit from a larger sample size with a comparison group to ascertain the effect of a patient portal on self-management skills in a diverse AYA population and inform best practices.
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Affiliation(s)
- Sophie Allende-Richter
- Division of General Pediatrics, Department of Medicine (S Allende-Richter, AD Benitez, M Ramirez, W Rivera, KP Gray, F Bourgeois) Boston Children's Hospital, Boston, Mass; Department of Pediatrics (S Allende-Richter, KP Gray, F Bourgeois) Harvard Medical School, Boston, Mass.
| | - Ashley D Benitez
- Division of General Pediatrics, Department of Medicine (S Allende-Richter, AD Benitez, M Ramirez, W Rivera, KP Gray, F Bourgeois) Boston Children's Hospital, Boston, Mass; Department of Community Health (AD Benitez, M Ramirez), Tufts University, Boston, Mass
| | - Melanie Ramirez
- Division of General Pediatrics, Department of Medicine (S Allende-Richter, AD Benitez, M Ramirez, W Rivera, KP Gray, F Bourgeois) Boston Children's Hospital, Boston, Mass; Department of Community Health (AD Benitez, M Ramirez), Tufts University, Boston, Mass
| | - William Rivera
- Division of General Pediatrics, Department of Medicine (S Allende-Richter, AD Benitez, M Ramirez, W Rivera, KP Gray, F Bourgeois) Boston Children's Hospital, Boston, Mass
| | - Shanshan Liu
- Biostatistics and Research Design Core (S Liu, KP Gray), Institutional Centers of Clinical and Translational Research, Boston Children's Hospital, Boston, Mass
| | - Kathryn P Gray
- Division of General Pediatrics, Department of Medicine (S Allende-Richter, AD Benitez, M Ramirez, W Rivera, KP Gray, F Bourgeois) Boston Children's Hospital, Boston, Mass; Department of Pediatrics (S Allende-Richter, KP Gray, F Bourgeois) Harvard Medical School, Boston, Mass; Biostatistics and Research Design Core (S Liu, KP Gray), Institutional Centers of Clinical and Translational Research, Boston Children's Hospital, Boston, Mass
| | - Fabienne Bourgeois
- Division of General Pediatrics, Department of Medicine (S Allende-Richter, AD Benitez, M Ramirez, W Rivera, KP Gray, F Bourgeois) Boston Children's Hospital, Boston, Mass; Department of Pediatrics (S Allende-Richter, KP Gray, F Bourgeois) Harvard Medical School, Boston, Mass
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12
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Wyld K, Hendrieckx C, Griffin A, Barrett H, D'Silva N. Agenda-setting by young adults with type 1 diabetes and associations with emotional well-being/social support: results from an observational study. Intern Med J 2023; 53:1347-1355. [PMID: 36008367 DOI: 10.1111/imj.15919] [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: 01/20/2022] [Accepted: 08/15/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Diabetes Psychosocial Assessment Tool (DPAT) was developed to assess the psychosocial well-being of young adults with type 1 diabetes in clinical practice. The DPAT includes three validated questionnaires (assessing diabetes distress, anxiety/depressive symptoms and emotional well-being) and an agenda-setting tool. It is currently used by the Queensland Statewide Diabetes Clinical Network (available at Clinical Excellence Queensland). AIMS To describe agenda items set by young adults with type 1 diabetes and investigate their association with emotional well-being/social support. METHODS The DPAT was completed by young adults attending routine diabetes outpatient appointments at the Mater Hospital (Brisbane) between November 2016 and January 2020. For the current analysis, data included responses on agenda-setting and outcomes from three validated questionnaires. RESULTS Responses of 277 young adults (15-26 years) were analysed. Ninety-four (34%) reported one to three agenda item(s). Common agenda items were diabetes technology and medications, but other topics raised included pregnancy, body image and eating concerns. Participants with moderate diabetes distress or anxiety symptoms were more likely to list at least one agenda item (P = 0.006; P = 0.002), as were females and older participants. CONCLUSION Several agenda items for young adults with type 1 diabetes were identified and were more likely to be raised by those with elevated diabetes distress and anxiety symptoms. The DPAT is a valuable and convenient tool that can be easily applied in routine clinical practice to enable clinicians to understand the concerns of the young adult population and deliver personalised medicine to optimise long-term outcomes.
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Affiliation(s)
- Katherine Wyld
- Queensland Diabetes and Endocrine Centre, Mater Hospital, Brisbane, Brisbane, Queensland, Australia
| | - Christel Hendrieckx
- Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia
- Deakin University, Geelong, Victoria, Australia
| | - Alison Griffin
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Helen Barrett
- Queensland Diabetes and Endocrine Centre, Mater Hospital, Brisbane, Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Neisha D'Silva
- Queensland Diabetes and Endocrine Centre, Mater Hospital, Brisbane, Brisbane, Queensland, Australia
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13
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Hodnekvam K, Iversen HH, Gani O, Brunborg C, Skrivarhaug T. Do adolescents and emerging adults receive the diabetes care they truly need? A nationwide study of the quality of diabetes health care during the transition from paediatric to adult care. Diabet Med 2023:e15091. [PMID: 36932850 DOI: 10.1111/dme.15091] [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: 04/06/2022] [Revised: 02/14/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023]
Abstract
AIMS The aim of this study was to assess the paediatric and adult diabetes care provided to adolescents and young adults with childhood-onset type 1 diabetes during the transition. METHODS This nationwide population-based cohort study included 776 individuals with type 1 diabetes who were last registered in the Norwegian Childhood Diabetes Registry (NCDR) between 2009 and 2012 and had received adult health care for at least 2 years. The patients' experiences were reported in a validated questionnaire. Clinical data from the annual registrations in the NCDR were coupled with data from the medical records in adult diabetes care. The longitudinal measures of glycaemic control were analysed using a growth mixture model. RESULTS A total of 321 young people answered the questionnaire and provided written informed consent for the collection of their data from their medical records. The mean age at transfer was 18.0 years (range = 15.0-23.5 years), and the mean age at participation was 22.7 years (range = 20.9-26.7 years). Significant differences (p < 0.001) in patient experiences were found between paediatric and adult diabetes care in several areas: contact with health-care personnel, continuity of care, interval between consultations and overall satisfaction. Registry and medical records data confirmed the patient-reported experiences. The longitudinal analyses identified two groups with distinctly different trajectories of glycaemic outcome over time. Patient-provider continuity and perceived preparedness for transfer were the most influential predictors. CONCLUSIONS This study highlights several areas to be addressed for improving health care and the transition to adult diabetes care in adolescents and young adults with type 1 diabetes, including provider continuity, individualised care and involvement of multidisciplinary teams.
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Affiliation(s)
- Kristin Hodnekvam
- Department of Paediatric and Adolescent Medicine, Telemark Hospital, Skien, Norway
- The Norwegian Childhood Diabetes Registry, Oslo University Hospital, Oslo, Norway
| | - Hilde H Iversen
- Division of Health Services, Department for Research and Analysis of Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Osman Gani
- The Norwegian Childhood Diabetes Registry, Oslo University Hospital, Oslo, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Torild Skrivarhaug
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Oslo Diabetes Research Centre, Oslo University Hospital, Oslo, Norway
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14
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Ozawa N, Shibayama T, Hiraga N, Fukushima H, Suzuki R, Furuya K. Parental readiness for the transition to adulthood of children with a chronic disease. J Pediatr Nurs 2023; 69:56-61. [PMID: 36641998 DOI: 10.1016/j.pedn.2022.12.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/24/2022] [Accepted: 12/24/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE To investigate parental readiness for their child's transition to adulthood among pediatric patients with chronic disease in Japan. DESIGN AND METHODS In this cross-sectional study, parents of children with chronic diseases attending a pediatric outpatient hospital completed an anonymous self-administered questionnaire to investigate demographics and parental readiness for children's transition to adulthood. Logistic regression analysis was conducted to determine whether parents' readiness differed according to their children's disease types. RESULTS A total of 179 parents responded to the survey. Of these, 60% confirmed awareness and knowledge of their children's disease and treatment with their children. They also thought and accepted that there would be a time when their children would move from pediatrics to an adult department. More than half of parents had discussions with their children about the children's interests and would discuss with each other if their children's choice differed from the parents' opinion. <20% of parents had gathered information about the transition and made sure their children saw the outpatient clinic alone or encouraged them to write a record of their visits. The readiness of parents of children with diabetes and of children with cardiovascular disease was higher than those of children with cancer and blood diseases on several items. CONCLUSIONS Parental readiness to support their children's transitions did not progress well, suggesting the need for relevant interventions. PRACTICE IMPLICATIONS Children and parents should be supported in acquiring information about the transition to adulthood and in implementing child-oriented outpatient visits.
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Affiliation(s)
- Noriko Ozawa
- Faculty of Nursing and Medical Care, Keio University, Tokyo, Japan.
| | | | | | - Hiriko Fukushima
- Department of Child Health, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Ryoko Suzuki
- Department of Child Health, Institute of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kayuri Furuya
- Faculty of Global Nursing, Iryo Sosei University, Chiba, Japan
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15
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Małachowska M, Gosławska Z, Rusak E, Jarosz-Chobot P. The role and need for psychological support in the treatment of adolescents and young people suffering from type 1 diabetes. Front Psychol 2023; 13:945042. [PMID: 36687959 PMCID: PMC9845699 DOI: 10.3389/fpsyg.2022.945042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 12/05/2022] [Indexed: 01/06/2023] Open
Abstract
Psychological support might be perceived as one of the most important factors in the treatment of people suffering from type 1 diabetes, particularly among vulnerable groups such as adolescents and young people. Problems arising from extreme pressure put on young patients, high expectations, and specific limitations associated with diabetes often reflect in negative wellbeing and affect patients' behavior, resulting in lower self-esteem, mood swings, depression, or even eating disorders. Therefore, the need for a more holistic approach to the treatment of diabetes and caring about psychological support can be observed, which may contribute to better functioning and management of the disease. Differentiation of certain approach methods such as the positive approach (PA) discussed in the text may help young patients in motivation and coping with their disease as well as accepting limitations caused by type 1 diabetes. This would decrease the risk of potential revolt against medical recommendations, common for patients at the mentioned age, and help raise awareness of the problem. Maintaining life balance through undertaking regular physical activities and being open to new strategies such as telenursing can also result in the improvement of glycemic control. The studies presented have proven the great effectiveness of personalized care adjusted to the patient with psychological support, as well as the invaluable role of education in diabetes, which includes not only standard procedures such as calculating an appropriate insulin dose but also the invention of effective coping mechanisms, which influence patients' performance and wellbeing.
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Affiliation(s)
- Magdalena Małachowska
- Students' Scientific Association at the Department of Children's Diabetology, Medical University of Silesia, Katowice, Poland,Faculty of Medicine, The Medical University of Warsaw, Warsaw, Poland,*Correspondence: Magdalena Małachowska ✉
| | - Zuzanna Gosławska
- Department of Clinical Endocrinology, Independent Public Health Care Central Clinical Hospital of the Medical University, Łódź, Poland
| | - Ewa Rusak
- Department of Children's Diabetology, Medical University of Silesia, Katowice, Poland
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16
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Yüksel Yılmaz D, Yardımcı F, Erdemir F, Karabudak R. Defining the experiences of adolescent patients with multiple sclerosis in transition from pediatric care to adult care. Mult Scler Relat Disord 2022; 68:104123. [PMID: 36058194 DOI: 10.1016/j.msard.2022.104123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/14/2022] [Accepted: 08/14/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the experiences of patients aged 18-24 years who were diagnosed with multiple sclerosis before the age of eighteen, during the transition from pediatric care to adult care. METHODS This research was in the type of phenomenological qualitative research. Focus group interviews were conducted between December 2020 and October 2021 with seventeen participants who had been diagnosed with multiple before the age of eighteen, aged 18-24, voluntarily having agreed to participate in the study. The views of the participants were analyzed with Maxqda Plus v10 data analysis software, and thematic coding was created by the researchers. RESULTS Of the participants, 58.9% were female, 76.5% had their first attack after the age of 13, and it was determined that 64.7% of them took oral tablets for therapeutic purposes. As a result of the content analysis; four thematic codes emerged: (a) Perceptions of the Illness and Pediatric Clinic Before Transition, (b) Perceptions of the Disease and Adult Clinic After Transition to the Adult Clinic, (c) Expectations from the Clinic They Received Service from During Their Childhood, (d) Expectations from the Clinic They Used in Adulthood. CONCLUSION This study revealed that individuals with multiple sclerosis did not receive any medical care regarding the transition from pediatric clinics to adult clinics. Describing the experiences of young adult patients with multiple sclerosis in pediatric clinics and their experiences in the transition to adult clinics allows for the definition of comprehensive, individualized and transitional nursing interventions.
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Affiliation(s)
- Didem Yüksel Yılmaz
- Research Assistant, RN, Ufuk University, School of Nursing, Mevlana Boulevard (Konya Yolu) No:86-88 Balgat, Ankara, Turkey.
| | - Figen Yardımcı
- Associate Professor, Ege University, Faculty of Nursing, Department of Child Health and Diseases, Izmir, Turkey
| | - Firdevs Erdemir
- Professor, Near East University, Faculty of Nursing, Department of Child Health and Diseases, Nicosia, Cyprus
| | - Rana Karabudak
- Professor, Hacettepe University Faculty of Medicine, Department of Neurology, Ankara, Turkey
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17
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Wang XS, Marani H, Harris‐Taylor C, Drazek L, Rusen J, Farnell N, Lipscombe L, Mukerji G. Quality gaps in care delivery among emerging adults with type 1 diabetes: A retrospective cohort study. Health Sci Rep 2022; 5:e823. [PMID: 36210875 PMCID: PMC9528951 DOI: 10.1002/hsr2.823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 07/29/2022] [Accepted: 08/24/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Xinye S. Wang
- Faculty of MedicineUniversity of TorontoTorontoOntarioCanada,Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Husayn Marani
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada,Women's College Hospital Institute for Health System Solutions and Virtual CareWomen's College HospitalTorontoOntarioCanada
| | - Cheryl Harris‐Taylor
- Division of Endocrinology and MetabolismWomen's College HospitalTorontoOntarioCanada
| | - Leah Drazek
- Division of Endocrinology and MetabolismWomen's College HospitalTorontoOntarioCanada
| | - Janis Rusen
- Division of Endocrinology and MetabolismWomen's College HospitalTorontoOntarioCanada
| | - Nicola Farnell
- Division of Endocrinology and MetabolismWomen's College HospitalTorontoOntarioCanada
| | - Lorraine Lipscombe
- Faculty of MedicineUniversity of TorontoTorontoOntarioCanada,Division of Endocrinology and MetabolismWomen's College HospitalTorontoOntarioCanada,Women's College Research InstituteWomen's College HospitalTorontoOntarioCanada
| | - Geetha Mukerji
- Faculty of MedicineUniversity of TorontoTorontoOntarioCanada,Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada,Women's College Hospital Institute for Health System Solutions and Virtual CareWomen's College HospitalTorontoOntarioCanada,Division of Endocrinology and MetabolismWomen's College HospitalTorontoOntarioCanada
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18
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Tilden DR, French B, Shoemaker AH, Corathers S, Jaser SS. Prolonged lapses between pediatric and adult care are associated with rise in HbA1c and inpatient days among patients with type 1 diabetes. Diabetes Res Clin Pract 2022; 192:110113. [PMID: 36208847 PMCID: PMC9867942 DOI: 10.1016/j.diabres.2022.110113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 09/16/2022] [Accepted: 09/30/2022] [Indexed: 01/26/2023]
Abstract
AIM To quantify the association between the duration of the pediatric-to-adult care transfer with glycemic control among patients with type 1 diabetes (T1D). METHODS This retrospective cohort study included patients with T1D who completed transfer between pediatric and adult diabetes clinics at a single academic medical center between 2004 and 2020. The primary exposure was time from the last pediatric to first adult diabetes care encounter. The primary outcome was the average HbA1c in the first year after entry into adult care. RESULTS A total of 449 patients (mean age at transfer 19.8yrs, 51.7 % male) were included for analysis. Transfer required a median of nearly 5 months (196 days; IQR:93-251) and in adjusted and unadjusted models was strongly associated with increased HbA1c within 1 year of transfer (0.19 %, 2 mmol/mol; 95 %CI:0.04 %-0.33 %) for each 6 months of latency. In secondary analyses, transfer latency also exhibited a significant association with days spent hospitalized (IRR 1.23 per 6 months; 95 %CI:1.08-1.33). CONCLUSIONS Our findings isolate and quantify the impact of prolonged lapses in care associated with the pediatric-to-adult care transfer. These findings underscore the need for providers and healthcare systems to improve this care transition in order to improve outcomes for this vulnerable patient population.
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Affiliation(s)
- Daniel R Tilden
- Division of Endocrinology, Diabetes, and Clinical Pharmacology, Department of Medicine, University of Kansas Medical Center, Kansas City, KS, United States.
| | - Benjamin French
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Ashley H Shoemaker
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sarah Corathers
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Sarah S Jaser
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States; Division of Pediatric Psychology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
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19
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Pembroke S, Cody D, Roche EF, Sleath B, Hilliard C, Brenner M, Coyne I. Encouraging adolescents' participation during paediatric diabetes clinic visits: Design and development of a question prompt list intervention. Diabetes Res Clin Pract 2022; 190:109985. [PMID: 35809690 DOI: 10.1016/j.diabres.2022.109985] [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: 05/10/2022] [Revised: 06/27/2022] [Accepted: 07/04/2022] [Indexed: 11/30/2022]
Abstract
AIMS To investigate adolescents' communication with healthcare providers (HCPs) and co- design a question prompt list as one part of an intervention to increase patient participation and communication at diabetes clinic visits. METHODS Using an adolescent-led co-design approach we conducted interviews and focus groups with adolescents, parents, and healthcare providers (HCPs) and held workshops with both a Youth Advisory Group (YAG) and a Parent Advisory Group (PAG). RESULTS Adolescents and parents identified challenges categorised into four themes: negative experience communicating with HCPs, lacking patient education leading to disinterest, low self-confidence out of fear of being wrong and forgetting to ask question(s). Adolescents identified that a Question Prompt List (QPL) could help them to ask questions, be more confident and participate more. The design process was an iterative development that engaged all stakeholders. Parents and HCPs assumed adolescents had greater knowledge about diabetes than they had in reality. CONCLUSIONS Divergence in perceptions between adults and adolescents regarding patient knowledge of diabetes care demonstrates the importance of encouraging adolescents to ask the questions that matter to them. The QPL could be a useful means of supporting adolescents to actively participate in clinic encounters with healthcare providers.
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Affiliation(s)
- Sinead Pembroke
- Trinity College Dublin, the University of Dublin College Green, Dublin 2, Ireland.
| | - Declan Cody
- Children's Health Ireland Crumlin, Cooley Road, Dublin 12, Ireland
| | - Edna F Roche
- Trinity College Dublin, the University of Dublin College Green, Dublin 2, Ireland and Children's Health Ireland, Tallaght, Tallaght, Dublin 24, Ireland
| | - Betsy Sleath
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Carol Hilliard
- Children's Health Ireland, Crumlin, Cooley Road, Dublin 12, Ireland and University College Dublin, Belfield, Dublin 4, Ireland
| | - Maria Brenner
- Trinity College Dublin, the University of Dublin College Green, Dublin 2, Ireland
| | - Imelda Coyne
- Trinity College Dublin, the University of Dublin College Green, Dublin 2, Ireland.
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20
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Rea KE, Cushman GK, Quast LF, George RP, Basu A, Ford R, Book W, Blount RL. Initial attendance and retention in adult healthcare as criteria for transition success among organ transplant recipients. Pediatr Transplant 2022; 26:e14280. [PMID: 35388604 DOI: 10.1111/petr.14280] [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: 05/24/2021] [Revised: 03/15/2022] [Accepted: 03/26/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adolescent and young adult (AYA) solid organ transplant recipients experience worsening medical outcomes during transition to adult healthcare. Current understanding and definitions of transition success emphasize first initiation of appointment attendance in adult healthcare; however, declines in attendance over time after transfer remain possible, particularly as AYAs are further removed from their pediatric provider and assume greater independence in their care. METHODS The current study assessed health-care utilization, medical outcomes, and transition success among 49 AYA heart, kidney, or liver recipients recently transferred to adult healthcare. Differences in outcomes were examined along two transition success criteria: (1) initial engagement in adult healthcare within 6 or 12 months of last pediatric appointment and (2) retention in adult healthcare over 3 years following last pediatric appointment. Growth curve modeling examined change in attendance over time. RESULTS Successful retention in adult healthcare was significantly related to more improved clinical outcomes, including decreased number and duration of hospitalizations and greater medication adherence, as compared to initial engagement. Significant declines in appointment attendance over 3 years were noted, and individual differences in declines were not accounted for by age at transfer or time since transplant. CONCLUSIONS Findings underscore support for AYAs after transfer, as significant declines in attendance were noted after initiating adult care. Clinical care teams should examine transition success longitudinally to address changes in health-care utilization and medical outcomes. Attention to interventions and administrative support aimed at maintaining or increasing attendance and identifying risk factors and intervention for unsuccessful transition is warranted.
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Affiliation(s)
- Kelly E Rea
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| | - Grace K Cushman
- Department of Psychology, University of Georgia, Athens, Georgia, USA.,Alpert Medical School of Brown University, Bradley/Hasbro Children's Research Center, Providence, USA
| | - Lauren F Quast
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| | - Roshan P George
- Department of Pediatrics, Emory University School of Medicine, Athens, Georgia, USA
| | - Arpita Basu
- Emory Transplant Center, Emory University School of Medicine, Athens, Georgia, USA
| | - Ryan Ford
- Emory Transplant Center, Emory University School of Medicine, Athens, Georgia, USA
| | - Wendy Book
- Emory Transplant Center, Emory University School of Medicine, Athens, Georgia, USA
| | - Ronald L Blount
- Department of Psychology, University of Georgia, Athens, Georgia, USA
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21
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Kariyawasam D, Soukup T, Parsons J, Sevdalis N, Baldellou Lopez M, Forde R, Ismail K, Jones M, Ford-Adams M, Yemane N, Pender S, Thomas S, Murrells T, Silverstien A, Forbes A. Protocol for a feasibility study and process evaluation of a psychosocially modelled diabetes education programme for young people with type 1 diabetes: the Youth Empowerment Skills (YES) programme. BMJ Open 2022; 12:e062971. [PMID: 35680254 PMCID: PMC9185576 DOI: 10.1136/bmjopen-2022-062971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Adolescence is a challenging period for young people with type 1 diabetes, associated with worsening glycaemia and care disengagement. Educational interventions in this period tend to focus on diabetes-specific skills, with less emphasis on the psychosocial challenges associated with diabetes experienced by young people. To address this limitation, we codesigned with young people a psychosocially modelled programme of diabetes education, named 'Youth Empowerment Skills' (YES). The programme aims to facilitate a positive adaptation to life with diabetes and engagement with diabetes care through peer-based learning, immersive simulations and support from an outreach youth worker. Here, we present a protocol for a feasibility study of the YES programme. METHODS AND ANALYSIS The study was designed following the Medical Research Council Complex Intervention Evaluation Framework to: test the feasibility (acceptance, implementability, recruitment and completion) of the YES programme; and estimate its efficacy in relation to metabolic and psychosocial outcomes. The study will take place in diabetes centres serving socioculturally diverse populations. We will conduct a feasibility randomised controlled trial (waiting-list design) with integrated process evaluation. Fifty young people with type 1 diabetes (aged 14-19 years) will be randomly allocated to either the YES intervention or a waiting-list control. Randomisation acceptability will be assessed with provision for a preference allocation. Outcomes will be evaluated at 6 months, at which point the waiting list participants will be exposed to the YES programme with further follow-up to 12 months. A simultaneous process evaluation will use a mixed-methods approach collecting qualitative and quantitative data. Study findings will be used to optimise the intervention components, outcome measures and recruitment methods to inform a subsequent definitive trial. ETHICS AND DISSEMINATION The protocol has ethical approval from the UK Health Research Authority (approval IRAS project ID: 279877). Findings will be disseminated in multiple formats for lay and professional audiences. PROTOCOL DATE AND VERSION 7 April 2021, V.1.1. TRIAL REGISTRATION NUMBER NCT04670198.
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Affiliation(s)
- Dulmini Kariyawasam
- Department of Diabetes and Endocrinology, Guy's and St.Thomas 'NHS foundation Trust, London, UK
| | - Tayana Soukup
- Health Service and Population Research Department, King's College London, London, UK
| | - Judith Parsons
- Division of Care Long-term Conditions, King's College London Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London, UK
| | - Nick Sevdalis
- Health Service and Population Research Department, King's College London, London, UK
| | - Maria Baldellou Lopez
- Health Service and Population Research Department, King's College London, London, UK
| | - Rita Forde
- Division of Care Long-term Conditions, King's College London Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London, UK
| | - Khalida Ismail
- Health Service and Population Research Department, King's College London, London, UK
| | - Marie Jones
- Department of Diabetes and Endocrinology, Guy's and St.Thomas 'NHS foundation Trust, London, UK
| | - Martha Ford-Adams
- Paediatric Diabetes Department, King's College Hospital NHS Foundation Trust, London, UK
| | - Nardos Yemane
- Department of Diabetes and Endocrinology, Guy's and St.Thomas 'NHS foundation Trust, London, UK
| | - Siobhan Pender
- Department of Diabetes and Endocrinology, Guy's and St.Thomas 'NHS foundation Trust, London, UK
| | - Stephen Thomas
- Department of Diabetes and Endocrinology, Guy's and St.Thomas 'NHS foundation Trust, London, UK
| | - Trevor Murrells
- National Nursing Research Unit, King's College London, London, UK
| | - Alex Silverstien
- Division of Care Long-term Conditions, King's College London Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London, UK
| | - Angus Forbes
- Division of Care Long-term Conditions, King's College London Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London, UK
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22
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Wang YW, Carnevale FA, Chougui K, Tsimicalis A. How Children's participation ought to be practiced: A preliminary ethical framework to optimise the participation of children with osteogenesis imperfecta in health care. J Clin Nurs 2022; 32:2773-2789. [PMID: 35676775 DOI: 10.1111/jocn.16398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/14/2022] [Accepted: 05/16/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND A three-phase ethnography was conducted at a paediatric orthopaedic hospital exploring the actual and desired participation of children with Osteogenesis Imperfecta in discussions, decisions and actions in the hospital and community. Phase I and Phase II revealed how childhood ethics are understood and practiced in the hospital using artmaking to engage children in discussions about their health-related experiences. Children expressed frustration, anger and disappointment when their desired level of participation in care was not actualized due to forgone opportunities for engagement by clinicians or lack of child-oriented health resources. OBJECTIVES The objective of this study (Phase III) was to specify how childhood ethics ought to be understood and practiced in the hospital by (1) convening hospital stakeholders in a collaborative setting to disseminate findings, identify ethical concerns and generate action steps; and (2) develop a preliminary ethical framework to optimise the participation of children with OI in health care. DESIGN Focused ethnography reported using the SRQR checklist. METHODS A focus group was conducted with 14 interdisciplinary hospital stakeholders. Data were analysed using qualitative, thematic analysis to understand primary ethical concerns and accompanying action steps. The findings were consolidated into a preliminary ethical framework and worksheet for clinicians. RESULTS Four main factors impeding children's voices and desired participation were identified: legal and contextual factors; variations in clinicians' skills, practice and knowledge; difficulties incorporating alternative engagement methods into practice; and need for interprofessional collaboration. Five action steps were identified: Recognise, Elicit, Interpret, Act and Optimise. RELEVANCE TO CLINICAL PRACTICE The focus group and creation of clinician resources were important steps towards addressing the ethical concerns of children with OI, such as marginalisation or exclusion in their OI care. This study better prepares us to disseminate our findings on a larger scale and create ethical frameworks and resources to improve how vulnerable children's voices are heard, understood and acted upon in healthcare settings.
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Affiliation(s)
- Yi Wen Wang
- McGill University, Montreal, QC, Canada.,Shriners Hospitals for Children®-Canada, Montreal, QC, Canada
| | - Franco A Carnevale
- McGill University, Montreal, QC, Canada.,Shriners Hospitals for Children®-Canada, Montreal, QC, Canada
| | - Khadidja Chougui
- McGill University, Montreal, QC, Canada.,Université de Montréal, Montreal, QC, Canada
| | - Argerie Tsimicalis
- McGill University, Montreal, QC, Canada.,Shriners Hospitals for Children®-Canada, Montreal, QC, Canada
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23
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Davidse K, van Staa A, Geilvoet W, van Eck JP, Pellikaan K, Baan J, Hokken-Koelega ACS, van den Akker ELT, Sas T, Hannema SE, van der Lely AJ, de Graaff LCG. We mind your step: understanding and preventing drop-out in the transfer from paediatric to adult tertiary endocrine healthcare. Endocr Connect 2022; 11:e220025. [PMID: 35521816 PMCID: PMC9175586 DOI: 10.1530/ec-22-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/22/2022] [Indexed: 11/16/2022]
Abstract
Introduction Transition from paediatric to adult endocrinology can be challenging for adolescents, their families and healthcare professionals. Previous studies have shown that up to 25% of young adults with endocrine disorders are lost to follow-up after moving out of paediatric care. This poses a health risk for young adults, which can lead to serious and expensive medical acute and long-term complications. Methods In order to understand and prevent dropout, we studied electronic medical records of patients with endocrine disorders. These patients were over 15 years old when they attended the paediatric endocrine outpatient clinic (OPC) of our hospital in 2013-2014 and should have made the transfer to adult care at the time of the study. Results Of 387 adolescents, 131 had an indication for adult follow-up within our university hospital. Thirty-three (25%) were lost to follow-up. In 24 of them (73%), the invitation for the adult OPC had never been sent. We describe the failures in logistic processes that eventually led to dropout in these patients. Conclusion We found a 25% dropout during transfer from paediatric to adult tertiary endocrine care. Of all dropouts, 73% could be attributed to the failure of logistic steps. In order to prevent these dropouts, we provide practical recommendations for patients and paediatric and adult endocrinologists.
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Affiliation(s)
- Kirsten Davidse
- Department of Internal Medicine-Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Anneloes van Staa
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - Wanda Geilvoet
- Department of Internal Medicine-Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Judith P van Eck
- Department of Paediatric Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Karlijn Pellikaan
- Department of Internal Medicine-Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Janneke Baan
- Department of Internal Medicine-Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Anita C S Hokken-Koelega
- Department of Paediatric Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Academic Centre for Growth, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Dutch Growth Research Foundation, Rotterdam, the Netherlands
| | - Erica L T van den Akker
- Department of Paediatric Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Theo Sas
- Department of Paediatric Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Diabeter, National Diabetes Care and Research Centre, Rotterdam, the Netherlands
| | - Sabine E Hannema
- Department of Paediatric Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Department of Paediatrics, Leiden University Medical Centre, Leiden, the Netherlands
| | - Aart Jan van der Lely
- Department of Internal Medicine-Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Laura C G de Graaff
- Department of Internal Medicine-Endocrinology, Erasmus University Medical Centre, Rotterdam, the Netherlands
- Academic Centre for Growth, Erasmus University Medical Centre, Rotterdam, the Netherlands
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24
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Viktorsson L, Törnvall E, Falk M, Wåhlin I, Yngman-Uhlin P. Young adults’ needs when seeking first-line healthcare: A grounded theory design. PLoS One 2022; 17:e0263963. [PMID: 35167607 PMCID: PMC8846516 DOI: 10.1371/journal.pone.0263963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 01/31/2022] [Indexed: 11/19/2022] Open
Abstract
Background Healthcare outpatient visits have increased in recent years, and young adults are often given as an explanatory factor for many avoidable visits. Objective The objective of this study was to explore how young adults perceive seeking first-line healthcare. Design and setting The study utilized a grounded theory design with data collection at primary healthcare centres and emergency departments in southeast Sweden. Method Data were collected during individual interviews and patient observations with subsequent interviews during the years 2017–2018. The analysis was performed using grounded theory. Results The main concern when young adults are seeking healthcare is that their worries are taken seriously. It is a four-part process: becoming aware of, verifying, communicating, and receiving an opinion about one’s symptoms. The process includes external factors, clarity of symptoms, behavioural approaches, healthcare know-how, enabling self-management, and prior healthcare experience(s). When communicating symptoms, the clearer the symptoms, the less there needs to be communicated. When symptoms are unclear, the importance of different behavioural approaches and healthcare know-how increases. When receiving a medical opinion about symptoms, young adults want to learn how to self-manage their symptoms. Depending on previous healthcare experience, the healthcare visit can either harm or help the patient in their healthcare-seeking process. Conclusion This study reflects several insights in the healthcare-seeking process from a young adult perspective. Based on the results, we suggest that healthcare providers focus on the final step in the healthcare-seeking process when giving their medical opinion about symptoms. Having extra minutes to give support for future self-care regardless of diagnosis could increase positive healthcare experiences and increase future self-care among young adults.
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Affiliation(s)
- Lisa Viktorsson
- Unit for Research and Development, and Department of Health, Medicine and Caring Science, Linköping University, Linköping, Sweden
- * E-mail:
| | - Eva Törnvall
- Management Department in Region Östergötland, and Department of Health, Medicine and Caring Science, Linköping University, Linköping, Sweden
| | - Magnus Falk
- Primary Health Care Centre Kärna, and Department of Health, Medicine and Caring Science, Linköping University, Linköping, Sweden
| | - Ingrid Wåhlin
- Research Section, Region Kalmar County, Kalmar, Sweden
- School of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Pia Yngman-Uhlin
- Unit for Research and Development, and Department of Health, Medicine and Caring Science, Linköping University, Linköping, Sweden
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25
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Feeney C, Hotez E, Wan L, Bishop L, Timmerman J, Haley M, Kuo A, Fernandes P. A Multi-Institutional Collaborative To Assess the Knowledge and Skills of Medicine-Pediatrics Residents in Health Care Transition. Cureus 2022; 13:e20327. [PMID: 35028223 PMCID: PMC8748002 DOI: 10.7759/cureus.20327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/09/2021] [Indexed: 01/23/2023] Open
Abstract
Background Pediatric to adult health care transition (HCT) is an essential process in the care of youth with special health care needs (YSHCN). Many internal medicine-pediatrics (med-peds) residency programs have developed curricula to teach transition knowledge and skills for the care of YSHCN. Objective Using a national med-peds program director quality improvement collaborative to improve transition curriculum, we aim to identify curricular content areas of improvement by describing baseline trainee knowledge and skills taught through existing transition curricula in med-peds programs. Methods We analyzed data collected during the 2018-2019 national med-peds program director quality improvement collaborative to improve transition curriculum. Program directors assessed their programs, and trainees assessed themselves on five transition goals by completing a Likert-scale questionnaire. In addition, trainees received an objective assessment of their knowledge through a multiple-choice questionnaire (MCQ). Results All 19 programs in the collaborative, and 193 of 316 trainees from these programs, completed the questionnaires. Most programs were based at academic centers (68%) and provided transition training via didactics (63%) and/or subspecialty rotations (58%). More programs had high confidence (95%) than trainees (58%) in goal 1 (knowledge and skills of the issues around transition), whereas more trainees had high confidence (60%) than programs (47%) in goal 2 (understanding the developmental and psychosocial aspects of transition). Programs and trainees self-assessed lower in goals related to health insurance, educational and vocational needs, and application of health care system knowledge to the practice environment (goals 3, 4, and 5, respectively). Conclusions Using the assessments of the program directors and resident trainees, we identified subject areas for improvement of transition curricula, including health insurance and the application of health care system knowledge to the practice environment.
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Affiliation(s)
- Colby Feeney
- Medicine and Pediatrics, Duke University School of Medicine, Durham, USA
| | - Emily Hotez
- Internal Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Lori Wan
- Medicine and Pediatrics, University of California San Diego, San Diego, USA
| | - Laura Bishop
- Medicine and Pediatrics, University of Louisville School of Medicine, Louisville, USA
| | - Jason Timmerman
- Internal Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Madeline Haley
- Internal Medicine and Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Alice Kuo
- Internal Medicine and Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Priyanka Fernandes
- Internal Medicine and Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
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26
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Yi-Frazier JP, Senturia K, Wright DR, Lind C, Malik FS. The clock is ticking: Parental stress around emerging adulthood for adolescents with type 1 diabetes. J Pediatr Nurs 2022; 62:164-170. [PMID: 34294485 PMCID: PMC9273159 DOI: 10.1016/j.pedn.2021.07.012] [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: 12/09/2020] [Revised: 07/13/2021] [Accepted: 07/13/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Our goal was to explore parental views on the challenges and stressors of transition to young adulthood for adolescents with type 1 diabetes and to describe specific strategies used to reduce parents' own stress during this time. DESIGN AND METHODS Focus groups with 39 parents of adolescents with type 1 diabetes were conducted in the greater Seattle area. Semi-structured prompts addressed adolescents' self-care tasks, parental assistance with care, challenges and barriers with self-care tasks, and stress/pressure around self-care. Data was analyzed using qualitative methods for emerging themes. RESULTS Parental stress was heightened when adolescents were approaching common developmental milestones such as driving, moving out, and engaging in risky behaviors that could be exacerbated by poor diabetes management. Thus, most parents reported providing assistance even late into adolescence. Parents shared strategies for guiding adolescents' transition from assisted to independent care with an emphasis on active behaviors parents could continue, thereby lowering their own stress. CONCLUSIONS Parents of adolescents with type 1 diabetes experienced significant stress around their children's transition to independent diabetes self-care management. PRACTICE IMPLICATIONS As part of overall preparation for transition, care providers should be encouraged to communicate with parents about these common stressors and promising avenues for nurturing a teen's independence.
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Affiliation(s)
- Joyce P Yi-Frazier
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA.
| | - Kirsten Senturia
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Davene R Wright
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Cara Lind
- Center for Child Health Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Faisal S Malik
- Center for Child Health Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
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27
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Wongyai W, Boonchaya-Anant P, Laichuthai N, Aroonparkmongkol S, Veerapong V, Leepulsup S, Teeratongdee C, Anunapibut N, Sahakitrungruang T. Outcomes of a multidisciplinary transition clinic for youth with type 1 diabetes. Pediatr Int 2022; 64:e15356. [PMID: 36564347 DOI: 10.1111/ped.15356] [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: 04/13/2022] [Revised: 08/20/2022] [Accepted: 09/09/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Emerging adults with type 1 diabetes (T1D) have several challenges regarding diabetes management and care transition from pediatric to adult services. In this study we aimed to assess the effectiveness of the newly established transition clinic for emerging adults with T1D. METHODS We conducted an observational study of emerging adults with T1D treated in a transition clinic jointly operated by a pediatric and adult multidisciplinary care team during 2019-2021. A retrospective chart review of hemoglobin A1c (HbA1c), frequency of clinic attendance, acute diabetes-related complications, assessment of gaps in knowledge and behavior, and psychosocial outcomes was analyzed. RESULTS A total of 21 patients with T1D were included. Median age at the transfer to the transition clinic was 24 years (range 21-34). Fifteen patients (71%) were successfully transferred to adult services; mean duration of follow-up at the transition clinic was 9.2 months (SD 3.9). None of the patients was lost to follow-up or experienced serious diabetes related complications. Mean (95% confidence interval) HbA1c levels decreased from 8.97% (7.87-10.07) at baseline to 8.25% (7.45-9.05) at the most recent visit (p = 0.01). A proportion of patients achieving the glycemic target (HbA1c < 7.5%) was increased from 24% at the first visit to 38% at the most recent visits. Patients' HbA1c levels at the adult clinic continued a favorable trend. Seven patients (33%) were identified as having symptoms of depression. Knowledge and behavioral gaps were identified and counselled by clinical care team. CONCLUSION The multidisciplinary transition clinic has shown to be beneficial in terms of improving glycemic control, maintaining continuity of care and clinic attendance.
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Affiliation(s)
- Wariya Wongyai
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Excellence Center for Diabetes, Hormone and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Patchaya Boonchaya-Anant
- Excellence Center for Diabetes, Hormone and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nitchakarn Laichuthai
- Excellence Center for Diabetes, Hormone and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Suphab Aroonparkmongkol
- Excellence Center for Diabetes, Hormone and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Varaporn Veerapong
- Excellence Center for Diabetes, Hormone and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Suwaputr Leepulsup
- Excellence Center for Diabetes, Hormone and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Chantaporn Teeratongdee
- Excellence Center for Diabetes, Hormone and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Nuntawan Anunapibut
- Excellence Center for Diabetes, Hormone and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Taninee Sahakitrungruang
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Excellence Center for Diabetes, Hormone and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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28
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Jarvis S, Flemming K, Richardson G, Fraser L. Adult healthcare is associated with more emergency healthcare for young people with life-limiting conditions. Pediatr Res 2022; 92:1458-1469. [PMID: 35152268 PMCID: PMC9700517 DOI: 10.1038/s41390-022-01975-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/04/2022] [Accepted: 01/24/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Children with life-limiting conditions receive specialist paediatric care in childhood, but the transition to adult care during adolescence. There are concerns about transition, including a lack of continuity in care and that it may lead to increases in emergency hospital visits. METHODS A retrospective cohort was constructed from routinely collected primary and hospital care records for young people aged 12-23 years in England with (i) life-limiting conditions, (ii) diabetes or (iii) no long-term conditions. Transition point was estimated from the data and emergency inpatient admissions and Emergency Department visits per person-year compared for paediatric and adult care using random intercept Poisson regressions. RESULTS Young people with life-limiting conditions had 29% (95% CI: 14-46%) more emergency inpatient admissions and 24% (95% CI: 12-38%) more Emergency Department visits in adult care than in paediatric care. There were no significant differences associated with the transition for young people in the diabetes or no long-term conditions groups. CONCLUSIONS The transition from paediatric to adult healthcare is associated with an increase in emergency hospital visits for young people with life-limiting conditions, but not for young people with diabetes or no long-term conditions. There may be scope to improve the transition for young people with life-limiting conditions. IMPACT There is evidence for increases in emergency hospital visits when young people with life-limiting conditions transition to adult healthcare. These changes are not observed for comparator groups - young people with diabetes and young people with no known long-term conditions, suggesting they are not due to other transitions happening at similar ages. Greater sensitivity to changes at transition is achieved through estimation of the transition point from the data, reducing misclassification bias.
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Affiliation(s)
- Stuart Jarvis
- Martin House Research Centre, University of York, York, UK.
| | - Kate Flemming
- grid.5685.e0000 0004 1936 9668Department of Health Sciences, University of York, York, UK
| | - Gerry Richardson
- grid.5685.e0000 0004 1936 9668Centre for Health Economics, University of York, York, UK
| | - Lorna Fraser
- grid.5685.e0000 0004 1936 9668Martin House Research Centre, University of York, York, UK
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29
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The added value of transition programs in Dutch diabetes care: A controlled evaluation study. J Pediatr Nurs 2022; 62:155-163. [PMID: 34419327 DOI: 10.1016/j.pedn.2021.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE The desirability of evaluating transition programs is widely acknowledged. This study aimed to explore the added value of transitional care investments for young adults with type 1 diabetes mellitus. DESIGN AND METHODS Based on qualitative data, two groups of diabetes teams were created through cluster analysis: paying more (HI-ATT) versus less attention (LO-ATT) to transitional care. Retrospective controlled evaluation included chart reviews on healthcare use and clinical outcomes; and a survey on young adults' experiences, satisfaction with care, and self-management skills. RESULTS Data from 320 patients in fifteen diabetes teams were collected; 123 young adults (38.4%) completed a questionnaire. Self-reported outcomes showed that young adults treated by a HI-ATT team felt better prepared for transfer (p < .05). Self-management outcomes did not differ between groups. HI-ATT teams had more scheduled consultations in the year after transfer (p < .05); only 10.6% of all measurements had reached targeted HbA1c scores. CONCLUSIONS Current transitional care investments in Dutch diabetes care did not lead to notable improvements in experiences and outcomes, except for preparation for transfer. The period after transfer, however, is just as important. Attention is required for parent involvement. PRACTICE IMPLICATIONS Transitional care investments should extend beyond the transfer. By educating young adults about the importance of regular clinic attendance and introducing additional person-centered consultations in adult care, nurses may help ensure continuity of care. Nurses could also introduce support programs for parents to prepare for the transition and their change in role, taking into account their continuing partnership.
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30
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Momani AM, Callery P, Lin YL, Abduelkader RH, Al Akash HY. "It [Diabetes] is From God and I Need to Take Care of Myself": Type 1 Diabetes Self-Management Among Adolescents and Their Parents in Jordan. Curr Diabetes Rev 2022; 18:e140222201109. [PMID: 35156585 DOI: 10.2174/1573399818666220214114908] [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: 03/18/2021] [Revised: 10/28/2021] [Accepted: 11/04/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Type 1 diabetes is the most common endocrine condition among adolescents. Diabetes self-management can be challenging during adolescence. OBJECTIVE The objective of this study is to understand how adolescents and their parents manage type 1 diabetes in Jordan. METHODS Constructivist grounded theory methodology principles were used to achieve the study aim. A total of 48 participants were recruited using purposive and theoretical sampling techniques, including adolescents and their parents. Data were collected (October 2016 - April 2017) using 38 semi-structured, audio-recorded interviews (one-to-one or joint interviews based on participants' preferences). Data were collected and analyzed concurrently using different levels of coding, constant comparative analysis, and memo writing. This study was approved by relevant ethics committees from the University of Manchester and Jordan University Hospital. RESULTS The theme of living with diabetes is presented and discussed in this article. Culture emerged as the central theme; two aspects of culture are presented in this article: collectivism and cultural beliefs. CONCLUSION This study identified that diabetes self-management could be influenced by the culture in which Jordanian adolescents live in as well as being shaped by their religious beliefs. These findings are potentially transferable to other Arab and non-Arab countries that share similar cultural aspects and religious beliefs.
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Affiliation(s)
| | - Peter Callery
- School of Biology, Medicine and Health, Division of Nursing, Midwifery and Social Work at the University of Manchester, Manchester, UK
| | - Yin-Ling Lin
- School of Biology, Medicine and Health, Division of Dentistry at the University of Manchester, Manchester, UK
| | | | - Hekmat Y Al Akash
- School of Nursing at the Applied Science Private University, Amman, Jordan
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Vidal Flor M, Jansà i Morató M, Yoldi Vergara C, Cardona-Hernández R, Giménez Alvárez M, Conget Donlo I, Isla Pera P. Type 1 Diabetes Patient Experiences Before and After Transfer from a Paediatric to an Adult Hospital. Patient Prefer Adherence 2022; 16:2229-2246. [PMID: 36017376 PMCID: PMC9397429 DOI: 10.2147/ppa.s363081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/31/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The management of type 1 diabetes (T1D) is especially complex during adolescence when youths are transferred to adult care centres. The objectives of this qualitative study were to: a) determine the expectations of young T1D patients prior to transfer, b) evaluate the transfer process between the 2 centres, and c) evaluate the therapeutic education and care programme (TECP) in the adult centre from their point of view. MATERIAL AND METHODS Opinion sampling of adolescents from 2018-2019 was performed: Phase 1: adolescents with T1D prior to transfer to the adult hospital; Phase 2: adolescents with T1D one or two years after transfer and having undergone TECP. A focus group (1.5h) and semi-structured interviews (45 min) were performed and taped, transcribed, and sent to the participants for confirmation. Date analysis was performed of the transcriptions of the focus group and interviews. Fragments were selected and meta-categories created. RESULTS Eleven youths accepted to participate: 7 in Phase 1, 4 repeated in Phase 2 and 4 more transferred 2 years previously were added. The meta-categories obtained were: 1) perception of the quality of care and therapeutic education in the paediatric hospital. 2) transfer to the adult hospital. 3) experience of the youths 1-2 years after transfer and having undergone TECP. The data are presented in narrative form and are supported with text fragments of the participants' discussions. DISCUSSION AND CONCLUSIONS Analysis of patients' experience complemented by clinical-educational evaluation of TECP provides understanding of the perspectives of youths on the complexity of living with a chronic disease since childhood. It also provides information regarding the factors favouring quality care and therapeutic education, the complexity of transfer from paediatric to adult care, determination of the strong and weak points and the establishment of strategies to improve the programme.
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Affiliation(s)
- Mercè Vidal Flor
- Diabetes Unit, Department of Endocrinology and Nutrition, Hospital Clínic of Barcelona, Barcelona, Spain
- Correspondence: Mercè Vidal Flor, Diabetes Unit, Department of Endocrinology and Nutrition, Hospital Clínic of Barcelona, Villarroel, 170, Barcelona, 08036, Spain, Tel +34 93 2279846, Email
| | - Margarida Jansà i Morató
- Diabetes Unit, Department of Endocrinology and Nutrition, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Carmen Yoldi Vergara
- Diabetes Unit, Endocrinology Service, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Roque Cardona-Hernández
- Diabetes Unit, Endocrinology Service, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Marga Giménez Alvárez
- Diabetes Unit, Department of Endocrinology and Nutrition, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Ignacio Conget Donlo
- Diabetes Unit, Department of Endocrinology and Nutrition, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Pilar Isla Pera
- School of Nursing, University of Barcelona, Barcelona, Spain
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Jarvis S, Richardson G, Flemming K, Fraser L. Estimation of age of transition from paediatric to adult healthcare for young people with long term conditions using linked routinely collected healthcare data. Int J Popul Data Sci 2021; 6:1685. [PMID: 34805553 PMCID: PMC8576739 DOI: 10.23889/ijpds.v6i1.1685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction Healthcare transitions, including from paediatric to adult services, can be disruptive and cause a lack of continuity in care. Existing research on the paediatric-adult healthcare transition often uses a simple age cut-off to assign transition status. This risks misclassification bias, reducing observed changes at transition (adults are included in the paediatric group and vice versa) possibly to differing extents between groups that transition at different ages. Objective To develop and assess methods for estimating the transition point from paediatric to adult healthcare from routine healthcare records. Methods A retrospective cohort of young people (12 to 23 years) with long term conditions was constructed from linked primary and secondary care data in England. Inpatient and outpatient records were classified as paediatric or adult based on treatment and clinician specialities. Transition point was estimated using three methods based on record classification (First Adult: the date of first adult record; Last Paediatric: date of last paediatric record; Fitted: a date determined by statistical fitting). Estimated transition age was compared between methods. A simulation explored impacts of estimation approaches compared to a simple age cut-off when assessing associations between transition status and healthcare events. Results Simulations showed using an age-based cut-off at 16 or 18 years as transition point, common in research on transition, may underestimate transition-associated changes. Many health records for those aged <14 years were classified as adult, limiting utility of the First Adult approach. The Last Paediatric approach is least sensitive to this possible misclassification and may best reflect experience of the transition. Conclusions Estimating transition point from routine healthcare data is possible and offers advantages over a simple age cut-off. These methods, adapted as necessary for data from other countries, should be used to reduce risk of misclassification bias in studies of transition in nationally representative data.
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Affiliation(s)
- Stuart Jarvis
- Martin House Research Centre, Department of Health Sciences University of York, United Kingdom
| | | | - Kate Flemming
- Department of Health Sciences, University of York, United Kingdom
| | - Lorna Fraser
- Martin House Research Centre, Department of Health Sciences University of York, United Kingdom
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Commissariat PV, Wentzell K, Tanenbaum ML. Competing Demands of Young Adulthood and Diabetes: A Discussion of Major Life Changes and Strategies for Health Care Providers to Promote Successful Balance. Diabetes Spectr 2021; 34:328-335. [PMID: 34866865 PMCID: PMC8603129 DOI: 10.2337/dsi21-0009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Young adults (YAs) are often faced with many new transitions and major milestones specific to their life stage. For YAs with diabetes, it can be particularly difficult to balance diabetes management with the age-typical demands of young adulthood. Clinicians can play an important role in helping YAs navigate major life changes and find balance in the competing demands of young adulthood, while protecting their health and well-being.
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Pembroke S, Roche EF, Sleath B, Brenner M, Hilliard C, Cody D, Coyne I. Developing a video intervention to improve youth question-asking and provider education during paediatric diabetes clinic encounters: The Promoting Adolescents Communication and Engagement study. PATIENT EDUCATION AND COUNSELING 2021; 104:2170-2176. [PMID: 33640232 DOI: 10.1016/j.pec.2021.02.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/27/2020] [Accepted: 02/09/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Research on long-term health conditions indicates that adolescents are not actively involved during their medical visits. Active involvement is essential because this can help adolescents learn how to self-manage their treatment plan. OBJECTIVE To co-design a video intervention to improve youth question-asking and provider education during paediatric diabetes visits. PATIENT INVOLVEMENT A participatory-led approach was used to co-design the video, through a combination of interviews/ focus groups and the establishment of a Youth Advisory Group. METHODS First, focus groups and one-to-one interviews were held with adolescents, parents and healthcare providers. Second, two workshops were held with the Youth Advisory Group, Parent Advisory Group and stakeholders on script design. Finally, an iterative development of the video took place between the research team, videographer, both advisory groups and the steering committee. There were three rounds of feedback before the video was finalised. RESULTS Adolescents' content preferences included: 1) message of empowerment; 2) managing your diabetes so you can get on with the fun stuff in life; 3) Promoting independence; 4) Reasons for not speaking at clinic visits and reassurance; 5) Becoming comfortable to speak and ask questions at clinic visits; 6) Practical advice on how to ask questions. Formatting preferences included that the video should be short, divided into segments, with adolescents with diabetes acting in it, and speaking directly to the camera. DISCUSSION Identifying and reflecting adolescents' needs and preferences for engagement with healthcare providers was critical in the development process. Adolescents' participation in the co-design process was pivotal to the acceptability of the intervention for adolescents with diabetes. PRACTICAL VALUE The intervention may increase adolescents' participation in communication and interactions with healthcare providers, which may help them to be more active in the self-management of their condition.
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Affiliation(s)
- Sinead Pembroke
- School of Nursing and Midwifery, Trinity College Dublin, the University of Dublin College Green, 24 D'Olier Street, Trinity College Dublin, Dublin 2, Ireland.
| | - Edna F Roche
- Department of Endocrinology and Diabetes, Children's Health Ireland, Tallaght, Dublin 24, Ireland; School of Medicine, Trinity College Dublin, the University of Dublin College Green, Dublin 2, Ireland
| | - Betsy Sleath
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Maria Brenner
- School of Nursing and Midwifery, Trinity College Dublin, the University of Dublin College Green, 24 D'Olier Street, Trinity College Dublin, Dublin 2, Ireland
| | - Carol Hilliard
- Department of Diabetes and Endocrinology, Children's Health Ireland, Crumlin, Cooley Road, Dublin 12, Ireland; School of Medicine, Trinity College Dublin, the University of Dublin College Green, Dublin 2, Ireland
| | - Declan Cody
- Department of Diabetes and Endocrinology, Children's Health Ireland, Crumlin, Cooley Road, Dublin 12, Ireland
| | - Imelda Coyne
- School of Nursing and Midwifery, Trinity College Dublin, the University of Dublin College Green, 24 D'Olier Street, Trinity College Dublin, Dublin 2, Ireland
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Li MK, Sathiyamoorthy T, Regina A, Strom M, Toulany A, Hamilton J. "Your own pace, your own path": perspectives of adolescents navigating life after bariatric surgery. Int J Obes (Lond) 2021; 45:2546-2553. [PMID: 34385587 PMCID: PMC8359630 DOI: 10.1038/s41366-021-00928-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/19/2021] [Accepted: 07/23/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Bariatric surgery, an established weight-loss tool, may be offered to some adolescents with severe obesity. However, few studies explore adolescents' postoperative experiences beyond physical and metabolic outcomes and quality-of-life measures. METHODS Between 2016 and 2021, 45 semi-structured interviews were conducted with adolescents (16-20 years) at 6 months (N = 15), 12 months (N = 15), and 24 months (N = 15) following bariatric surgery. A deductive thematic analysis framework was applied by two independent coders (Cronbach's α = 0.84). Themes were identified and refined iteratively, and discrepancies were resolved through discussion. RESULTS Five major themes emerged related to: (1) weight-loss expectations vs. reality, (2) social landscape, (3) body image, (4) eating and moving, and (5) challenges for long-term success. The pace of and satisfaction with weight loss and side effects was heterogenous among participants, with most changes occurring early and stabilizing by 24 months. Adolescents adapted over time to their new social landscapes (e.g., relationships) and reported improved body image and confidence, yet persistently struggled to reconcile their internal identity with evolving external perceptions and discomfort with new attention. Participants experienced changes to lifestyle routines after surgery (e.g., eating, moving, habits), which introduced distress at 6 months but resolved over time. Life transitions in early adulthood (e.g., moving away, university/college, employment), concurrent with their evolving and increasing autonomy, physical, social, and financial independence, imposed unexpected challenges to postoperative routines and support systems. Participants unanimously reaffirmed that bariatric surgery is a lifelong journey and that they were committed to long-term success. CONCLUSION Our findings provide insight into optimizing adolescent selection for bariatric surgery and perioperative support. Specifically, important life transitions during this developmental period impact postoperative experiences and outcomes and adolescents may benefit from postoperative counseling focused on managing weight-loss expectations and adapting to evolving nutritional needs and changing social circumstances.
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Affiliation(s)
- Ming K Li
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Andrea Regina
- Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada.,Division of Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Michele Strom
- Division of Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Alene Toulany
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jill Hamilton
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada. .,Division of Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada.
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Chiang Y, Tsay P, Chen C, Hsu C, Yu H, Chang C, Lo F, Moons P. A Delphi Study on the Healthcare Needs of Patients with Type 1 Diabetes during the Transition from Adolescence to Adulthood: Consensus among Patients, Primary Caregivers, and Healthcare Providers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137149. [PMID: 34281086 PMCID: PMC8296953 DOI: 10.3390/ijerph18137149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 11/16/2022]
Abstract
Patients with type 1 diabetes mellitus at the age of 16-25 face the challenges of the deterioration of disease control and accelerated exacerbation. Providing interventions that meet patient's healthcare needs can reduce the impact and improve health outcome. The purpose of this study was to identify the healthcare needs of patients with type 1 diabetes during the adolescence to adulthood transition period from the perspectives of patients, parents and healthcare providers. A two-round Delphi study was conducted among 48 participants, and included 17 patients, 16 primary caregivers, and 15 healthcare providers. The central tendency and dispersion were computed to establish a consensus. Seventy-one healthcare needs were identified across five dimensions-technology, external support, internal support, management, and healthcare-and 56 were considered as important healthcare needs and with a moderate to high level of agreement. Meanwhile, patients, primary caregivers, and healthcare providers were found to display significantly different opinions (p < 0.05) for 23 healthcare needs. This study concluded the consensus of the healthcare needs of patients with type 1 diabetes mellitus during the adolescence to adulthood transition period from a systematic investigation. The findings can serve as reference for developing transitional intervention strategies.
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Affiliation(s)
- Yuehtao Chiang
- School of Nursing, College of Medicine, Chang-Gung University, Taoyuan 33302, Taiwan; (H.Y.); (C.C.)
- Division of Pediatric Endocrinology & Genetics, Department of Pediatrics, Chang-Gung Memorial Hospital, Taoyuan 33305, Taiwan
- Correspondence: (Y.C.); (F.L.); Tel.: +886-3-2118800 (ext. 3866) (Y.C.); Tel.: +886-3-3281200 (ext. 8969) (F.L.)
| | - Peikwei Tsay
- Department of Public Health and Center of Biostatistics, College of Medicine, Chang-Gung University, Taoyuan 33302, Taiwan;
| | - Chiwen Chen
- College of Nursing, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan;
| | - Chienlung Hsu
- Department of Information Management, Chang-Gung University, Taoyuan 33302, Taiwan;
- Graduate Institute of Business and Management, Chang Gung University, Taoyuan 33302, Taiwan
- Healthy Aging Research Center, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Visual Communication Design, Ming Chi University of Technology, New Taipei 24301, Taiwan
- Department of Nursing, Taoyuan Chang Gung Memorial Hospital, Taoyuan 33044, Taiwan
| | - Hsingyi Yu
- School of Nursing, College of Medicine, Chang-Gung University, Taoyuan 33302, Taiwan; (H.Y.); (C.C.)
- Department of Nursing, Chang-Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Chiwen Chang
- School of Nursing, College of Medicine, Chang-Gung University, Taoyuan 33302, Taiwan; (H.Y.); (C.C.)
- Division of Pediatric Endocrinology & Genetics, Department of Pediatrics, Chang-Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Fusung Lo
- Division of Pediatric Endocrinology & Genetics, Department of Pediatrics, Chang-Gung Memorial Hospital, Taoyuan 33305, Taiwan
- College of Medicine, Chung-Gung University, Taoyuan 33302, Taiwan
- Correspondence: (Y.C.); (F.L.); Tel.: +886-3-2118800 (ext. 3866) (Y.C.); Tel.: +886-3-3281200 (ext. 8969) (F.L.)
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven-University of Leuven, 3000 Leuven, Belgium;
- Institute of Health and Care Sciences, University of Gothenburg, 40530 Gothenburg, Sweden
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town 7701, South Africa
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Oldham-Cooper R, Semple C. Prevention and early help for eating disorders in young people with type 1 diabetes. Clin Child Psychol Psychiatry 2021; 26:656-668. [PMID: 33601920 DOI: 10.1177/1359104521994172] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
There is building evidence that early intervention is key to improving outcomes in eating disorders, whereas a 'watch and wait' approach that has been commonplace among GPs and other healthcare professionals is now strongly discouraged. Eating disorders occur at approximately twice the rate in individuals with type 1 diabetes compared to the general population. In this group, standard eating disorder treatments have poorer outcomes, and eating disorders result in a particularly high burden of morbidity. Therefore, our first priority must be prevention, with early intervention where disordered eating has already developed. Clinicians working in both eating disorders and diabetes specialist services have highlighted the need for multidisciplinary team collaboration and specific training, as well as improved treatments. We review the current evidence and future directions for prevention, identification and early intervention for eating disorders in children and young people with type 1 diabetes.
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Affiliation(s)
- Rosie Oldham-Cooper
- Psychological Health Service, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Royal Hospital for Children, UK.,School of Psychological Science, University of Bristol, UK
| | - Claire Semple
- Psychological Health Service, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Royal Hospital for Children, UK
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Nursing's Influence on the Evolution of the Field of Health Care Transition and Future Implications. J Pediatr Health Care 2021; 35:408-413. [PMID: 34053794 DOI: 10.1016/j.pedhc.2021.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/07/2021] [Indexed: 11/20/2022]
Abstract
Health care transition (HCT) is an emerging field of practice and research with unlimited opportunities for nursing involvement. This article will highlight the unique contributions of nurse clinicians and researchers worldwide that have influenced HCT practice and research. The historical underpinnings of nursing practice will be discussed and feature the distinctive models and concepts of care that have and will continue to be contributed to HCT practice and research. Dimensions of prominent nursing contributions in collaboration with interdisciplinary partners as it pertains to scholarship, research, practice, and policymaking will be presented. The implications for future nursing involvement in this emerging field will be discussed.
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A Patient Navigator Intervention Supporting Timely Transfer Care of Adolescent and Young Adults of Hispanic Descents Attending an Urban Primary Care Pediatrics Clinic. Pediatr Qual Saf 2021; 6:e391. [PMID: 33718746 PMCID: PMC7952101 DOI: 10.1097/pq9.0000000000000391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/30/2020] [Indexed: 11/25/2022] Open
Abstract
While comprehensive health care transition is associated with better health outcomes, navigating health care transition can be difficult for adolescents and young adults (AYAs), especially those with fewer resources. Our practice serves low-income patients from birth to their 26th birthday; many are medically and socially complex and experience several obstacles to navigate care. As a result, most have not initiated a transfer to adult medicine by age 25. This quality-improvement initiative was designed to implement a structured intervention that supports the planned transfer of care to adult primary care. Methods Informed by our baseline data on all patients eligible to transfer care, we designed a patient outreach workflow centered on a patient navigator (PN) intervention. We used a Plan-Do-Study-Act format to optimize our process and run charts to evaluate our intervention. Results Over 3 years, our PN reached out to 96% of patients (n = 226) eligible to transfer care and offered transfer assistance in person or in writing. Among those surveyed, 92% (n = 93) reported awareness of our practice transition policy, and 83% (n = 64) rated their confidence to transfer care at 3 or higher on a 5-point scale. Conclusions AYAs are aware of our practice transition policy, yet they welcome in-person transfer assistance. This intervention seems to improve their confidence to transfer care. However, despite PN outreach efforts, many remain empaneled in our practice and thus lack the self-care skills necessary to complete the transfer independently. Future transition interventions should address AYA's self-management skills toward transition readiness.
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Sanjari M, Peyrovi H, Mehrdad N. The Process of Managing the Children with Type 1 Diabetes in the Family: A Grounded Theory Study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 26:25-33. [PMID: 33954095 PMCID: PMC8074732 DOI: 10.4103/ijnmr.ijnmr_5_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 08/02/2020] [Accepted: 08/23/2020] [Indexed: 11/04/2022]
Abstract
Background: Diabetes is a disease that affects all family members. Parents of children with type 1 diabetes are always concerned about all aspects of children's life. The aim of this study was to elucidate the process of managing children with diabetes in the family. Materials and Methods: This is a qualitative grounded theory of a doctoral dissertation, which was done on 2016. The 18 participants were selected through purposive and theoretical sampling until data saturation. The main participants in this study included parents, siblings, and children with type 1 diabetes. The data was gathered by semi-structured interviews as well as field notes and memos. Data analysis was done concurrently with data collection in four levels, including data analysis for concept and contex, bringing the process into the analysis, and integration of categories according to Corbin and Struss (2008). Core category appeared at the end of integrated categories. Results: “The family with diabetes in the child's diabetes orbit” as a core category contains the process of managing children with diabetes within the family, which included three main subcategories, including “entering into the diabetes orbit”, “movement into the diabetes orbit”, and “living into the diabetes orbit”. Conclusions: The family through the concept of “The family with diabetes in the child's diabetes orbit “as a main concern of families with diabetes suffering diabetes attempt to select and practicing appropriate strategies and manage diabetes and children with diabetes.
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Affiliation(s)
- Mahnaz Sanjari
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Peyrovi
- Department of Critical Care Nursing, Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Neda Mehrdad
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Le Roux E, Menesguen F, Tejedor I, Popelier M, Halbron M, Faucher P, Malivoir S, Pinto G, Léger J, Hatem S, Polak M, Poitou C, Touraine P. Transition of young adults with endocrine and metabolic diseases: the 'TRANSEND' cohort. Endocr Connect 2021; 10:21-28. [PMID: 33263561 PMCID: PMC7923139 DOI: 10.1530/ec-20-0520] [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: 10/23/2020] [Accepted: 11/25/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The transition from paediatric to adult medicine involves risks of poor patient outcomes and of significant losses of patients to follow up. The research aimed to analyse the implementation in an initial cohort of patients of a new programme of transition to adult care based on a case management approach. DESIGN A longitudinal study of the case management approach to transition, initiated in a university hospital in France in September 2016. METHODS Patients with the endocrine or metabolic disease diagnosed during childhood and transferred to adult care were included. The transition programme includes three steps based on case management: liaising with paediatric services, personalising care pathways, and liaising with structures outside the hospital (general practitioners, agencies in the educational and social sector). RESULTS The cohort included 500 patients, with malignant brain tumour (n = 56 (11%)), obesity (n = 55 (11%)), type 1 diabetes (n = 54 (11%)), or other disease (n = 335 (67%)). Their median age at transfer was 19, and the sex ratio was 0.5. At median 21 months of follow-up, 439 (88%) had a regular follow-up in or outside the hospital, 47 (9%) had irregular follow-up (absence at the last appointment or no appointment scheduled within the time recommended), 4 had stopped care on doctor's advice, 4 had died, 3 had moved, and 3 had refused care. The programme involved 9615 case management actions; 7% of patients required more than 50 actions. Patients requiring most support were usually those affected by a rare genetic form of obesity. CONCLUSIONS Case managers successfully addressed the complex needs of patients. Over time, the cohort will provide unprecedented long-term outcome results for patients with various conditions who experienced this form of transition.
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Affiliation(s)
- Enora Le Roux
- Université de Paris, ECEVE UMR 1123, Inserm, Paris, France
- AP-HP.Nord-Université de Paris, Hôpital Universitaire Robert Debré, Unité d’Épidémiologie Clinique, Inserm, Paris, France
| | - Florence Menesguen
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière-Charles Foix, Service d’Endocrinologie et Médecine de la Reproduction, Centre de Maladies Endocriniennes Rares de la Croissance et du Développement, Centre de Pathologies Gynécologiques Rares, Paris, France
| | - Isabelle Tejedor
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière-Charles Foix, Service d’Endocrinologie et Médecine de la Reproduction, Centre de Maladies Endocriniennes Rares de la Croissance et du Développement, Centre de Pathologies Gynécologiques Rares, Paris, France
| | - Marc Popelier
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière-Charles Foix, Service de Diabétologie, Paris, France
| | - Marine Halbron
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière-Charles Foix, Service de Diabétologie, Paris, France
| | - Pauline Faucher
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière-Charles Foix, Service de Nutrition, Centre du Syndrome de Prader-Willi et Autres Obésités Rares, Paris, France
| | - Sabine Malivoir
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière-Charles Foix, Service d’Endocrinologie et Médecine de la Reproduction, Centre de Maladies Endocriniennes Rares de la Croissance et du Développement, Centre de Pathologies Gynécologiques Rares, Paris, France
| | - Graziella Pinto
- AP-HP.Université de Paris Centre, Hôpital Universitaire Necker Enfants Malades, Département d’Endocrinologie, Diabétologie et Gynécologie Pédiatrique, Paris, France; Centre de Maladies Endocriniennes Rares de la Croissance et du Développement, Centre de Pathologies Gynécologiques Rares, Paris, France
| | - Juliane Léger
- AP-HP.Nord-Université de Paris, Hôpital Universitaire Robert Debré, Service d’Endocrinologie Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes de la Croissance et du Développement, Paris, France
| | | | - Michel Polak
- AP-HP.Université de Paris Centre, Hôpital Universitaire Necker Enfants Malades, Département d’Endocrinologie, Diabétologie et Gynécologie Pédiatrique, Paris, France; Centre de Maladies Endocriniennes Rares de la Croissance et du Développement, Centre de Pathologies Gynécologiques Rares, Paris, France
| | - Christine Poitou
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière-Charles Foix, Service de Nutrition, Centre du Syndrome de Prader-Willi et Autres Obésités Rares, Paris, France
| | - Philippe Touraine
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière-Charles Foix, Service d’Endocrinologie et Médecine de la Reproduction, Centre de Maladies Endocriniennes Rares de la Croissance et du Développement, Centre de Pathologies Gynécologiques Rares, Paris, France
- Correspondence should be addressed to P Touraine:
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Jarvis SW, Roberts D, Flemming K, Richardson G, Fraser LK. Transition of children with life-limiting conditions to adult care and healthcare use: a systematic review. Pediatr Res 2021; 90:1120-1131. [PMID: 33654285 PMCID: PMC8671088 DOI: 10.1038/s41390-021-01396-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Improved survival has led to increasing numbers of children with life-limiting conditions transitioning to adult healthcare services. There are concerns that transition may lead to a reduction in care quality and increases in emergency care. This review explores evidence for differences in health or social care use post- versus pre-transition to adult services. METHODS MEDLINE, EMBASE, CINAHL, PsychINFO and Social Science Citation Index were searched. Studies published in English since 1990 including individuals with any life-limiting condition post- and pre-transition and reporting a health or social care use outcome were included. Data were extracted and quality assessed by one reviewer with 30% checked by an independent reviewer. RESULTS Nineteen papers (18 studies) met the inclusion criteria. There was evidence for both increases and decreases (post- versus pre-transition) in outpatient attendance, inpatient admissions, inpatient bed days and health service costs; for increases in Emergency Department visits and for decreases in individuals receiving physiotherapy. CONCLUSIONS Evidence for changes in healthcare use post- versus pre-transition is mixed and conflicting, although there is evidence for an increase in Emergency Department visits and a reduction in access to physiotherapy. More high-quality research is needed to better link changes in care to the transition. IMPACT Evidence for changes in healthcare use associated with transition to adult services is conflicting. Emergency Department visits increase and access to physiotherapy decreases at transition. There are marked differences between care patterns in the United States and Canada.
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Affiliation(s)
- Stuart W. Jarvis
- grid.5685.e0000 0004 1936 9668Martin House Research Centre, University of York, York, UK
| | - Daniel Roberts
- grid.413991.70000 0004 0641 6082Leeds Children’s Hospital, Leeds, UK
| | - Kate Flemming
- grid.5685.e0000 0004 1936 9668Department of Health Sciences, University of York, York, UK
| | - Gerry Richardson
- grid.5685.e0000 0004 1936 9668Centre for Health Economics, University of York, York, UK
| | - Lorna K. Fraser
- grid.5685.e0000 0004 1936 9668Martin House Research Centre, University of York, York, UK
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Wenger JK, Niemann M. Continue the Conversation: A Complex Care Pediatrician's Perspective on Improving Healthcare Transitions for Pediatric Neurology Patients. Semin Pediatr Neurol 2020; 36:100854. [PMID: 33308518 DOI: 10.1016/j.spen.2020.100854] [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: 11/17/2022]
Abstract
Inadequate preparation for transition to adult-oriented systems of care leads to gaps in treatment and can result in poor health outcomes for youth with special healthcare needs. Coordination between primary care and specialists must occur at multiple levels of organizations to improve transition for youth with neurological disorders. This review focuses on the transition process from the pediatrician's perspective, highlights common obstacles, addresses the unique needs of youth with intellectual disabilities, reviews relevant guidelines, and discusses emerging transition strategies. Key recommendations include defining the roles of the different healthcare providers and using multidisciplinary collaboration to overcome limited resources.
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Affiliation(s)
- Jodi K Wenger
- Department of pediatrics, Boston University School of Medicine, Boston, MA.
| | - Madeline Niemann
- Department of Pediatrics, Division of Pediatric Neurology, Boston Medical Center, Boston, MA
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Vidal Flor M, Jansà I Morató M, Roca Espino D, Viñals Domenech C, Quirós López C, Mesa Pineda Á, Yoldi Vergara C, Cardona-Hernandez R, Giménez Álvarez M, Esmatjes Mompó E, Conget Donlo I. Results of a specific and structured program in the transition of young patients with type 1 diabetes from the paediatric center to an adult hospital. The experience of a decade. ACTA ACUST UNITED AC 2020; 68:82-91. [PMID: 32912806 DOI: 10.1016/j.endinu.2020.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Evaluate the results of a healthcare and therapeutic education programme (TEP) aimed at young patients with type 1 diabetes (T1D) transferred from a paediatric centre. METHODOLOGY This was a prospective, pre-postest in young T1D patients transferred from 2005-2015. The programme has four phases: coordinated transfer, evaluation and objective pacting, knowledge (DKQ2) adherence (SCI-R.es) and quality of life (DQoL and SF12). Results were compared according to Multiple Daily Injections (MDI) vs. Continuous Subcutaneous Insulin Infusión (CSII) and adherence (SCI-R.es < 65 vs. > 65%). RESULTS A total of 330 patients were transferred (age 18.19 ± 0.82 years, 49% females, glycated haemoglobin [HbA1c] 8.6 ± 1.4%). The programme was completed by 68%, and 61% did a group course. While no changes in HbA1c were observed at one year (8.3 ± 1.4 vs. 8.2 ± 1.4%), there were changes in severe hypoglycaemias/patient/year (0.23 ± 0.64 to 0.05 ± 0.34 p < 0.001) and mild > 5 hypoglycaemias/patient/week (6.9% vs. 3.9% p = 0.09). DQK2 knowledge increased (25.7 ± 3.6 vs. 27.8 ± 3.8 p < 0.001), with no changes in quality of life or grade of adherence. Patients with CSII (n = 21) performed more blood glucose controls and showed greater programme adherence with no changes in metabolic control. Patients with the best initial adherence presented the best control (p < 0.0001). A lower initial HbA1c and receiving the group course were associated with better clinical HbA1c results ≥ 0.5% (p < 0.05) CONCLUSIONS: The TEP improved some parameters of metabolic control without modifying the quality of life in young T1D patients. When comparing patients on MDI vs. CSII, there were no differences in metabolic control but there were when differences were evaluated considering treatment adherence.
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Affiliation(s)
- Mercè Vidal Flor
- Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, España.
| | - Margarida Jansà I Morató
- Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, España
| | - Daria Roca Espino
- Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, España
| | - Clara Viñals Domenech
- Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, España
| | - Carmen Quirós López
- Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, España; Servicio de Endocrinología, Mútua de Terrassa, Barcelona, España
| | - Álex Mesa Pineda
- Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, España
| | - Carmen Yoldi Vergara
- Unidad de Endocrinología pediátrica, Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | - Roque Cardona-Hernandez
- Unidad de Endocrinología pediátrica, Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | - Marga Giménez Álvarez
- Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, España; IDIBAPS. Institut d'investigacions biomèdiques August Pi i Sunyer, Cataluña, España; CIBERDEM, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades metabólicas, Madrid, España
| | - Enric Esmatjes Mompó
- Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, España
| | - Ignacio Conget Donlo
- Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, España; IDIBAPS. Institut d'investigacions biomèdiques August Pi i Sunyer, Cataluña, España; CIBERDEM, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades metabólicas, Madrid, España
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Perry L, Dunbabin J, Xu X, Lowe J, Acharya S, James S, Steinbeck KS. Service use of young people with Type 1 diabetes after transition from paediatric to adult-based diabetes health care. AUST HEALTH REV 2020; 44:601-608. [PMID: 32600522 DOI: 10.1071/ah19117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 12/15/2019] [Indexed: 01/21/2023]
Abstract
Objective The aim of this study was to determine, in the first 2 years after the last planned appointment with paediatric diabetes services for young people with Type 1 diabetes (T1D): (1) the number of planned and unplanned healthcare contacts and HbA1c measurements made; (2) factors linked to diabetes-related service use; and (3) factors predictive of the number of planned and unplanned service contacts, and of meeting the minimum number of planned service contacts. Methods Healthcare records of a major public healthcare provider in Australia were audited for preventive and acute service use by young people with T1D transferring from paediatric to adult public healthcare services. Statistical analyses included use of t-tests and logistic regression modelling. Results Of 172 young people with T1D, 21% had no planned specialist care and 49% accessed acute services for diabetes-related matters. Residents of metropolitan areas and users of continuous subcutaneous insulin infusion therapy were more likely to access specialist care and were less likely to use acute services for unplanned care. Those achieving a minimum of nine planned care contacts in 2 years had a shorter duration between the last paediatric and first adult healthcare contact. Conclusions Lack of specialist care in early adult years and non-metropolitan relative disadvantage compromise the present and future health of young people with diabetes. What is known about the topic? Well-managed transition is thought to offer the best chance of achieving cost-effective continuing engagement with specialist services for planned preventive care, effective T1D self-management and deferral or early attention to diabetes-related vascular complications. However, transition is commonly reported as problematic. What does this paper add? The findings of this study indicate a positive trend but continuing need to improve transition care for young people with T1D, especially those living in non-metropolitan areas and those not using continuous subcutaneous insulin infusion therapy. What are the implications for practitioners? Without service innovation, suboptimal and delayed access to planned care, high use of acute services for unplanned care and poor glycaemic control will continue to threaten the future health and well-being of young people with T1D.
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Affiliation(s)
- Lin Perry
- University of Technology Sydney, Faculty of Health, 15 Broadway, Ultimo, NSW 2007, Australia. ; ; and South Eastern Sydney Local Health District, Prince of Wales Hospital, 320-346 Barker Street, Randwick, NSW 2031, Australia
| | - Janet Dunbabin
- University of Newcastle, Faculty of Health and Medicine, University Drive, Callaghan, NSW 2308, Australia. ;
| | - Xiaoyue Xu
- University of Technology Sydney, Faculty of Health, 15 Broadway, Ultimo, NSW 2007, Australia. ; ; and University of Newcastle, Faculty of Health and Medicine, University Drive, Callaghan, NSW 2308, Australia. ;
| | - Julia Lowe
- University of Newcastle, Faculty of Health and Medicine, University Drive, Callaghan, NSW 2308, Australia. ;
| | - Shamasunder Acharya
- Hunter New England Local Health District, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305, Australia.
| | - Steven James
- University of the Sunshine Coast, School of Nursing, Midwifery and Paramedicine, 80-106 Tallon Street, Caboolture, Qld 4510, Australia; and Corresponding author.
| | - Katharine S Steinbeck
- University of Sydney, Discipline of Paediatrics and Child Health, Camperdown, NSW 2006, Australia. ; and The Children's Hospital at Westmead, Department of Adolescent Medicine, corner Hawkesbury Road and Hainsworth Street, Westmead, NSW 2145, Australia
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Chung RJ, Mackie AS, Baker A, de Ferranti SD. Cardiovascular Risk and Cardiovascular Health Behaviours in the Transition From Childhood to Adulthood. Can J Cardiol 2020; 36:1448-1457. [PMID: 32585325 DOI: 10.1016/j.cjca.2020.05.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/23/2020] [Accepted: 05/26/2020] [Indexed: 01/17/2023] Open
Abstract
The prevention and management of cardiovascular risk factors during the transition from childhood to adulthood is critically important in defining cardiovascular health trajectories. Unfortunately, many young people fall out of clinical care during this important time, leading to worsening cardiovascular risk and missed opportunities to modify future outcomes. The field of health care transition has evolved to support young people with complex health needs in developing self-management and self-advocacy skills to promote positive health outcomes despite changes in health care providers and resources. While transitional care efforts are largely focused on childhood-onset chronic illnesses such as sickle cell disease and cystic fibrosis, young people with cardiovascular risk factors such as hypertension, obesity, and dyslipidemia also stand to benefit from structured supports to ensure continuity in care and positive health behaviours. On the backdrop of the broader health care transition literature, we offer practical insights and suggestions for ensuring that young people with cardiovascular risk factors experience uninterrupted high-quality care and support as they enter the adult health care system. Starting transition preparation in early adolescence, actively engaging all key stakeholders throughout the process, and remaining mindful of the developmental underpinnings and social context of transition are keys to success.
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Affiliation(s)
- Richard J Chung
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA.
| | - Andrew S Mackie
- Division of Cardiology, Stollery Children's Hospital, Edmonton, Alberta, Canada; Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Annette Baker
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sarah D de Ferranti
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
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Ibanez-Bruron MC, Solebo AL, Cumberland P, Rahi JS. Epidemiology of visual impairment, sight-threatening or treatment-requiring diabetic eye disease in children and young people in the UK: findings from DECS. Br J Ophthalmol 2020; 105:729-734. [PMID: 32536608 DOI: 10.1136/bjophthalmol-2020-315886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/08/2020] [Accepted: 05/26/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND We investigated the incidence and causes of sight-threatening diabetes-related eye disease in children living with diabetes in the UK, to inform the national eye screening programme and enable monitoring of trends. METHODS We undertook a prospective active national surveillance via the British Ophthalmic Surveillance Unit. Eligible cases were children aged 18 years or younger, with type 1 or 2 diabetes, newly diagnosed between January 2015 and February 2017 with sight-threatening diabetic eye disease. RESULTS Eight children were reported. The annual incidence of all sight-threatening diabetes-related eye disease requiring referral to an ophthalmologist among children living with diabetes (n=8) in the UK was 1.21 per 10 000 person-years (95% CI 0.52 to 2.39) and was largely attributable to cataract (n=5) 0.76 per 10 000 person-years (95% CI 0.25 to 1.77). The incidence of sight-threatening diabetic retinopathy (n=3) among those eligible for screening (12 to 18 year-olds living with diabetes) was 1.18 per 10 000 person-years (95% CI 0.24 to 3.46). No subjects eligible for certification as visually impaired or blind were reported. CONCLUSIONS Secondary prevention of visual disability due to retinopathy is currently the sole purpose of national eye screening programmes globally. However, the rarity of treatment-requiring retinopathy in children/young people living with diabetes, alongside growing concerns about suboptimal screening uptake, merit new consideration of the utility of screening for primary prevention of diabetes-related morbidity by using the screening event and findings as a catalyst for better diabetes self-management.
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Affiliation(s)
- Maria Carolina Ibanez-Bruron
- Great Ormond Street Institute of Child Health, University College London, London, UK.,Departamento de Oftalmologia, Pontificia Universidad Católica de Chile, Santiago, Chile.,Ulverscroft Vision Research Group, London, UK
| | - Ameenat Lola Solebo
- Great Ormond Street Institute of Child Health, University College London, London, UK.,Ulverscroft Vision Research Group, London, UK.,Moorfields NIHR Biomedical Research Centre, London, UK.,Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Institute of Ophthalmology, University College London, London, UK
| | - Phillippa Cumberland
- Great Ormond Street Institute of Child Health, University College London, London, UK.,Ulverscroft Vision Research Group, London, UK
| | - Jugnoo S Rahi
- Great Ormond Street Institute of Child Health, University College London, London, UK .,Ulverscroft Vision Research Group, London, UK.,Moorfields NIHR Biomedical Research Centre, London, UK.,Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Institute of Ophthalmology, University College London, London, UK
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Williams S, Newhook LAA, Power H, Shulman R, Smith S, Chafe R. Improving the transitioning of pediatric patients with type 1 diabetes into adult care by initiating a dedicated single session transfer clinic. Clin Diabetes Endocrinol 2020; 6:11. [PMID: 32518677 PMCID: PMC7275548 DOI: 10.1186/s40842-020-00099-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 05/28/2020] [Indexed: 12/20/2022] Open
Abstract
Background Young adults with type 1 diabetes face potential health problems and disruptions in accessing care related to their move from pediatrics into adult care. At a medium-sized pediatric hospital with no formal transition support program, we developed and evaluated the use of a single-session transfer clinic as an initial quality improvement intervention to improve patient satisfaction, clinic attendance, and knowledge of transition related issues. Methods Following a jurisdictional scan of other diabetes programs, the pediatric diabetes program developed a half-day transfer clinic. After the first transfer clinic was held, evaluation surveys were completed by patients, parents, and healthcare providers. Based on the feedback received, we altered the structure and evaluated the revised clinic by surveying patients and parents. Results All patients and parents who attended reported high levels of satisfaction with the clinic. Providers were also mostly positive regarding their participation. Feedback from the first clinic was used to modify the structure of the second clinic to better meet the needs of participants and to allow the clinic to run more efficiently. The use of group sessions and adapting resources developed by other diabetes programs were viewed favourably by participants and lessened the burden on staff who delivered the clinic. Conclusions A half-day transfer clinic is a viable step towards improving patient and parent satisfaction during the transition into adult care without requiring additional staff or significant expenditures of new resources. This type of clinic can also be incorporated into a larger program of transition supports or be adopted by programs serving young adults with other chronic diseases.
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Affiliation(s)
- Sarah Williams
- Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Canada
| | - Leigh Anne Allwood Newhook
- Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Canada.,Janeway Pediatric Research Unit, Memorial University of Newfoundland and Labrador, St. John's, Canada.,Division of Children and Women's Health, Eastern Health, St. John's, Canada
| | - Heather Power
- Janeway Pediatric Research Unit, Memorial University of Newfoundland and Labrador, St. John's, Canada.,Division of Children and Women's Health, Eastern Health, St. John's, Canada
| | - Rayzel Shulman
- Hospital for Sick Children, Toronto, Canada.,SickKids Research Institute, Toronto, Canada.,Institute for Clinical and Evaluative Sciences, Toronto, Canada
| | - Sharon Smith
- Janeway Pediatric Research Unit, Memorial University of Newfoundland and Labrador, St. John's, Canada
| | - Roger Chafe
- Faculty of Medicine, Memorial University of Newfoundland and Labrador, St. John's, Canada.,Janeway Pediatric Research Unit, Memorial University of Newfoundland and Labrador, St. John's, Canada
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Malik FS, Senturia KD, Lind CD, Chalmers KD, Yi-Frazier JP, Shah SK, Pihoker C, Wright DR. Adolescent and parent perspectives on the acceptability of financial incentives to promote self-care in adolescents with type 1 diabetes. Pediatr Diabetes 2020; 21:533-551. [PMID: 31863541 PMCID: PMC7663046 DOI: 10.1111/pedi.12970] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 10/02/2019] [Accepted: 11/25/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND An understanding of acceptability among potential intervention participants is critical to the design of successful real-world financial incentive (FI) programs. The purpose of this qualitative study was to explore adolescent and parent perspectives on the acceptability of using FI to promote engagement in diabetes self-care in adolescents with type 1 diabetes (T1D). METHODS Focus groups with 46 adolescents with T1D (12-17 years old) and 39 parents of adolescents with T1D were conducted in the Seattle metropolitan area. Semistructured questions addressed participants' current use of incentives to promote change in diabetes self-care and receptivity to a theoretical incentive program administered by a third-party. Qualitative data were analyzed and emergent themes identified. RESULTS Three thematic categories informed participant views about the acceptability of FI programs: (a) the extent to which using FIs in the context of diabetes management fit comfortably into a family's value system, (b) the perceived effectiveness for FIs to promote improved diabetes self-care, and (c) the urgent need for improved self-care due to the threat of diabetes-related health complications. These factors together led most parents and adolescents to be open to FI program participation. CONCLUSIONS The results from this qualitative study suggest that well-designed FI programs to support diabetes management are acceptable to families with adolescents with T1D. Additionally, the use of FIs may have the potential to support adolescents with T1D in developing strong self-care habits and ease the often-turbulent transition to independent self-care.
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Affiliation(s)
- Faisal S. Malik
- Department of Pediatrics, University of Washington, 1959 NE Pacific St, Seattle, WA, USA,Seattle Children’s Research Institute, 2001 8th Ave #400, Seattle, WA, USA
| | | | - Cara D. Lind
- Seattle Children’s Research Institute, 2001 8th Ave #400, Seattle, WA, USA
| | | | | | - Seema K. Shah
- Northwestern University, 680 N Lake Shore Drive, Chicago, IL, USA
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington, 1959 NE Pacific St, Seattle, WA, USA,Seattle Children’s Research Institute, 2001 8th Ave #400, Seattle, WA, USA
| | - Davene R. Wright
- Department of Pediatrics, University of Washington, 1959 NE Pacific St, Seattle, WA, USA,Seattle Children’s Research Institute, 2001 8th Ave #400, Seattle, WA, USA
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Davis S, MacKay L. Moving Beyond the Rhetoric of Shared Decision-Making: Designing Personal Health Record Technology With Young Adults With Type 1 Diabetes. Can J Diabetes 2020; 44:434-441. [PMID: 32616277 DOI: 10.1016/j.jcjd.2020.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 03/17/2020] [Accepted: 03/17/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Engaging young adults with type 1 diabetes (T1D) in the self-management of daily tasks and decision-making provides opportunities for positive health outcomes. However, emerging adulthood and care transitions are associated with decreased clinic attendance and diabetes complications. Shared decision-making (SDM) is an optimal approach for health decisions; however, it has been difficult to implement in practice. Personal health record (PHR) technology is a promising approach for overcoming such barriers. Still, today, PHRs have yet to root themselves into care and present an opportunity for improvement in SDM and engagement in self-management decision-making. The objective of this study was to confirm a functional model of an integrated shared decision-making-personal health record system (e-PHR) by young adults with T1D and care providers. METHODS User-centred design approach whereby young adults with T1D, 18 to 24 years of age, and care providers matched PHR functions for the SDM process to confirm an e-PHR functional model. RESULTS An e-PHR functional model justified by young adults (n=7) and providers (n=15) was confirmed. The conceptual design was architected within an interconnected digital health ecosystem and integrated 23 PHR functionalities for SDM with a moderate level of agreement between patients and providers (Cohen kappa 0.60 to 0.74). CONCLUSIONS The establishment of an e-PHR functional model is a precursor to system design requirements. Results highlight the conceivable value of integrating SDM into PHRs for engagement of young adults with T1D in self-management decision-making. Design implications highlight key challenges for future research and system development, including information exchange across disparate systems, usability considerations and system intelligence for information personalization and decision-support tools.
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Affiliation(s)
- Selena Davis
- School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada.
| | - Lee MacKay
- Kootenay Lake Hospital Diabetes Clinic and Kootenay Boundary Division of Family Practice, Nelson, British Columbia, Canada
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