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Esser K, Adams S, Chung C, McKay T, Moore C, Wagman H, Lee S, Orkin J. A quality improvement evaluation of a standardized intervention for children with medical complexity transitioning to adult care. Paediatr Child Health 2024; 29:274-279. [PMID: 39281362 PMCID: PMC11398935 DOI: 10.1093/pch/pxae027] [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: 02/08/2024] [Accepted: 06/12/2024] [Indexed: 09/18/2024] Open
Abstract
Children with medical complexity have medical fragility, chronic disease, technology dependence, and high healthcare use. Their transition to adult health care at age 18 involves medical and social elements and follows no standardized process. Our goal was to improve transition readiness in children with medical complexity using a transition intervention within a Complex Care program. All children with medical complexity aged 14 to 18 were included in this quality improvement (QI) project (n = 54). We conducted a pre- and post-intervention chart review to assess transition outcomes and implemented a transition intervention for 6 months, which included an age-stratified checklist, charting template, and transition rounds. Before the intervention, 72% of 17- to 18-year-old patients had documented transition discussions, which increased to 86%. Patients with a family physician increased as well (61% to 73% for 17- to 18-year-olds). Three transition education rounds were held. The intervention increased transition readiness, provided tools to facilitate transition, and created a forum for conversation.
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Affiliation(s)
- Kayla Esser
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sherri Adams
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Canada
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Christopher Chung
- Division of Neonatology and Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Taylor McKay
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Clara Moore
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Hayley Wagman
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Stephanie Lee
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Julia Orkin
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
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Graziani V, Suprani T, Di Bartolo P, Marchetti F. From pediatric to adult care: a survey on the transition process in type 1 diabetes mellitus and the diabetes services in Italy. Acta Diabetol 2024; 61:1069-1076. [PMID: 38700547 DOI: 10.1007/s00592-024-02268-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/24/2024] [Indexed: 08/17/2024]
Abstract
AIMS The present study assessed the transitioning process of young adults with type 1 diabetes mellitus (T1D) in Italy. MATERIALS AND METHODS We asked Pediatric Diabetes Centers (PDC) and Adult Diabetes Centers (CAD) to fill in a web-based survey on the current state of services, the number of transitioning adolescents with T1D within the last year, observations on limitations, and future directions. RESULTS 93 centers (46 PDCs, 47 CADs) joined the study. The total number of subjects with T1D being followed by a PDC was 16,261 (13,779 minors and 2483 young adults), while CADs had 25,500 patients. The survey showed an uneven situation. Only some services had a dedicated diabetes team (78% of PDCs, 64% of CADs). 72% of PDCs and 58% of CADs reported a protocol dedicated to transition. The median age for transition was 19 (range 16-25 years); the time required for preparing transition, indicated by both PDCs and CADs, was 5.5 months. A high percentage of CADs (80%) confirmed receiving sufficient clinical information, mainly through paper or computerized reports. The transition process is hampered by a lack of resources, logistical facilities, and communication between services. While some services have a protocol, monitoring of results is only carried out in a few cases. Most specialists expressed the need to enhance integration and continuity of treatment. CONCLUSIONS The current situation could be improved. Applying standard guidelines, taking into consideration both clinicians' and patients' necessities, would lead to a more successful transition process.
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Affiliation(s)
- Vanna Graziani
- Department of Pediatrics, Romagna Local Health Authority, Santa Maria delle Croci Hospital, Viale Randi 5, AUSL della Romagna, Ravenna, Italy.
| | - Tosca Suprani
- Department of Pediatrics, Romagna Local Health Authority, Santa Maria delle Croci Hospital, Viale Randi 5, AUSL della Romagna, Ravenna, Italy
| | - Paolo Di Bartolo
- Diabetes Clinic, Romagna Local Health Authority, Santa Maria delle Croci Hospital, Ravenna, Italy
| | - Federico Marchetti
- Department of Pediatrics, Romagna Local Health Authority, Santa Maria delle Croci Hospital, Viale Randi 5, AUSL della Romagna, Ravenna, Italy
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Tóbi L, Prehoda B, Balogh AM, Nagypál P, Kovács K, Miheller P, Iliás Á, Dezsőfi-Gottl A, Cseh Á. Transition is associated with lower disease activity, fewer relapses, better medication adherence, and lower lost-to-follow-up rate as opposed to self-transfer in pediatric-onset inflammatory bowel disease patients: results of a longitudinal, follow-up, controlled study. Therap Adv Gastroenterol 2024; 17:17562848241252947. [PMID: 39156978 PMCID: PMC11327998 DOI: 10.1177/17562848241252947] [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: 09/13/2023] [Accepted: 04/15/2024] [Indexed: 08/20/2024] Open
Abstract
Background Despite the continuously rising rate of pediatric-onset inflammatory bowel diseases (PIBD), there are no consensus transitional guidelines or standardized practices. Objectives We aimed to examine: (1) the determinants of a successful transfer, (2) the effects of the transfer versus transition on the disease course and patient compliance, (3) the unique characteristics of PIBD patients, that need special attention in adult care. Design Longitudinal, follow-up, controlled study conducted between 2001 and 2022, with retrospective data collection until 2018, thence prospective. Methods Three hundred fifty-one PIBD patients enrolled in the study, of whom 152 were moved to adult care, with a mean post-transfer follow-up time of 3 years. Seventy-three patients took part in structured transition, whereas 79 self-transferred to adult care. The main outcome measures were disease activity (defined by PCDAI, PUCAI, CDAI, and Mayo-scores) and course, hospitalizations, surgeries, IBD-related complications, including anthropometry and bone density, patient compliance, medication adherence, and continuation of medical care. Results Patients who underwent structured transition spent significantly more time in remission (83.6% ± 28.5% versus 77.5% ± 29.7%, p = 0.0339) and had better adherence to their medications (31.9% versus 16.4% non-adherence rate, p = 0.0455) in adult care, with self-transferred patients having a 1.59-fold increased risk of discontinuing their medical care and a 1.88-fold increased risk of experiencing a relapse. Post-transfer the compliance of patients deteriorated (38.5% versus 29%, p = 0.0002), with the highest lost-to-follow-up rate during the changing period between the healthcare systems (12.7%), in which female gender was a risk factor (p = 0.010). PIBD patients had experienced IBD-related complications (23.4%) and former surgeries (15%) upon arriving at adult care, with high rates of malnutrition, growth impairment, and poor bone health. Conclusion Structured transition plays a key role in ensuring the best disease course and lowering the lost-to-follow-up rate among PIBD patients. Brief summary Structured transition plays a key role in ensuring the best disease outcome among PIBD patients, as in our study it was associated with lower disease activity, fewer relapses, better medication adherence, and lower lost-to-follow-up rate as opposed to self-transfer.
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Affiliation(s)
- Luca Tóbi
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Post Office Box 2, Budapest 1428, Hungary
| | - Bence Prehoda
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Anna M. Balogh
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Petra Nagypál
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Krisztián Kovács
- Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | - Pál Miheller
- Department of Surgery, Transplantation, and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Ákos Iliás
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Antal Dezsőfi-Gottl
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
| | - Áron Cseh
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
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Vitale RJ, Asher N, Shank K, Katyal B, Tinsley LJ, Garvey KC, Laffel LMB. Transition to self-management among emerging adults with type 1 diabetes: a mixed methods study. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2024; 5:1332159. [PMID: 38774897 PMCID: PMC11106212 DOI: 10.3389/fcdhc.2024.1332159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/22/2024] [Indexed: 05/24/2024]
Abstract
Introduction Emerging adulthood is challenging for young people with type 1 diabetes (T1D). This study evaluated transition to diabetes self-management and perceptions of care transfer using mixed methods. Methods An online survey queried demographics, management characteristics, diabetes knowledge, self-care readiness, adherence, and diabetes distress. T-tests compared survey scores between those with self-reported target A1c <7.0% versus ≥7.0%. Pearson correlations assessed associations between A1c and diabetes distress, stratified by A1c <7.0% versus ≥7.0%. Qualitative semi-structured interviews elicited perceptions of young adults; transcripts were analyzed using directed qualitative content analysis. Results Of 141 participants (30% male, 84% non-Hispanic white) completing the survey, 41% self-reported target A1c <7.0%. Diabetes knowledge and self-care readiness scores did not differ between those with A1c <7.0% versus ≥7.0%, while diabetes distress was lower (45 ± 20 vs 52 ± 20, p=0.01) and adherence higher (77 ± 12 vs 71 ± 14, p=0.02) in those with A1c <7.0% versus ≥7.0%. Diabetes distress was significantly associated with glycemic outcomes in those reporting A1c ≥7.0% (R=0.36, p<0.01). Qualitative analysis (24 participants) revealed five themes and two sub-themes, notable for need for more mental health support, support from others with T1D, benefits of technology for care autonomy, and challenges of obtaining diabetes supplies. Discussion Emerging adults with self-reported target A1c endorsed lower diabetes distress and higher adherence than those with elevated A1c. Mental health access, support from others with T1D, technology use, and guidance for supply acquisition may improve transition to self-management and care transfer for emerging adults with T1D.
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Affiliation(s)
- Rebecca J. Vitale
- Section on Clinical, Behavioral, and Outcomes Research, Joslin Diabetes Center, Boston, MA, United States
- Division of Endocrinology, Department of Medicine, Brigham & Women’s Hospital, Boston, MA, United States
- Division of Endocrinology, Department of Pediatrics, Boston Children’s Hospital, Boston, MA, United States
| | - Noa Asher
- Section on Clinical, Behavioral, and Outcomes Research, Joslin Diabetes Center, Boston, MA, United States
| | - Kaitlyn Shank
- Department of Medicine, Brigham & Women’s Hospital, Boston, MA, United States
- Department of Pediatrics, Boston Children’s Hospital, Boston, MA, United States
| | - Biren Katyal
- Section on Clinical, Behavioral, and Outcomes Research, Joslin Diabetes Center, Boston, MA, United States
| | - Liane J. Tinsley
- Section on Clinical, Behavioral, and Outcomes Research, Joslin Diabetes Center, Boston, MA, United States
| | - Katharine C. Garvey
- Division of Endocrinology, Department of Pediatrics, Boston Children’s Hospital, Boston, MA, United States
| | - Lori M. B. Laffel
- Section on Clinical, Behavioral, and Outcomes Research, Joslin Diabetes Center, Boston, MA, United States
- Division of Endocrinology, Department of Pediatrics, Boston Children’s Hospital, Boston, MA, United States
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Sullivan MO, Curtin M, Flynn R, Cronin C, Mahony JO, Trujillo J. Telehealth interventions for transition to self-management in adolescents with allergic conditions: A systematic review. Allergy 2024; 79:861-883. [PMID: 38041398 DOI: 10.1111/all.15963] [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: 10/04/2023] [Revised: 11/14/2023] [Accepted: 11/19/2023] [Indexed: 12/03/2023]
Abstract
Telehealth is an emerging approach that uses technology to provide healthcare remotely. Recent publications have outlined the importance of supporting the transition to self-management of adolescents with allergic conditions. However, no synthesis of the evidence base on the use and impact of telehealth interventions for this purpose has been conducted to date. This review achieves these aims, in addition to exploring the language use surrounding these interventions, and their implementation. Four databases were searched systematically. References were independently screened by two reviewers. Methodological quality was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis was undertaken. Eighteen articles were included, reporting on 15 telehealth interventions. A total of 86% targeted adolescents with asthma. Mobile applications were the most common telehealth modality used, followed by video-conferencing, web-based, virtual reality and artificial intelligence. Five intervention content categories were identified; educational, monitoring, behavioural, psychosocial and healthcare navigational. Peer and/or healthcare professional interaction, gamification and tailoring may increase engagement. The studies showed positive effects of the interventions or no difference from active controls, in self-management outcomes such as knowledge, health outcomes such as quality-of-life, and economic outcomes such as healthcare utilization. The most common implementation outcomes reported were acceptability, appropriateness, feasibility and fidelity.
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Affiliation(s)
- Meg O' Sullivan
- University College Cork, Cork, Ireland
- Cork University Hospital, Cork, Ireland
| | | | | | | | | | - Juan Trujillo
- University College Cork, Cork, Ireland
- Cork University Hospital, Cork, Ireland
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Mathias P, Corathers SD, Carreon SA, Hilliard ME, Papadakis JL, Weissberg-Benchell J, Raymond JK, Pyatak EA, Agarwal S. Young Adults with Type 1 Diabetes. Endocrinol Metab Clin North Am 2024; 53:39-52. [PMID: 38272597 DOI: 10.1016/j.ecl.2023.09.001] [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] [Indexed: 01/27/2024]
Abstract
Young adults experience multiple developmental transitions across social, educational, vocational, residential, and financial life domains. These transitions are potential competing priorities to managing a chronic condition such as type 1 diabetes and can contribute to poor psychosocial and medical outcomes. In this narrative review, we describe population outcomes of young adult populations and the unique considerations associated with managing type 1 diabetes in young adulthood. We provide an overview of the current evidence-based strategies to improve care for young adults with type 1 diabetes and recommendations for future directions in the field.
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Affiliation(s)
- Priyanka Mathias
- Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine-Montefiore Medical Center, 1180 Morris Park Avenue, Bronx, NY 10467, USA
| | - Sarah D Corathers
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Samantha A Carreon
- Baylor College of Medicine and Texas Children's Hospital, 1102 Bates Avenue, Suite 940, Houston, TX 77030, USA
| | - Marisa E Hilliard
- Baylor College of Medicine and Texas Children's Hospital, 1102 Bates Avenue, Suite 940, Houston, TX 77030, USA
| | - Jaclyn L Papadakis
- Northwestern University Feinberg School of Medicine, Pritzker Department of Psychiatry and Behavioral Health, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 10, Chicago, IL 60611, USA
| | - Jill Weissberg-Benchell
- Northwestern University Feinberg School of Medicine, Pritzker Department of Psychiatry and Behavioral Health, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 10, Chicago, IL 60611, USA
| | - Jennifer K Raymond
- Division of Pediatric Endocrinology, Children's Hospital Los Angeles, 4650 Sunset Boulevard. MS 61, Los Angeles, CA, USA
| | - Elizabeth A Pyatak
- Chan Division of Occupational Science and Occupational Therapy, Ostrow School of Dentistry, University of Southern California, 1540 Alcazar Street, CHP-133, Los Angeles, CA 90089-9003, USA
| | - Shivani Agarwal
- Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine-Montefiore Medical Center, 1180 Morris Park Avenue, Bronx, NY 10467, USA; NY Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, 1180 Morris Park Avenue, Bronx, NY 10467, USA.
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Shukla M, Carcone A, Mooney M, Kannikeswaran N, Ellis DA. Evaluating barriers and facilitators to healthcare providers' use of an emergency department electronic referral portal for high-risk children with asthma using the Theoretical Domains Framework. J Asthma 2024; 61:184-193. [PMID: 37688796 PMCID: PMC10922072 DOI: 10.1080/02770903.2023.2257318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/16/2023] [Accepted: 09/05/2023] [Indexed: 09/11/2023]
Abstract
OBJECTIVE Urban children with asthma are at risk for frequent emergency department (ED) visits and suboptimal asthma management. ED visits provide an opportunity for referrals to community-based asthma management services. Electronic medical record-based referral portals have been shown to improve quality of care but use of these portals by healthcare providers (HCPs) is variable. The purpose of the study was to investigate facilitators, barriers, and recommendations to improve the use of an electronic referral portal to connect children presenting with asthma exacerbations in an urban pediatric ED to community-based education and case management services. METHODS The study was grounded in the Theoretical Domains Framework, an implementation provided the theoretical basis of the study. All ED HCPs were invited to complete qualitative interviews; twenty-three HCPs participated. Interviews were coded using directed content analysis. RESULTS Facilitators to portal use included its relative ease of use and HCP beliefs regarding the importance of such referrals for preventive asthma care. Barriers included insufficient time to make referrals, lack of information regarding the community agency and challenges communicating the value of the referral to patients and/or their caregivers. CONCLUSIONS Successfully engaging HCPs working in ED settings to use electronic portals to refer children with asthma to community agencies for health services may involve helping providers increase their comfort and knowledge of the external provider agency, ensuring organizational leaders support the need for preventive asthma care and provision of feedback to HCPs on the success of such referrals in meeting the needs of those families served.
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Affiliation(s)
| | - April Carcone
- Family Medicine, Wayne State University, Detroit, MI, USA
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Malik FS, Weaver KW, Corathers SD, White PH. Incorporating the Six Core Elements of Health Care Transition in Type 1 Diabetes Care for Emerging Adults. Endocrinol Metab Clin North Am 2024; 53:53-65. [PMID: 38272598 DOI: 10.1016/j.ecl.2023.09.003] [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] [Indexed: 01/27/2024]
Abstract
A growing body of literature finds persistent problems in the provision of recommended health care transition services, as well as adverse outcomes associated with the lack of these services in emerging adults with type 1 diabetes. The Six Core Elements of Health Care Transition offers a structured approach to the phases of health care transition support for both pediatric and adult diabetes practices. This article reviews strategies to incorporate the Six Core Elements into ambulatory diabetes care to support successful health care transition for emerging adults with type 1 diabetes.
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Affiliation(s)
- Faisal S Malik
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA; Development, Seattle Children's Research Institute, Center for Child Health, Behavior, 1920 Terry Avenue, CURE-3, Seattle, WA 98101, USA.
| | - Kathryn W Weaver
- Department of Medicine, University of Washington School of Medicine, 325 Ninth Avenue, Seattle, WA 98104, USA
| | - Sarah D Corathers
- Cincinnati Children's Hospital Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 7012, Cincinnati, OH 45229, USA
| | - Patience H White
- Department of Medicine and Pediatrics, George Washington University School of Medicine, 5335 Wisconsin Avenue NW, Suite 440, Washington, DC 20015, USA
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Iyengar JJ, Ang L, Rodeman KB, Rao A, Lin YK, Broome DT, Fanous N, Reinert RB, Konigsberg A, Weatherup E, Hagar C, Rogosch D, Florek J, Carey B, Wyckoff J, Lee J, Thomas IH, Soleimanpour SA. A Novel Receivership Model for Transition of Young Adults With Diabetes: Experience From a Single-center Academic Transition Program. Endocr Pract 2024; 30:113-121. [PMID: 38029926 DOI: 10.1016/j.eprac.2023.11.008] [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: 08/22/2023] [Revised: 11/08/2023] [Accepted: 11/21/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE The transition from pediatric to adult care for young adults with diabetes represents an important but often challenging time characterized by a shift from a family-centered care model of pediatrics to a patient-centered care model of adult medicine. We developed a structured transition program based on an adult receivership model at a large academic medical center to improve care coordination and patient satisfaction with the transition process. METHODS From 2016 to 2020, we implemented a series of quality improvement efforts for young adults aged 18 to 23 years with diabetes by incorporating best practices from the American Diabetes Association guidelines on care for emerging adults. We measured transition orientation attendance, patient satisfaction, hemoglobin A1c (HbA1c) pre- and post-transfer, and care gaps to determine the impact of the program. RESULTS In this study, 307 individuals with type 1 diabetes and 16 individuals with type 2 diabetes were taken care of by the adult endocrinology department at the University of Michigan between January 1, 2016 and October 31, 2020. We observed high attendance rates (86% among internal transfers) and favorable patient satisfaction scores for the transition orientation session. Despite the glycemic challenges posed during the transition, HbA1c modestly yet significantly improved 1-year after transfer (-0.4%, P < .01). CONCLUSION We successfully established and maintained a young adult diabetes transition program using a quality improvement approach. Future work will focus on reducing care gaps at the time of transfer, assessing long-term retention rates, and enhancing care coordination for patients referred from outside the health network.
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Affiliation(s)
- Jennifer J Iyengar
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.
| | - Lynn Ang
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Kathryn Bux Rodeman
- Department of Maternal Fetal Medicine and Endocrinology, Promedica Physicians Group, Perrysburg, Ohio
| | - Amith Rao
- Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona
| | - Yu Kuei Lin
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - David T Broome
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Nada Fanous
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Rachel B Reinert
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Anna Konigsberg
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Emily Weatherup
- Adult Diabetes Education Program, Michigan Medicine, Ann Arbor, Michigan
| | - Christine Hagar
- Adult Diabetes Education Program, Michigan Medicine, Ann Arbor, Michigan
| | - Danielle Rogosch
- Adult Diabetes Education Program, Michigan Medicine, Ann Arbor, Michigan
| | - Jacinta Florek
- Division of Endocrinology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Brittany Carey
- Division of Endocrinology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Jennifer Wyckoff
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Joyce Lee
- Division of Endocrinology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan; Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan
| | - Inas H Thomas
- Division of Endocrinology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Scott A Soleimanpour
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan; Department of Molecular and Integrative Physiology, University of Michigan Medical School, Ann Arbor, Michigan; Medicine Service, Endocrinology and Metabolism Section, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.
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Wang R, Rouleau G, Booth GL, Brazeau AS, El-Dassouki N, Taylor M, Cafazzo JA, Greenberg M, Nakhla M, Shulman R, Desveaux L. Understanding Whether and How a Digital Health Intervention Improves Transition Care for Emerging Adults Living With Type 1 Diabetes: Protocol for a Mixed Methods Realist Evaluation. JMIR Res Protoc 2023; 12:e46115. [PMID: 37703070 PMCID: PMC10534286 DOI: 10.2196/46115] [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: 01/31/2023] [Revised: 06/27/2023] [Accepted: 07/24/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Emerging adults living with type 1 diabetes (T1D) face a series of challenges with self-management and decreased health system engagement, leading to an increased risk of acute complications and hospital admissions. Effective and scalable strategies are needed to support this population to transfer seamlessly from pediatric to adult care with sufficient self-management capability. While digital health interventions for T1D self-management are a promising strategy, it remains unclear which elements work, how, and for which groups of individuals. OBJECTIVE This study aims to evaluate the design and implementation of a multicomponent SMS text message-based digital health intervention to support emerging adults living with T1D in real-world settings. The objectives are to identify the intervention components and associated mechanisms that support user engagement and T1D health care transition experiences and determine the individual characteristics that influence the implementation process. METHODS We used a realist evaluation embedded alongside a randomized controlled trial, which uses a sequential mixed methods design to analyze data from multiple sources, including intervention usage data, patient-reported outcomes, and realist interviews. In step 1, we conducted a document analysis to develop a program theory that outlines the hypothesized relationships among "individual-level contextual factors, intervention components and features, mechanisms, and outcomes," with special attention paid to user engagement. Among them, intervention components and features depict 10 core characteristics such as transition support information, problem-solving information, and real-time interactivity. The proximal outcomes of interest include user engagement, self-efficacy, and negative emotions, whereas the distal outcomes of interest include transition readiness, self-blood glucose monitoring behaviors, and blood glucose. In step 2, we plan to conduct semistructured realist interviews with the randomized controlled trial's intervention-arm participants to test the hypothesized "context-intervention-mechanism-outcome" configurations. In step 3, we plan to triangulate all sources of data using a coincidence analysis to identify the necessary combinations of factors that determine whether and how the desired outcomes are achieved and use these insights to consolidate the program theory. RESULTS For step 1 analysis, we have developed the initial program theory and the corresponding data collection plan. For step 2 analysis, participant enrollment for the randomized controlled trial started in January 2023. Participant enrollment for this realist evaluation was anticipated to start in July 2023 and continue until we reached thematic saturation or achieved informational power. CONCLUSIONS Beyond contributing to knowledge on the multiple pathways that lead to successful engagement with a digital health intervention as well as target outcomes in T1D care transitions, embedding the realist evaluation alongside the trial may inform real-time intervention refinement to improve user engagement and transition experiences. The knowledge gained from this study may inform the design, implementation, and evaluation of future digital health interventions that aim to improve transition experiences. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/46115.
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Affiliation(s)
- Ruoxi Wang
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Geneviève Rouleau
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
- Département des Sciences Infirmières, Université du Québec en Outaouais, St-Jérôme, QC, Canada
- Faculté des sciences infirmières, l'Université de Montréal, Montreal, QC, Canada
| | - Gillian Lynn Booth
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - Noor El-Dassouki
- Centre for Digital Therapeutics, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Madison Taylor
- Centre for Digital Therapeutics, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Joseph A Cafazzo
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Centre for Digital Therapeutics, Toronto General Hospital, University Health Network, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Department of Computer Science, University of Toronto, Toronto, ON, Canada
| | - Marley Greenberg
- Department of Philosophy, Joint Centre for Bioethics, University of Toronto, Toronto, ON, Canada
- Diabetes Action Canada, Toronto, ON, Canada
| | - Meranda Nakhla
- Division of Endocrinology, Montreal Children's Hospital, McGill University, Montréal, QC, Canada
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Rayzel Shulman
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada
- Division of Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Laura Desveaux
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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11
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Crossen SS, Wagner DV. Narrowing the Divide: The Role of Telehealth in Type 1 Diabetes Care for Marginalized Communities. J Diabetes Sci Technol 2023; 17:901-908. [PMID: 36896887 PMCID: PMC10348000 DOI: 10.1177/19322968231157367] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Widespread uptake of telehealth in response to the COVID-19 pandemic has highlighted geographic, demographic, and economic disparities in access to virtual care. However, research studies and clinical programs that predate the pandemic demonstrate the potential for telehealth-based interventions to improve access to and outcomes of type 1 diabetes (T1D) care for individuals in geographically or socially marginalized communities. In this expert commentary, we discuss telehealth-based care models that have been successful in improving care for marginalized T1D populations. We also outline the policy changes needed to expand access to such interventions to reduce established disparities in T1D care and promote better health equity among people living with T1D.
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Affiliation(s)
- Stephanie S. Crossen
- Division of Pediatric Endocrinology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - David V. Wagner
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
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12
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Hornung RJ, Reed PW, Gunn AJ, Albert B, Hofman PL, Farrant B, Jefferies C. Transition from paediatric to adult care in young people with diabetes; A structured programme from a regional diabetes service, Auckland, New Zealand. Diabet Med 2023; 40:e15011. [PMID: 36398457 DOI: 10.1111/dme.15011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 10/26/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022]
Abstract
AIM To assess participation with a structured transition programme for adolescents with diabetes. METHODS Data from a regional cohort aged less than 16 years of age with type 1 (T1) and type 2 diabetes (T2D) in Auckland, New Zealand (2006-2016). Participation was defined as opting into a structured transition programme. RESULTS Five hundrend and twelve adolescents who were to be transferred to adult care (476 type 1 (T1D) and 36 type 2 (T2D)), overall participation rate of 83%, 86% (408/476) with T1D compared to 47% (17/36) with T2D. Within the cohort of T1D, participation rates for Māori and Pacific were lower (74% and 77%, respectively) than New Zealand Europeans (88%, p = 0.020 and p = 0.039, respectively). Lower socio-economic status was associated with reduced participation (77%) compared to higher socio-economic status (90%, p = 0.002). Of the 476 T1D who participated, 408 (96%) subsequently attended at least one adult service clinic ("capture"). 42% attended an adult clinic within the planned 3 months, 87% at 6 months and retention in adult clinics over 5 years of follow-up was 78%. By contrast, the 68 young people with T1D who did not participate in the structured transition had a capture rate of 78% (p < 0.001) and retention of 63% (p = 0.036). CONCLUSIONS In adolescents with diabetes, a formal transition from a paediatric service was associated with high rates of adult capture and subsequent retention in adult care over a 5-year follow-up period. Low socio-economic status, Māori or Pacific ethnicity and T2D were associated with reduced participation in the structured transition programme.
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Affiliation(s)
- Rosalie J Hornung
- Starship Children's Health, Paediatric Diabetes and Endocrinology Service, Auckland District Health Board, Auckland, New Zealand
| | - Peter W Reed
- Starship Children's Health Children's Research Centre, Auckland District Health Board, Auckland, New Zealand
| | - Alistair J Gunn
- Starship Children's Health, Paediatric Diabetes and Endocrinology Service, Auckland District Health Board, Auckland, New Zealand
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Ben Albert
- Starship Children's Health, Paediatric Diabetes and Endocrinology Service, Auckland District Health Board, Auckland, New Zealand
| | - Paul L Hofman
- Starship Children's Health, Paediatric Diabetes and Endocrinology Service, Auckland District Health Board, Auckland, New Zealand
- The Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Bridget Farrant
- Centre for Youth Health, Counties Manukau District Health Board, Auckland, New Zealand
| | - Craig Jefferies
- Starship Children's Health, Paediatric Diabetes and Endocrinology Service, Auckland District Health Board, Auckland, New Zealand
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13
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Wyngaert KV, Nédée ML, Piessevaux O, De Martelaer T, Van Biesen W, Cocquyt V, Van Daele S, De Munter J. The role and the composition of a liaison team to facilitate the transition of adolescents and young adults: an umbrella review. Eur J Pediatr 2023; 182:1483-1494. [PMID: 36735061 DOI: 10.1007/s00431-023-04835-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 02/04/2023]
Abstract
Adolescents and young adults (AYAs) benefit from healthcare transition (HCT) programs. Despite the well-established literature reviewing HCT, a considerable heterogeneity exists on the involved healthcare professionals. This review aims to explore systematic reviews on the practices and recommendations on which disciplines of professionals should be involved in HCT. An umbrella review was performed using the MEDLINE, EMBASE, and Web of Science databases. To be eligible, systematic reviews had to report on the composition and/or the rationale of members of a transition team. Seventeen reviews were included in this systematic review. A healthcare professional that coordinates HCT was identified as a key caregiver in all reviews. Other reported members of a HCT team were nurses (75% of the reviews), social workers (44%), and peers/mentors (35%). The reported key responsibilities of a HCT team were to (i) manage communication, (ii) ensure continuity of care, and (iii) maintain contact with community services. Conclusions: A team responsible for HCT should be active on the organizational, medical, and social levels. Key members of a HCT team vary little between diseases and included a coordinator, social worker, and nurse. A coordinating physician could facilitate transition in complex conditions. At all times, the condition and needs of the AYA should determine who should be involved as caregiver. What is Known: • The psychosocial needs of adolescents and young adults during healthcare transition are largely similar between chronic diseases. What is New: • Coordinators, nurses and social workers were the most involved, independent of the condition. • A liaison team should be active on organizational-, medical- and social-levels.
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Affiliation(s)
- Karsten Vanden Wyngaert
- Department of Internal Medicine, Renal Division, Ghent University Hospital, Corneel-Heymanslaan 10, Ghent, 9000, Belgium.
| | - Marie-Lise Nédée
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Odile Piessevaux
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Tine De Martelaer
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Wim Van Biesen
- Department of Internal Medicine, Renal Division, Ghent University Hospital, Corneel-Heymanslaan 10, Ghent, 9000, Belgium
| | - Veronique Cocquyt
- Department of Internal Medicine, Medical Oncology Division, Ghent University Hospital, Ghent, Belgium
| | - Sabine Van Daele
- Pediatric Pulmonology, Ghent University Hospital, Ghent, Belgium
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14
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Chai TYL, Farrell K, Holmes-Walker DJ. Use of continuous subcutaneous insulin infusion versus multiple daily injections in emerging adults with type 1 diabetes is associated with better clinical engagement but not glycaemic control. Intern Med J 2023; 53:255-261. [PMID: 34561942 DOI: 10.1111/imj.15539] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 09/15/2021] [Accepted: 09/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Limited studies have compared outcomes between emerging adults with type 1 diabetes mellitus (T1D) attending a diabetes transition support programme using multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII). AIMS To assess glycaemic control and service utilisation in emerging adults with T1D on MDI or CSII attending a young adult diabetes clinic (YAC). METHODS A retrospective cohort analysis was conducted from January 2013 to December 2015. Data collected included clinic visits per year, after-hours mobile telephone use, diabetic ketoacidosis (DKA) admissions and all HbA1c levels. Independent t-test was used to compare continuous variables whilst Pearson's Chi-squared test was used for categorical variables. Linear mixed effects models explored mean changes in HbA1c levels over time. RESULTS Over 3 years, 318 youth with T1D (176 MDI, 121 CSII, 21 switched from MDI to CSII) attended our YAC. Aggregated mean HbA1c levels remained similar between modalities (CSII 9.1% vs MDI 9.3%; P = 0.23); however, mean change in HbA1c at 3 years was significantly increased in CSII users at 0.55% (95% CI 0.15-0.95; P < 0.01) compared with no significant change in MDI users. Clinic visits per year were improved in CSII users (CSII 2.8 vs MDI 2.5; P = 0.02), while DKA admissions remained similar between MDI and CSII users (3.6 admissions per 100 patient-years). CONCLUSION In our YAC cohort, glycaemic control in CSII and MDI users was similar but well below recommended international glycaemic targets (HbA1c level < 7.0%). Despite increased clinical engagement occurring in CSII users, glycaemic deterioration was observed over the 3 years.
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Affiliation(s)
- Thora Y L Chai
- Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia.,Diabetes Transition Support Program, Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Kaye Farrell
- Diabetes Transition Support Program, Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Deborah J Holmes-Walker
- Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia.,Diabetes Transition Support Program, Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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15
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Lee MA, Holmes-Walker DJ, Farrell K, Clark-Luccitti A. Impact of continuous glucose monitoring in youth with type 1 diabetes aged 15-21 years. Intern Med J 2023; 53:209-215. [PMID: 33949770 DOI: 10.1111/imj.15347] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/11/2021] [Accepted: 04/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND People with type 1 diabetes (T1D) aged <21 years are eligible for subsidised continuous glucose monitoring (CGM) products under the Australian National Diabetes Services Scheme. There are few real-world published studies to evaluate the benefits of CGM in young adults. AIMS To perform a real-world observation study among youth with T1D to evaluate CGM use and benefits of CGM. METHODS Patients at the Westmead Hospital Young Adult Diabetes Clinic aged 15-21 years who commenced CGM before July 2018 were followed for 6 months post commencement of CGM. Differences in HbA1c and glucose metrics at baseline and follow up are compared between those commencing CGM and those that did not. RESULTS Forty-four (38%) of 115 eligible patients commenced CGM. Demographic characteristics and baseline HbA1c did not differ significantly between those started on CGM and those that did not. At 6 months, 18 (41%) of 44 patients still used CGM, with discomfort and inconvenience the most common reasons for dropout. In CGM continuers, at 6 months compared with baseline, there was no change in HbA1c (8.2% vs 8.0%; P = 0.8), coefficient of variation of glucose (38% vs 39%; P = 0.5) or percentage time in range (52% vs 58%; P = 0.3). Six-month follow-up HbA1c in CGM non-users deteriorated significantly compared with users. Mean hypoglycaemia fear scores (worry scale) were significantly decreased from baseline at 6 months (33 vs 18; P < 0.01). CONCLUSION There are high rates of discontinuation in CGM use among youth with T1D. At 6 months of CGM use, there was no significant change in glycaemic control, although HbA1c in non-users deteriorated significantly. Worry of hypoglycaemia was significantly decreased among those who continued CGM.
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Affiliation(s)
- Myron Andrew Lee
- Endocrinology and Chemical Pathology Registrar, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Department of Diabetes and Endocrinology, Westmead Hospital, New South Wales, Australia.,Diabetes Transition Support Programme, Department of Diabetes and Endocrinology, Westmead Hospital, New South Wales, Australia.,Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Deborah Jane Holmes-Walker
- Department of Diabetes and Endocrinology, Westmead Hospital, New South Wales, Australia.,Diabetes Transition Support Programme, Department of Diabetes and Endocrinology, Westmead Hospital, New South Wales, Australia.,Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Kaye Farrell
- Diabetes Transition Support Programme, Department of Diabetes and Endocrinology, Westmead Hospital, New South Wales, Australia
| | - Ashley Clark-Luccitti
- Diabetes Transition Support Programme, Department of Diabetes and Endocrinology, Westmead Hospital, New South Wales, Australia
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16
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Bray EA, Everett B, George A, Salamonson Y, Ramjan LM. Co-designed healthcare transition interventions for adolescents and young adults with chronic conditions: a scoping review. Disabil Rehabil 2022; 44:7610-7631. [PMID: 34595986 DOI: 10.1080/09638288.2021.1979667] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE To determine the scope of published literature on healthcare transition (HCT) interventions that have been co-designed with adolescents and young adults with chronic conditions, and to undertake feasibility assessments. METHODS Using Scopus, CINAHL, Medline-Ovid, Cochrane and PsycINFO databases, publications that included a HCT intervention to support paediatric to adult healthcare transition were included. Study location, design, population, description of the intervention, co-design methods, feasibility evidenced using Bowen and colleagues' framework, and outcome measures were extracted for review. RESULTS A total of 21 studies were included, relating to 17 co-designed HCT interventions that ranged across multiple medical specialties. There was no standard HCT intervention; characteristics, format and delivery mode varied. Only three studies reported a detailed description of the co-design method(s) used and none reported on the facilitators or barriers. Among the studies, five of Bowen and colleagues' eight dimensions of feasibility were measured. CONCLUSIONS Despite the co-design process being neither described or evaluated extensively, all co-designed HCT interventions included in this review were considered to be feasible. Nevertheless, HCT interventions varied in their format and delivery method making it difficult to compare between them. Furthermore, interventions were often condition-specific and not representative of the extensive range of chronic conditions.Implications for RehabilitationHealthcare transition interventions can improve adherence to care, health outcomes, ongoing rehabilitation, and quality of life of adolescents and young adults with chronic conditions.Healthcare transition interventions should maximise long-term functioning and prioritise rehabilitation aimed at enhancing independence and self-management skills, while reducing hospitalisations.The engagement of individuals with lived experience in the co-design of interventions has been strongly advocated as it brings unique knowledge and experience to the research process.Minimal attention has been given to the involvement of adolescents and young adults with chronic conditions in the development of healthcare transition interventions, however, healthcare transition interventions co-designed with adolescents and young adults with chronic conditions are both feasible and acceptable.
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Affiliation(s)
- Emily Alice Bray
- School of Nursing and Midwifery, Western Sydney University, Penrith, Australia
| | - Bronwyn Everett
- School of Nursing and Midwifery, Western Sydney University, Penrith, Australia
| | - Ajesh George
- School of Nursing and Midwifery, Western Sydney University, Penrith, Australia
| | - Yenna Salamonson
- School of Nursing and Midwifery, Western Sydney University, Penrith, Australia
| | - Lucie M Ramjan
- School of Nursing and Midwifery, Western Sydney University, Penrith, Australia
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17
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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] [MESH Headings] [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
- Department of Health Sciences, University of York, York, UK
| | | | - Lorna Fraser
- Martin House Research Centre, University of York, York, UK
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18
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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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19
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Al Ksir K, Wood DL, Hasni Y, Sahli J, Quinn M, Ghardallou M. Motivational interviewing to improve self-management in youth with type 1 diabetes: A randomized clinical trial. J Pediatr Nurs 2022; 66:e116-e121. [PMID: 35568602 DOI: 10.1016/j.pedn.2022.05.001] [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: 01/23/2022] [Revised: 04/23/2022] [Accepted: 05/04/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Effective interventions are needed to help adolescents with T1D develop independent self-management skills to prevent commonly observed deterioration of disease self-management resulting in poor health outcomes. Using a prospective RCT design, we assessed the impact of a nurse-led education program based on motivational interviewing (MI) in youth with Type 1 diabetes (T1D). DESIGN AND METHODS After parental consent and youth assent, we prospectively randomized 66 adolescents 13-18 years old with T1D to either usual care (every 3 months visit with pediatric endocrinologist) or usual care supplemented by 2 in-person and 4 follow-up phone calls with a nurse educator in a pediatric endocrinology clinic of the University Hospital Farhat Hached, Sousse, Tunisia. We used MI sessions to support youth general and disease specific self-management skills. Outcomes were change, between baseline and 6 months, in TRAQ (a validated measure of youth self-management) scores and HbA1c values. RESULTS Mean TRAQ scores (based on a 5-point Likert scale) increased by 1.44 points (s.d. = 0.56) in the Intervention Group versus 0.26 points (s.d. = 0.34) in the control group (p < 0.001). The mean HbA1C value decreased in the intervention group by 0.95 units versus a decrease of 0.12 units in the control group (p = 0.047). CONCLUSION We found that a brief, nurse-led MI-based educational intervention, integrated into specialty pediatric care, resulted in a significant improvement in both self-reported self-management skills and in HbA1c values. TRIAL REGISTRATION Registered in ClinicalTrials.gov Identifier: NCT04798937.
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Affiliation(s)
- Kawther Al Ksir
- College of Public Health, East Tennessee State University, Johnson City, TN, United States of America.
| | - David L Wood
- College of Public Health, East Tennessee State University, Johnson City, TN, United States of America; Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States of America
| | - Yosra Hasni
- Farhat Hached University Hospital Center, Endocrinology Department, Sousse, Tunisia
| | - Jihene Sahli
- Department of Family and Community Medicine, University of Sousse, Faculty of Medicine of Sousse, Sousse, Tunisia
| | - Megan Quinn
- College of Public Health, East Tennessee State University, Johnson City, TN, United States of America
| | - Meriam Ghardallou
- Department of Family and Community Medicine, University of Sousse, Faculty of Medicine of Sousse, Sousse, Tunisia
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20
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James S, Perry L, Lowe J, Harris M, Craig ME. Suboptimal glycemic control in adolescents and young adults with type 1 diabetes from 2011 to 2020 across Australia and New Zealand: Data from the Australasian Diabetes Data Network registry. Pediatr Diabetes 2022; 23:736-741. [PMID: 35561056 DOI: 10.1111/pedi.13364] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 05/02/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Competing challenges in adolescence and young adulthood can distract from optimal type 1 diabetes (T1D) self-management, and increase risks of premature morbidity and mortality. There are limited data mapping the glycemic control of people with T1D in this age group, across Australasia. RESEARCH DESIGN AND METHODS Clinical data were extracted from the Australasian Diabetes Data Network, a prospective clinical diabetes registry. Inclusion criteria were individuals with T1D aged 16-25 years at their last recorded T1D healthcare visit (from 1st January 2011 to 31st December 2020), with T1D duration of at least 1 year. Data were stratified by two last recorded T1D healthcare visit ranges, while generalized estimated equation (GEE) modeling was used to examine factors associated with HbA1c across visits during the 10 year period. RESULTS Data from 6329 young people (52.6% male) attending 24 diabetes centers across Australasia were included. At the last visit within the most recent 5 years, mean ± SD age was 18.5 ± 2.3 years, T1D duration was 8.8 ± 4.7 years and HbA1c was 8.8 ± 1.8% (72.2 ± 19.9 mmol/mol); only 12.3% had an HbA1c below the international target of <7.0% (53 mmol/mol). Across all T1D healthcare visits, in GEE modeling, higher HbA1c was associated with female sex (B = 0.20; 95% CI 0.12 to 0.29, p < 0.001), longer T1D duration (B = 0.04, 0.03 to 0.05, p < 0.001). Lower HbA1c was associated with attendance at a pediatric T1D healthcare setting (B = -0.33, -0.45 to -0.21, p < 0.001) and use of CSII versus BD/MDI therapy (B = -0.49, -0.59 to 0.40, p < 0.001). CONCLUSIONS This Australasian study demonstrates widespread and persistent sub-optimal glycemic control in young people with T1D, highlighting the urgent need to better understand how healthcare services can support improved glycemic control in this population.
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Affiliation(s)
- Steven James
- University of the Sunshine Coast, School of Nursing, Midwifery and Paramedicine, Petrie, Queensland, Australia.,University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Parkville, Victoria, Australia
| | - Lin Perry
- University of Technology Sydney, School of Nursing and Midwifery, Ultimo, New South Wales, Australia.,Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Julia Lowe
- University of Newcastle, School of Medicine and Public Health, Callaghan, New South Wales, Australia
| | - Margaret Harris
- University of Newcastle, School of Nursing and Midwifery, New South Wales, Australia
| | - Maria E Craig
- Children's Hospital at Westmead, Endocrinology, Westmead, New South Wales, Australia.,University of Sydney, Faculty of Health and Medicine, Sydney, New South Wales, Australia.,University of New South Wales, School of Women's and Children's Health, Kensington, New South Wales, Australia
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21
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Goyal A, Peerzada A, Sarteau AC, Praveen PA, Kalaivani M, Tandon N. A multi-center pediatric to adult care transition intervention program to improve clinic visit adherence and clinical outcomes among adolescents and emerging adults with type 1 diabetes mellitus [PATHWAY]: Protocol for a randomized controlled trial. Contemp Clin Trials 2022; 119:106830. [PMID: 35724840 DOI: 10.1016/j.cct.2022.106830] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This multi-center randomized controlled trial aims to evaluate the effectiveness of a context-specific transition intervention program to improve clinic visit adherence and clinical outcomes among emerging adults with type 1 diabetes mellitus (T1DM) in Delhi, India. METHODS We will recruit patients with T1DM of duration ≥1 year and age 15-19.5 years from the participating pediatric sites. After a baseline assessment and a "basic introductory session", which apprises participants about the concept of transition, study participants (proposed sample size =156) will be randomly allocated into an intervention and control arm. Participants in the intervention arm will receive a structured transition program delivered over a period of 15 months. On the other hand, control arm participants will continue to receive usual care from the pediatric site till the time of transfer to the adult site. The study assessments will be done at baseline, at the time of transfer, and at 1 and 2 years following the transfer. The primary outcome is the difference in clinic attendance rate between intervention and control arms at the end of 1-year post-transfer.The secondary outcomes include the difference in clinic attendance rate at the end of 2 years, difference in proportion of participants with a minimum of 4 visits in the first follow-up year, and process indicators such as diabetes knowledge and self-management skills, diabetes treatment satisfaction, overall quality of life, diabetes-related distress, hospitalization for acute complications and screening for chronic diabetes complications, and HbA1c. CONCLUSION This study will provide important new evidence about a potential strategy to improve clinical care among adolescents and emerging adults with T1DM in lower resource contexts during the vulnerable phase of transition from pediatric to adult healthcare. The trial is registered on the Clinical Trials Registry of India (http://ctri.nic.in) under the CTRI registration number CTRI/2020/10/028379.
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Affiliation(s)
- Alpesh Goyal
- All India Institute of Medical Sciences, Department of Endocrinology and Metabolism, New Delhi, India
| | - Ariba Peerzada
- All India Institute of Medical Sciences, Department of Endocrinology and Metabolism, New Delhi, India
| | | | - Pradeep A Praveen
- All India Institute of Medical Sciences, Department of Endocrinology and Metabolism, New Delhi, India
| | - Mani Kalaivani
- All India Institute of Medical Sciences, Department of Biostatistics, New Delhi, India
| | - Nikhil Tandon
- All India Institute of Medical Sciences, Department of Endocrinology and Metabolism, New Delhi, India.
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22
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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: 3] [Impact Index Per Article: 1.5] [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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23
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Protocol for READY2Exit: a patient-oriented, mixed methods study examining transition readiness in adolescents with co-occurring physical and mental health conditions. JOURNAL OF TRANSITION MEDICINE 2022. [DOI: 10.1515/jtm-2022-0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Abstract
Background
Up to 57% of adolescents and young adults (AYA) with chronic physical health conditions experience mental health conditions, the presence of which contributes to increased morbidity and poor quality of life. AYA with co-occurring physical and mental health conditions, therefore, may experience additional challenges as they transition from pediatric to adult services. While transition readiness – the acquisition of self-management and advocacy skills – contributes to successful transitions to adult care, this concept has not been adequately explored for AYA with co-occurring physical and mental health conditions. Research is needed to identify whether the presence of a mental health comorbidity is associated with transition readiness, and what the experiences of AYA with co-occurring conditions are as they exit pediatric services. This paper outlines the protocol for the Readiness and Experiences of ADolescents and Young Adults with Co-occurring Physical and Mental Health Conditions Exiting Pediatric Services (READY2Exit) study; the first study to address this gap using a patient-oriented, mixed methods design.
Methods
A sequential explanatory mixed methods design will be used to understand the transition readiness of 16–21 year olds with physical and mental health conditions using quantitative and qualitative data. First, Transition Readiness Assessment Questionnaire (TRAQ) scores will be compared among AYA with chronic health conditions, with and without mental health comorbidity. Interviews will then be conducted with approximately 15 AYA with co-occurring health and mental health conditions and analyzed using qualitative description. The READY2Exit study will be conducted in collaboration with five Young Adult Research Partners (YARP) aged 18–30 with lived experience in the health/mental health systems across Canada. The YARP will partner in key tasks such as interview guide co-design, data interpretation, and knowledge translation tool development.
Discussion
AYA with co-occurring physical and mental health conditions may have unique needs as they prepare for health care transitions. The results of this study will inform the refinement of transition readiness practices to improve care for this group. The active involvement of the YARP across study phases will bring the critical perspectives of young adults to READY2Exit, ensuring the methods, research approaches and outputs align with their needs.
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24
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Fu N, Bollegala N, Jacobson K, Kroeker KI, Frost K, Afif W, El-Matary W, Fowler SA, Griffiths AM, Huynh HQ, Jantchou P, Karimuddin A, Nguyen GC, Otley AR, Pears C, Seow CH, Toulany A, Tersigni C, Tignanelli J, Marshall JK, Boctor M, Hansen T, Pattni C, Wong A, Benchimol EI. Canadian Consensus Statements on the Transition of Adolescents and Young Adults with Inflammatory Bowel Disease from Pediatric to Adult Care: A Collaborative Initiative Between the Canadian IBD Transition Network and Crohn’s and Colitis Canada. J Can Assoc Gastroenterol 2022; 5:105-115. [PMID: 35669843 PMCID: PMC9157291 DOI: 10.1093/jcag/gwab050] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objectives With the increased prevalence of childhood-onset inflammatory bowel disease (IBD), there is a greater need for a planned transition process for adolescents and young adults (AYA). The Canadian IBD Transition Network and Crohn’s and Colitis Canada joined in collaborative efforts to describe a set of care consensus statements to provide a framework for transitioning AYA from pediatric to adult care. Methods Consensus statements were drafted after focus group meetings and literature reviews. An expert panel consisting of 20 IBD physicians, nurses, surgeon, adolescent medicine physician, as well as patient and caregiver representatives met, discussed and systematically voted. The consensus was reached when greater than 75% of members voted in agreement. When greater than 75% of members rated strong support, the statement was rendered a strong recommendation, suggesting that a clinician should implement the statement for all or most of their clinical practice. Results The Canadian expert panel generated 15 consensus statements (9 strong and 6 weak recommendations). Areas of focus of the statements included: transition program implementation, key stakeholders, areas of potential need and gaps in the research. Conclusions These consensus statements provide a framework for the transition process. The quality of evidence for these statements was generally low, highlighting the need for further controlled studies to investigate and better define effective strategies for transition in pediatric to adult IBD care.
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Affiliation(s)
- Nancy Fu
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Natasha Bollegala
- Division of Gastroenterology, Department of Medicine, Women’s College Hospital, Toronto, Ontario, Canada
| | - Kevan Jacobson
- Division of Gastroenterology, Hepatology and Nutrition, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Karen I Kroeker
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Karen Frost
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Waqqas Afif
- Division of Gastroenterology, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Wael El-Matary
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sharyle A Fowler
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Anne M Griffiths
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hien Q Huynh
- Division of Pediatric GI Nutrition, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Prévost Jantchou
- Division of Gastroenterology, Department of Pediatrics, CHU Sainte-Justine, Montréal, Quebec, Canada
| | - Ahmer Karimuddin
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Geoffrey C Nguyen
- Department of Medicine, Mount Sinai Hospital Inflammatory Bowel Disease Centre, University of Toronto, Toronto, Ontario, Canada
| | - Anthony R Otley
- Division of Pediatric Gastroenterology & Nutrition, IWK Health Centre, Halifax, Nova Scotia, Canada
| | | | - Cynthia H Seow
- Division of Gastroenterology and Hepatology, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Alene Toulany
- Division of Adolescent Medicine, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Claudia Tersigni
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - John K Marshall
- Division of Gastroenterology, Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Monica Boctor
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tawnya Hansen
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Chandni Pattni
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Wong
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric I Benchimol
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
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25
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Crossen SS, Bruggeman BS, Haller MJ, Raymond JK. Challenges and Opportunities in Using Telehealth for Diabetes Care. Diabetes Spectr 2022; 35:33-42. [PMID: 35308158 PMCID: PMC8914589 DOI: 10.2337/dsi21-0018] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The ongoing coronavirus pandemic led to a rapid and dramatic increase in the use of telehealth for diabetes care. In the wake of this transition, we examine new opportunities and ongoing challenges for using telehealth within diabetes management, based on data and experiences from the pre-pandemic and pandemic time frames.
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Affiliation(s)
- Stephanie S. Crossen
- Division of Pediatric Endocrinology, University of California, Davis, Sacramento, CA
| | | | - Michael J. Haller
- Division of Pediatric Endocrinology, University of Florida, Gainesville, FL
| | - Jennifer K. Raymond
- Division of Pediatric Endocrinology, Children’s Hospital Los Angeles, Los Angeles, CA
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26
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Haynes SC, Kompala T, Tancredi DJ, Neinstein AB, Crossen SS. Factors Associated With Discontinuation of Subspecialty Diabetes Care During the COVID-19 Pandemic: A Multisite Retrospective Cohort Study. Diabetes Care 2022; 45:e34-e36. [PMID: 35020822 PMCID: PMC8914412 DOI: 10.2337/dc21-1360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/11/2021] [Indexed: 02/03/2023]
Affiliation(s)
- Sarah C Haynes
- Department of Pediatrics, University of California, Davis, Davis, CA.,Center for Health and Technology, University of California, Davis, Davis, CA
| | - Tejaswi Kompala
- Department of Medicine, University of California, San Francisco, San Francisco, CA.,Teladoc Health, Harrison, NY
| | - Daniel J Tancredi
- Department of Pediatrics, University of California, Davis, Davis, CA.,Center for Healthcare Policy and Research, University of California, Davis, Davis, CA
| | - Aaron B Neinstein
- Department of Medicine, University of California, San Francisco, San Francisco, CA.,Center for Digital Health Innovation, University of California, San Francisco, San Francisco, CA
| | - Stephanie S Crossen
- Department of Pediatrics, University of California, Davis, Davis, CA.,Center for Health and Technology, University of California, Davis, Davis, CA
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27
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Ali N, Longson J, Myszka R, Park K, Low GKK, Leong GM, Bhurawala H, Liu A. Comparison of compliance and outcomes in adolescents with type 1 diabetes mellitus attending a co-located pediatric and transition diabetes service. JOURNAL OF TRANSITION MEDICINE 2022. [DOI: 10.1515/jtm-2021-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objectives
Adolescence is a challenging period for diabetes management, particularly when transitioning to adult care. There are reports highlighting concerns that transition to adult care may lead to poor glycemic control and clinic engagement. Our aim was to determine if a co-located pediatric and transition diabetes service would lead to better transition outcomes.
Methods
A retrospective medical records review was conducted on patients with type 1 diabetes attending a transition clinic in a metropolitan teaching hospital in Sydney, Australia. Patients referred from the hospital’s co-located pediatric diabetes clinic to the transition clinic were compared to those referred from external sources regarding important clinical outcomes such as glycosylated haemoglobin (HbA1c), clinic attendances, and complication rates between referral sources. Confounders such as age, gender, duration of diabetes and socioeconomic status were considered.
Results
Data was collected from 356 patients of which 121 patients were referred from the co-located pediatric diabetes clinic (IRG) and 235 patients from external sources (ERG). Improvements in HbA1c were only seen in the ERG at 6 and 12 months (p<0.001). Altogether 93% attended one or more medical appointments in the IRG compared to 83% in the ERG (p=0.03). There were more admissions for acute diabetes complications (17 vs. 8%, p=0.01) and more microvascular complications (20 vs. 9%, p<0.01) in the IRG vs. ERG group.
Conclusions
Although co-location of a pediatric and transition clinic improved medical engagement, this did not equate to better glycemic control or complication rates. Further research is warranted to determine what other strategies are required to optimise the transition process in diabetes care.
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Affiliation(s)
- Naushad Ali
- Department of Paediatrics , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
| | - Julie Longson
- Department of Endocrinology and Diabetes , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
| | - Rickie Myszka
- Department of Endocrinology and Diabetes , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
| | - Kris Park
- Department of Endocrinology and Diabetes , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
| | - Gary K. K. Low
- Research Operations , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
| | - Gary M. Leong
- Department of Paediatrics , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
- Discipline of Paediatrics , The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney , Derby St , Kingswood , NSW , 2750 , Australia
| | - Habib Bhurawala
- Department of Paediatrics , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
- Discipline of Paediatrics , The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney , Derby St , Kingswood , NSW , 2750 , Australia
| | - Anthony Liu
- Department of Paediatrics , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
- Discipline of Paediatrics , The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney , Derby St , Kingswood , NSW , 2750 , Australia
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28
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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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29
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Skogby S, Bratt EL, Johansson B, Moons P, Goossens E. Discontinuation of follow-up care for young people with complex chronic conditions: conceptual definitions and operational components. BMC Health Serv Res 2021; 21:1343. [PMID: 34911550 PMCID: PMC8672472 DOI: 10.1186/s12913-021-07335-x] [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] [Received: 04/15/2021] [Accepted: 11/25/2021] [Indexed: 11/10/2022] Open
Abstract
Background A substantial proportion of young people with Complex Chronic Conditions (CCCs) experience some degree of discontinuation of follow-up care, which is an umbrella term to describe a broken chain of follow-up. Discontinuation of follow-up care is not clearly defined, and the great plethora of terms used within this field cannot go unnoticed. Terms such as “lost to follow-up”, “lapses in care” and “care gaps”, are frequently used in published literature, but differences between terms are unclear. Lack of uniformity greatly affects comparability of study findings. The aims of the present study were to (i) provide a systematic overview of terms and definitions used in literature describing discontinuation of follow-up care in young people with CCC’s; (ii) to clarify operational components of discontinuation of follow-up care (iii); to develop conceptual definitions and suggested terms to be used; and (iv) to perform an expert-based evaluation of terms and conceptual definitions. Methods A systematic literature search performed in PubMed was used to provide an overview of current terms used in literature. Using a modified summative content analysis, operational components were analysed, and conceptual definitions were developed. These conceptual definitions were assessed by an expert panel using a survey. Results In total, 47 terms and definitions were retrieved, and a core set of operational components was identified. Three main types of discontinuation of follow-up care emerged from the analysis and expert evaluation, conceptually defined as follows: Lost to follow-up care: “No visit within a defined time period and within a defined context, and the patient is currently no longer engaged in follow-up care”;Gap in follow-up care: “Exceeded time interval between clinic visits within a defined context, and the patient is currently engaged in follow-up care”; andUntraceability: “Failure to make contact due to lack of contact information”. Conclusion By creating a common vocabulary for discontinuation of follow-up care, the quality of future studies could improve. The conceptual definitions and operational components provide guidance to both researchers and healthcare professionals focusing on discontinuation of follow-up care for young people with CCCs. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07335-x.
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Affiliation(s)
- Sandra Skogby
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden. .,Department of Paediatric Cardiology, Queen Silvia Children's Hospital, Gothenburg, Sweden. .,KU Leuven Department of Public Health and Primary Care, Leuven, Belgium.
| | - Ewa-Lena Bratt
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Paediatric Cardiology, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Bengt Johansson
- Department of Surgery and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Philip Moons
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,KU Leuven Department of Public Health and Primary Care, Leuven, Belgium.,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Eva Goossens
- KU Leuven Department of Public Health and Primary Care, Leuven, Belgium.,Research Foundation Flanders, Brussels, Belgium.,Center for Research and Innovation in Care, Faculty of Nursing, University of Antwerp, Antwerp, Belgium.,Department of Patient Care Services, Antwerp University Hospital, Antwerp, Belgium
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30
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Eight-Year Retrospective Study of Young Adults in a Diabetes Transition Clinic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312667. [PMID: 34886392 PMCID: PMC8656842 DOI: 10.3390/ijerph182312667] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 11/25/2021] [Accepted: 11/28/2021] [Indexed: 11/16/2022]
Abstract
The transition of people from paediatric to adult diabetes services is associated with worsening glycaemia and increased diabetes-related hospitalisation. This study compared the clinical characteristics of those with and without mental health conditions among attenders at a diabetes young adult clinic diabetes before and after changes in service delivery. Retrospective audit of 200 people with diabetes attending a Sydney public hospital over eight years corresponding to the period before (2012–2016) and after (2017–2018) restructuring of a clinic for young adults aged 16–25 years. Characteristics of those with and without mental health conditions (depression, anxiety, diabetes related distress, eating disorders), were compared. Among clinic attenders (type 1 diabetes n = 184, 83.2%), 40.5% (n = 89) had a mental health condition particularly, depression (n = 57, 64%), which was higher among Indigenous than non-Indigenous people (5.6% vs. 0.8%, p = 0.031) but similar between diabetes type. Over eight years, those with, compared with those without a mental health condition had higher haemoglobin A1c (HbA1c) at the last visit (9.4% (79 mmol/mol) vs. 8.7% (71 mmol/mol), p = 0.027), the proportion with diabetic ketoacidosis (DKA 60.7% vs. 42.7%, p = 0.009), smoking (38.4 vs. 13.6%, p = 0.009), retinopathy (9.0 vs. 2.3%, p = 0.025), multiple DKAs (28.4 vs. 16.0%, p = 0.031) were significantly higher. Having a mental health condition was associated with 2.02 (95% confidence intervals 1.1–3.7) fold increased risk of HbA1c ≥9.0% (75 mmol/mol). Changes to the clinic were not associated with improvements in mental health condition (39.0% vs. 32.4%, p = 0.096). In conclusion, we found that mental health conditions, particularly depression, are common in this population and are associated with diabetes complications. Diabetes type and clinic changes did not affect the reported mental health conditions. Additional strategies including having an in-house psychologist are required to reduce complication risks among those with mental health conditions.
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Time to First Completed Visit and Health Care Utilization Among Young Adults Transferring From Pediatric to Adult Rheumatologic Care in a Safety‐Net Hospital. Arthritis Care Res (Hoboken) 2021; 73:1730-1738. [DOI: 10.1002/acr.24409] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 08/04/2020] [Indexed: 12/13/2022]
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Rueter P, Farrell K, Phelan H, Colman P, Craig ME, Gunton J, Holmes-Walker DJ. Benchmarking care outcomes for young adults with type 1 diabetes in Australia after transition to adult care. ENDOCRINOLOGY DIABETES & METABOLISM 2021; 4:e00295. [PMID: 34505422 PMCID: PMC8502218 DOI: 10.1002/edm2.295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/25/2021] [Accepted: 07/30/2021] [Indexed: 11/09/2022]
Abstract
AIM To determine advantages conferred by a youth-specific transition clinic model for young adults with type 1 diabetes (T1D) at Westmead Hospital (WH) as compared with Australian registry data. METHODS Prospectively collected data included age, diabetes duration, visit frequency, post code, BMI, mode of insulin delivery, continuous glucose monitoring, HbA1c, albumin creatinine ratio, BP, retinopathy and diabetic ketoacidosis (DKA) for all WH T1D clinic attendees aged 16-25 between January 2017 and June 2018 (n = 269). Results were compared with data collected during the same time period from 2 separate Australian data registries, one longitudinal (Australasian Diabetes Data Network, ADDN) and one a spot survey (the Australian National Diabetes Audit, ANDA). RESULTS Across the three cohorts, HbA1c was similar (respectively, WH, ADDN, ANDA; 8.7%[72mmol/mol], 8.7%[72mmol/mol], 8.5%[69mmol/mol]) and HbA1c was significantly higher in young adults <21 years (8.7-8.9%[73-75mmol/mol]) as compared with ≥21 years (8.5%[69mmol/mol], p < .002). In the WH cohort, median interval between visits was shorter than in ADDN (4.5 vs. 9.0 months) and DKA was lower (respectively, 3.6 and 9.2/100 patient years; p < .001). CONCLUSIONS While suboptimal HbA1c was recorded in all centres, the WH model of care saw increased attendance and reduced admissions with DKA as compared with other Australian adult centres.
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Affiliation(s)
- Phidias Rueter
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Kaye Farrell
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, NSW, Australia
| | - Helen Phelan
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,John Hunter Children's Hospital, Newcastle, NSW, Australia
| | - Peter Colman
- Department Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, VIC, Australia.,Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Maria E Craig
- Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Westmead, NSW, Australia.,Charles Perkins Centre Westmead, University of Sydney, Sydney, NSW, Australia.,School of Women's and Children's Health, University of NSW, Sydney, NSW, Australia
| | - Jenny Gunton
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, NSW, Australia.,Westmead Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - D Jane Holmes-Walker
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, NSW, Australia
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Zaidi R. Transitional care in diabetes: a quest for the Holy Grail. PRACTICAL DIABETES 2021. [DOI: 10.1002/pdi.2339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Reza Zaidi
- MBBS, FRCP, Consultant Diabetologist, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK; Transition Lead – North West England Children and Young People Diabetes Network
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Chakraborty A, Pearson O, Schwartzkopff KM, O'rourke I, Ranasinghe I, Mah PM, Adams R, Boyd M, Wittert G. The effectiveness of in-hospital interventions on reducing hospital length of stay and readmission of patients with Type 2 Diabetes Mellitus: A systematic review. Diabetes Res Clin Pract 2021; 174:108363. [PMID: 32771487 DOI: 10.1016/j.diabres.2020.108363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 07/20/2020] [Accepted: 07/30/2020] [Indexed: 01/04/2023]
Abstract
AIM This review aimed to assess the effectiveness of multifaceted in-hospital interventions for patients with type 2 diabetes mellitus on hospital readmission, hospital length of stay (LOS), and glycated haemoglobin (HbA1c). METHODS The search included MEDLINE, EMBASE, Emcare, Web of Science, PsycINFO and Google Scholar from 2007 to current date and restricted to English. The differences in outcome measures were calculated to determine the effectiveness. RESULTS The title and abstract of 3251 records were initially screened. Nine studies met the inclusion criteria. Most studies comprised of a wide range of intervention components and outcome measures. The reduction in hospital LOS ranged from 0.5 to 0.8 of a day. Clinically significant improvements in HbA1c concentration levels ranged from a mean reduction of -1.1 (±2.2) mmol/L to -2.8 (±2.7) mmol/L. There were no significant changes in hospital readmission rates and no evidence of the impact of HbA1c on hospital LOS and readmission. Common strategies in reducing hospital LOS and HbA1c were a dedicated care team, hospital wide approach, quality improvement focus, insulin therapy, early short-term intensive program, transition to primary care physicians, and on-going outpatient follow-up for at least 6-12 months. CONCLUSIONS The findings illustrate that multifaceted in-hospital intervention for patients diagnosed with type 2 diabetes can contribute to improvements in hospital LOS and HbA1c concentration.
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Affiliation(s)
- Amal Chakraborty
- South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia; Research Centre for Palliative Care, Death and Dying, Flinders University, Bedford Park, SA 5042.
| | - Odette Pearson
- South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia; Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia
| | - Kate M Schwartzkopff
- South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
| | - Iris O'rourke
- South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia
| | - Isuru Ranasinghe
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia
| | - Peak Mann Mah
- Northern Adelaide Local Health Network (NALHN), SA Health, SA 5000, Australia
| | - Robert Adams
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia
| | - Mark Boyd
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia; Lyell McEwin Hospital, Elizabeth Vale, SA 5112, Australia
| | - Gary Wittert
- South Australian Health and Medical Research Institute, Adelaide, SA 5000, Australia; Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5000, Australia; Royal Adelaide Hospital, Adelaide, SA 5000, Australia
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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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Roeper M, Reinauer C, Biester T, Jivan M, Wendenburg J, Klinkert C, Kapellen TM, Müther S, Meissner T. Transition von Jugendlichen mit Diabetes in die Erwachsenenbetreuung – eine Expertenbefragung. DIABETOL STOFFWECHS 2021. [DOI: 10.1055/a-1347-0895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Zusammenfassung
Einleitung Der Transitionsprozess für Jugendliche mit chronischen Erkrankungen ist vielerorts noch ungeregelt, eine fachärztliche Weiterbetreuung ist oftmals nicht gesichert. Ziel der Studie war es, das derzeitige Vorgehen und mögliche Defizite bei der Transition von Jugendlichen mit Diabetes zu evaluieren und das Interesse und die Bereitschaft zur flächendeckenden Einführung von strukturierten Transitionsprogrammen in Deutschland zu erfragen.
Methode Eine anonymisierte Onlinebefragung der Mitglieder der „Arbeitsgemeinschaft für Pädiatrische Diabetologie e. V.“ (AGPD) wurde im Zeitraum von Oktober 2019 bis April 2020 durchgeführt.
Ergebnisse 60 der 492 über den strukturierten E-Mail-Newsletter kontaktierten Mitglieder der AGPD nahmen an der Befragung teil. 81,1 % der Studienteilnehmer gaben an, die Transition im Rahmen von regulären Ambulanzterminen mit den Patienten zu besprechen. 25,8 % nutzen ein intern erarbeitetes oder extern unterstütztes strukturiertes Transitionsprogramm. Die Befragten schätzen, dass 50 % der Patienten eine intensive Unterstützung bei der Transition benötigen und 20 % im Transitionsprozess den Kontakt zur spezialisierten medizinischen Betreuung verlieren. Fast alle Befragten (91,4 %) sahen Verbesserungsbedarf im aktuellen Transitionsprozedere. Im Vordergrund stehen dabei insbesondere eine engere Zusammenarbeit von Kinderdiabetologen und Erwachsenendiabetologen, die Einführung eines strukturierten, standardisierten Vorgehens sowie eine Optimierung der Vorbereitung und Motivation der Jugendlichen. Die Einführung von strukturierten Transitionsprogrammen mit externer Unterstützung wird von der überwiegenden Zahl der Befragten als dringend notwendig (27,6 %) bzw. wichtig (41,4 %) bewertet.
Schlussfolgerung Die Nutzung standardisierter strukturierter Transitionsprogramme in der Behandlung von Jugendlichen mit Diabetes ist in Deutschland bisher noch gering, aber notwendig, um eine kontinuierliche fachärztliche Betreuung zu gewährleisten. Die flächendeckende Einführung geeigneter und finanzierter Programme kann den Transitionsprozess und damit auch das langfristige Outcome der Patienten verbessern. Gerade in der Umbruchphase der Adoleszenz ist ein zuverlässiger Ansprechpartner erforderlich, der die Übernahme der Selbstverantwortung für den Diabetes begleitet.
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Affiliation(s)
- Marcia Roeper
- Klinik für Allgemeine Pädiatrie, Neonatologie und Kinderkardiologie, Universitätsklinikum Düsseldorf, Germany
| | - Christina Reinauer
- Klinik für Allgemeine Pädiatrie, Neonatologie und Kinderkardiologie, Universitätsklinikum Düsseldorf, Germany
| | - Torben Biester
- Diabetes-Zentrum für Kinder und Jugendliche, AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Marcelus Jivan
- Diabeteszentrum, Zentrum des Christlichen Jugenddorfwerks Deutschlands (CJD e. V.), Berchtesgaden, Germany
| | - Jutta Wendenburg
- Kinderdiabetologische Schwerpunktpraxis, Gemeinschaftspraxis für Kinder und Jugendliche, Jena, Germany
| | - Christof Klinkert
- Diabetesschwerpunktpraxis, Gemeinschaftspraxis für Kinder- und Jugendmedizin, Herford, Germany
| | | | - Silvia Müther
- Diabeteszentrum für Kinder und Jugendliche, DRK Kliniken Berlin Westend, Berlin, Germany
| | - Thomas Meissner
- Klinik für Allgemeine Pädiatrie, Neonatologie und Kinderkardiologie, Universitätsklinikum Düsseldorf, Germany
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Abstract
Diabetes management is well suited to use of telehealth, and recent improvements in both diabetes technology and telehealth policy make this an ideal time for diabetes providers to begin integrating telehealth into their practices. This article provides background information, specific recommendations for effective implementation, and a vision for the future landscape of telehealth within diabetes care to guide interested providers and practices on this topic. Note: This article was written prior to the COVID19 pandemic, and does not include information about recent telehealth policy changes that occurred during or as a result of this public health crisis.
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Affiliation(s)
- Stephanie Crossen
- Department of Pediatrics, University of California, Davis, Sacramento, California
- UC Davis Center for Health and Technology, Sacramento, California
- Address correspondence to: Stephanie Crossen, MD, MPH, Department of Pediatrics, University of California, Davis, 2516 Stockton Boulevard, Sacramento, CA 95817
| | - Jennifer Raymond
- Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Aaron Neinstein
- Department of Medicine, University of California, San Francisco, San Francisco, California
- UCSF Center for Digital Health Innovation, San Francisco, California
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Seaborg K, Faltersack K, Felton EA. Transition of Care for Adolescent and Young Adult Patients on Dietary Therapy for Epilepsy. JOURNAL OF PEDIATRIC EPILEPSY 2020. [DOI: 10.1055/s-0040-1716550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractKetogenic diets are high-fat, low-carbohydrate diets designed to alter metabolism, induce nutritional ketosis, and reduce seizures in patients with epilepsy. In the past 15 to 20 years, the diets have been refined, gaining momentum in the treatment of resistant epilepsy. As ketogenic diets have gained popularity for treatment of pediatric epilepsies, an increasing number of adolescents treated with dietary therapy are approaching the age of transitioning their care to adult providers. Transition of care for this vulnerable population brings unique challenges posed by a paucity of adult providers who prescribe ketogenic diets, a lack of adult nutritionists trained in dietary therapy for epilepsy, and reluctance of pediatric patients to transition care. In this article, we will discuss the rationale for establishing transition protocols for young adult patients with epilepsy and present guidelines for transition of care for patients treated with dietary therapy for epilepsy.
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Affiliation(s)
- Kristin Seaborg
- Department of Neurology, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - Kelly Faltersack
- UW Health - Department of Clinical Nutrition Services, University of Wisconsin–Madison, Madison, Wisconsin, United States
| | - Elizabeth A. Felton
- Department of Neurology, University of Wisconsin–Madison, Madison, Wisconsin, United States
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Diamanti A, Capriati T, Lezo A, Spagnuolo MI, Gandullia P, Norsa L, Lacitignola L, Santarpia L, Guglielmi FW, De Francesco A, Pironi L. Moving on: How to switch young people with chronic intestinal failure from pediatric to adult care. a position statement by italian society of gastroenterology and hepatology and nutrition (SIGENP) and italian society of artificial nutrition and metabolism (SINPE). Dig Liver Dis 2020; 52:1131-1136. [PMID: 32868212 DOI: 10.1016/j.dld.2020.07.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/17/2020] [Accepted: 07/29/2020] [Indexed: 02/08/2023]
Abstract
In 2019 the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition (SIGENP) and the Italian Society of Artificial Nutrition and Metabolism (SINPE) created a joint panel of experts with the aim of preparing an official statement on transition in Chronic Intestinal Failure (CIF). The transition from pediatric to adult care has a key role in managing all chronic diseases and in optimizing the compliance to care. Thus SIGENP and SINPE, in light of the growing number of patients with IF who need long-term Parenteral Nutrition (PN) and multidisciplinary rehabilitation programs throughout adulthood, shared a common protocol to provide an accurate and timely process of transition from pediatric to adult centers for CIF. The main objectives of the transition process for CIF can be summarized as the so-called "acronym of the 5 M": 1)Motivate independent choices which are characteristics of the adult world; 2)Move towards adult goals (e.g. self-management of his pathology and sexual issues); 3)Maintain the habitual mode of care; 4) Minimize the difficulties involved in the transition process and 5)Modulate the length of the transition so as to fully share with the adult's team the children's peculiarities.
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Affiliation(s)
- Antonella Diamanti
- Artificial Nutrition Unit, "Bambino Gesù" Children Hospital, Rome, Italy (SIGENP).
| | - Teresa Capriati
- Artificial Nutrition Unit, "Bambino Gesù" Children Hospital, Rome, Italy (SIGENP)
| | - Antonella Lezo
- Dietetics and Clinical Nutrition Unit, "Città della Salute e della Scienza", Regina Margherita Children's Hospital, Turin, Italy (SIGENP)
| | - Maria Immacolata Spagnuolo
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy (SIGENP)
| | - Paolo Gandullia
- Gastroenterology Unit, G.Gaslini Institute for Maternal and Child Health, IRCCS, Genova, Italy (SIGENP)
| | - Lorenzo Norsa
- Paediatric, Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy (SIGENP)
| | - Laura Lacitignola
- Department of Neuroscience, Psychology, Pharmacology and Child's Health, University of Florence, Meyer Hospital, Florence, Italy (SIGENP)
| | - Lidia Santarpia
- Internal Medicine and Clinical Nutrition. University of Naples Federico II, Naples, Italy (SINPE)
| | | | - Antonella De Francesco
- Dietetics and Clinical Nutrition Unit, "Città della Salute e della Scienza", Turin, Italy (SINPE)
| | - Loris Pironi
- Center for Chronic Intestinal Failure, Department of Digestive System, St. Orsola-Malpighi University Hospital, Bologna, Italy(SINPE)
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Nwosu BU, Yeasmin S, Ayyoub S, Rupendu S, Villalobos-Ortiz TR, Jasmin G, Parajuli S, Zahedi B, Zitek-Morrison E, Alonso LC, Barton BA. Continuous glucose monitoring reduces pubertal hyperglycemia of type 1 diabetes. J Pediatr Endocrinol Metab 2020; 33:865-872. [PMID: 32634109 PMCID: PMC9064487 DOI: 10.1515/jpem-2020-0057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/08/2020] [Indexed: 11/15/2022]
Abstract
Background Physiologic hyperglycemia of puberty is a major contributor to poor glycemic control in youth with type 1 diabetes (T1D). This study's aim was to determine the effectiveness of continuous glucose monitoring (CGM) to improve glycemic control in pubertal youth with T1D compared to a non-CGM cohort after controlling for age, sex, BMI, duration, and insulin delivery methodology. The hypothesis is that consistent CGM use in puberty improves compliance with diabetes management, leading to increased percentage (%) time in range (TIR70-180 mg/dL) of glycemia, and lowering of HbA1c. Methods A longitudinal, retrospective, case-controlled study of 105 subjects consisting of 51 T1D controls (60.8% male) age 11.5 ± 3.8 y; and 54 T1D subjects (48.1% male) age 11.1 ± 5.0 y with confirmed CGM use for 12 months. Pubertal status was determined by Tanner staging. Results were adjusted for baseline HbA1c and diabetes duration. Results HbA1c was similar between the controls and the CGM group at baseline: 8.2 ± 1.1% vs 8.3 ± 1.2%, p=0.48 respectively; but was significantly lower in the CGM group 12 months later, 8.2 ± 1.1% vs. 8.7 ± 1.4%, p=0.035. Longitudinal change in HbA1c was similar in the prepubertal cohort between the control- and CGM groups: -0.17 ± 0.98% vs. 0.38 ± 1.5%, p=0.17. In contrast, HbA1c increased with advancing age and pubertal status in the pubertal controls but not in the pubertal CGM group: 0.55 ± 1.4 vs -0.22 ± 1.1%, p=0.020. Percent TIR was inversely related to HbA1c in the CGM group, r=-0.6, p=0.0004, for both prepubertal and pubertal subjects. Conclusions CGM use significantly improved glycemic control in pubertal youth with T1D compared to non-CGM users.
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Affiliation(s)
- Benjamin Udoka Nwosu
- Department of Pediatrics, Division of Endocrinology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Shamima Yeasmin
- Department of Medicine, Division of Endocrinology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Sanaa Ayyoub
- Department of Medicine, Division of Endocrinology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Shwetha Rupendu
- Department of Pediatrics, Division of Endocrinology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Tony R. Villalobos-Ortiz
- Department of Pediatrics, Division of Endocrinology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Gabrielle Jasmin
- Department of Pediatrics, Division of Endocrinology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Sadichchha Parajuli
- Department of Pediatrics, Division of Endocrinology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Bita Zahedi
- Department of Medicine, Division of Endocrinology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Emily Zitek-Morrison
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Laura C. Alonso
- Weill Cornell Division of Endocrinology, Diabetes and Metabolism, New York, NYUSA
| | - Bruce A. Barton
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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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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Walch AM, Cobb CE, Tsaih SW, Cabrera SM. The medical transition of young adults with type 1 diabetes (T1D): a retrospective chart review identifies areas in need of improvement. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2020; 2020:10. [PMID: 32514267 PMCID: PMC7254679 DOI: 10.1186/s13633-020-00080-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 04/28/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND The transition process from pediatric to adult care in individuals with T1D has long-term ramifications on health outcomes. Recognition of differences in care delivery and changes made in management during this time may improve the process. We hypothesized that pediatric providers would be less likely to address T1D-related comorbidities than their adult counterparts, highlighting opportunities to strengthen care. METHODS A retrospective chart review of patients aged 16-21 years diagnosed with T1D before age 18 was performed. Data on diagnosis, screening, and management of hypertension, dyslipidemia, microalbuminuria, retinopathy, and neuropathy were collected for 1 year before and 1 year after transition to adult care. The 'ADA Standards of Medical Care in Diabetes' were used to determine adherence to the above parameters. Data before and after transition was compared by Fischer's Exact and Exact McNemar tests. RESULTS Complete medical records for 54 subjects were reviewed before and after transition from pediatric to adult care providers within a single academic medical system (52% male; 78% Caucasian). Transition to adult care occurred at a mean age of 18 years. Mean length of transition was 7.8 months with no significant change in an individual's HbA1c over that time. Over the transition period, there was no difference in diagnoses of hypertension or the use of anti-hypertensive. Adherence to lipid and retinopathy screening was similar across the transition period; however, adherence to microalbuminuria screening was higher after the transition to adult providers (p = 0.01). Neuropathy screening adherence was overall poor but also improved after transition (p < 0.001). CONCLUSIONS Overall, there were no significant changes in the diagnosis or management of several T1D-related comorbidities during the transition period in a small cohort of young adults with T1D. The transition length was longer than the recommended 3-months, highlighting an opportunity to improve the process. There was no deterioration of glycemic control over this time, although HbA1c values were above target. Adult providers had significantly higher rates of adherence to screening for microalbuminuria and neuropathy than their pediatric counterparts, but adherence for neuropathy was quite poor overall, indicating a need for practice improvement.
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Affiliation(s)
- Abby M. Walch
- Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Rd, Wauwatosa, WI 53226 USA
| | - Carmen E. Cobb
- Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Rd, Wauwatosa, WI 53226 USA
| | - Shirng-Wern Tsaih
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, 8701 Watertown Plank Rd, Wauwatosa, WI 53226 USA
| | - Susanne M. Cabrera
- Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Rd, Wauwatosa, WI 53226 USA
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Nabbout R, Teng T, Chemaly N, Breuillard D, Kuchenbuch M. Transition of patients with childhood onset epilepsy: Perspectives from pediatric and adult neurologists. Epilepsy Behav 2020; 104:106889. [PMID: 32028125 DOI: 10.1016/j.yebeh.2019.106889] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/22/2019] [Accepted: 12/22/2019] [Indexed: 01/19/2023]
Abstract
Transition from pediatric to adult care systems is a major challenge in the management of adolescents with epilepsy. The comparison of pediatric and adult physicians' points of view on this issue is scarcely described. The aim of this study was to understand pediatric and adult neurologists' experience and opinions on transition in epilepsy in France. We investigate the age at which they usually transfer patients, their opinion on the factors that positively or negatively impact transition, on the help provided during this transition period, and their propositions to improve this process. We prepared a targeted questionnaire with two versions, one adapted for neurologists and the other for child neurologists. The questionnaires were diffused through the Reference Centre for Rare Epilepsies, the French Chapter of the League Against Epilepsy, the French Association for Office-based Neurologists, and the French Pediatric Neurology Society. A total of sixty-eight physicians involved mostly in epilepsy care answered this questionnaire: 39 child neurologists and 29 neurologists. Questionnaires were filled at 96.8%. Twenty-six child neurologists followed patients aged over 18 years (70%), and 18 neurologists followed patients under the age of 12 years (66.6%). Cognitive impairment in childhood led significantly to a later transfer to adult care. The major factors believed to delay the transfer were attachment between child neurologists and families as reported in 96.3% by neurologists and in 81.1% by child neurologists, p = 0.07 and lack of adaptation of adult neurology facilities to adolescents especially with intellectual disability (59.3% neurologists, 75.7% child neurologists, p = 0.16). Factors that helped a transfer around 18-19 years were mainly pharmacoresistant epilepsy (71% for neurologists vs. 19% for child neurologists, p < 105) and pregnancy (72% for child neurologists versus 50% for neurologists, p = 0.08). Factors that negatively impacted transition were the lack of information about daily life in adulthood (driving license, contraception, sexuality, carrier guidance, etc.), the weak transition preparation in pediatric system, the lack of knowledge of pediatric epilepsy syndromes, and the lack of global support for patients with intellectual disability and multidisciplinary care needs in adult system. Both groups proposed joint clinics (>65% of providers) and development of care networks between pediatric and adult care for patients with epilepsy (>55%) to improve transition as well as introducing courses on transition. Few physicians were aware of transition and transfer recommendations. Although child and adult neurologists still have some preconceived beliefs, they were able to identify the strengths and weaknesses of both care systems paving the way for proposals to improve transition and transfer of patients with epilepsy from pediatric to adult care.
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Affiliation(s)
- Rima Nabbout
- Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Necker-Enfants Malades Hospital, APHP, Paris Descartes University, Paris, France; Institut Imagine, INSERM UMR 1163, Translational Research for Neurological Disorder, Paris Descartes University, France.
| | - Theo Teng
- Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Necker-Enfants Malades Hospital, APHP, Paris Descartes University, Paris, France
| | - Nicole Chemaly
- Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Necker-Enfants Malades Hospital, APHP, Paris Descartes University, Paris, France; Institut Imagine, INSERM UMR 1163, Translational Research for Neurological Disorder, Paris Descartes University, France
| | - Delphine Breuillard
- Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Necker-Enfants Malades Hospital, APHP, Paris Descartes University, Paris, France
| | - Mathieu Kuchenbuch
- Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Necker-Enfants Malades Hospital, APHP, Paris Descartes University, Paris, France; Institut Imagine, INSERM UMR 1163, Translational Research for Neurological Disorder, Paris Descartes University, France
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Harris M, James S, Perry L, Lowe J, Dunbabin J, Steinbeck K. Health care professionals talking: Are services for young adults with type 1 diabetes fit for purpose? J Eval Clin Pract 2020; 26:335-342. [PMID: 31287195 DOI: 10.1111/jep.13210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 12/28/2022]
Abstract
INTRODUCTION The challenges of becoming a mature adult may distract young adults with type 1 diabetes from disease self-management, increasing risks for premature morbidity and mortality. Despite the importance of young adults with type 1 diabetes engaging with preventative diabetes-related health care services, few studies report health care professionals' experiences and perceptions of the support that is available, including during the period of transition. This study sought to determine these factors across diverse contexts in one health jurisdiction. METHODS This qualitative study was undertaken in New South Wales, Australia. Recruitment was based on a snowball sampling technique, which began with members of an established diabetes service group. Data were collected by individual semistructured interviews with 16 health care professionals, most of whom were registered nurses (75%), working at differing levels of expertise and responsibility across metropolitan and regional/rural areas. Data were analysed using thematic analyses. RESULTS Participants overwhelmingly recognized the time and care needed to support young adults with type 1 diabetes to prepare them for adult self-management and to work with adult diabetes services, and the importance of youth-friendly services. They reported shortfalls and inequitous distribution in services for these young adults. Two themes, addressing the present and future possibilities, expressed their perceptions of services for this population: working with what is available and mapping a route to better services. CONCLUSION Findings identify opportunities for development in the planning and provision of specialist multidisciplinary health care support for this population. New ideas are needed for policy and practice innovation and for the infrastructure to facilitate this, to ensure that young adults with type 1 diabetes have access to consistent and coordinated diabetes health care services, particularly in nonmetropolitan settings.
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Affiliation(s)
- Margaret Harris
- Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Steven James
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Caboolture, Queensland, Australia
| | - Lin Perry
- Faulty of Health, University of Technology Sydney/South East Sydney Local Health District, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Julia Lowe
- Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Janet Dunbabin
- Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Katharine Steinbeck
- Discipline of Paediatrics and Child Health, University of Sydney/The Children's Hospital, Westmead, New South Wales, Australia
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Frequency and Predictors of Successful Transition of Care for Young Adults With Childhood Celiac Disease. J Pediatr Gastroenterol Nutr 2020; 70:190-194. [PMID: 31978015 DOI: 10.1097/mpg.0000000000002568] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Transition from pediatric to adult care for individuals with chronic conditions is important to prevent gaps in care, though this has not been well-studied in celiac disease (CD). The aim of this study was to discern rates and predictors of successful transition of care for young adults with childhood-diagnosed CD. METHODS An anonymous 21-question online survey was sent to individuals on our center's email contact list seeking responses from those ages 18 to 25 years diagnosed with CD before age 18 years. Information collected included method of diagnosis, demographics, CD-related care, reasons for not seeking care, and symptoms. RESULTS Respondents (n = 98), 70% women, had a median age of 21 years (IQR 19--23 years). The majority were full or part-time students (67%; 95% CI 59%-77%). Only 31% of respondents had successfully transitioned to an adult CD provider. Some 37% (95% CI 29%-48%) were not receiving any CD medical care. An older age at diagnosis was associated with successful transition to adult gastroenterology (P = 0.002) as well as with greater symptom scores (P = 0.002). Receiving a referral for ongoing adult CD care predicted successful transition to an adult provider (odds ratio [OR] 3.92, 95% CI 1.58-9.72). CONCLUSIONS Transition of care for young adults with CD is inconsistent, particularly among asymptomatic patients. Receipt of a referral for an adult provider significantly improves follow-up rates.
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Suzuki S, Kita S, Morisaki M, Kikuchi R, Sato I, Iwasaki M, Otomo E, Sekiguchi H, Hirata Y, Sato A, Sugiyama M, Kamibeppu K. Nurses' perceptions regarding transitional care for adolescents and young adults with childhood-onset chronic diseases. Jpn J Nurs Sci 2020; 17:e12323. [PMID: 31943766 DOI: 10.1111/jjns.12323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 06/11/2019] [Accepted: 12/06/2019] [Indexed: 11/28/2022]
Abstract
AIM Nurses are expected to have a role in the transition of care from pediatric to adult medical practices for adolescents and young adults with childhood-onset chronic diseases. This study compares the experience, knowledge, and perceptions regarding the ideal care among adult unit and pediatric nurses regarding the transition to adult care for those with childhood-onset chronic diseases. METHODS A cross-sectional study using self-report questionnaires was conducted with nurses in a tertiary hospital in Tokyo. Questions were generated based on a literature review and expert discussion. Data from 1,064 participants were analyzed (adult unit nurses: n = 959, 90.1%; pediatric nurses: n = 105, 9.9%). RESULTS Among 623 adult unit nurses who had care experience for adult patients with a childhood-onset chronic disease, 458 nurses (73.6%) were unaware of the concept of transitional care. As the obstructive factors for transition, pediatric nurses recognized problems in healthcare providers' attitudes and lack of transitional care coordinators, while the adult unit nurses emphasized the patients' wishes to continue to receive pediatric healthcare. Most adult unit nurses expected pediatric nurses to function as transitional care coordinators. CONCLUSION Adult unit and pediatric nurses had different perceptions of the barriers in transitioning children with chronic diseases to adult care. It is important to have educational programs focusing on transitional care for all nurses, both to enable pediatric nurses to improve transition readiness of children with chronic diseases and to offer adult patients with a childhood-onset chronic disease continuing support through adult unit nurses.
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Affiliation(s)
- Seigo Suzuki
- Department of Family Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sachiko Kita
- Department of Family Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mayumi Morisaki
- Department of Family Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryota Kikuchi
- Department of Family Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Iori Sato
- Department of Family Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Miwa Iwasaki
- Department of Nursing, The University of Tokyo Hospital, Tokyo, Japan
| | - Eiko Otomo
- Department of Nursing, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiromi Sekiguchi
- Department of Nursing, The University of Tokyo Hospital, Tokyo, Japan
| | - Yoichiro Hirata
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Atsushi Sato
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Masahiko Sugiyama
- Department of Pediatric Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Kiyoko Kamibeppu
- Department of Family Nursing, Division of Health Sciences & Nursing, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Health Quality and Outcome Research, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Samuel S, Dimitropoulos G, Schraeder K, Klarenbach S, Nettel-Aguirre A, Guilcher G, Pacaud D, Pinzon J, Lang E, Andrew G, Zwaigenbaum L, Scott S, McBrien K, Hamiwka L, Mackie A. Pragmatic trial evaluating the effectiveness of a patient navigator to decrease emergency room utilisation in transition age youth with chronic conditions: the Transition Navigator Trial protocol. BMJ Open 2019; 9:e034309. [PMID: 31826899 PMCID: PMC6924868 DOI: 10.1136/bmjopen-2019-034309] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Transition to adult care is a challenging and complex process for youth with special healthcare needs. We aim to compare effectiveness of a patient navigator service in reducing emergency room (ER) use among adolescents with chronic health conditions transitioning to adult care. METHODS AND ANALYSIS Pragmatic randomised controlled trial parallel group design comparing ER visit rates between patients with access to a personalised navigator intervention compared with usual care. Unit of randomisation is the patient. Treatment assignment will not be blinded. Embedded qualitative study to understand navigator's role and cost analysis attributable to the intervention will be performed. Patients aged 16-21 years, followed within a chronic disease clinic, expected to be transferred to adult care within 12 months and residing in Alberta during study period will be recruited from three tertiary care paediatric hospitals. Sample size will be 300 in each arm. Navigator intervention over 24 months is designed to assist participants in four domains: transition preparation, health system brokering, socioeconomic determinants of health and self-management. Primary outcome is ER visit rate during observation period. Secondary outcomes are ambulatory and inpatient care utilisation measures, as well as Transition Readiness Assessment Questionnaire score, and Short-Form Health Survey 12 (SF-12) score at 6 and 18 months post-randomisation. Poisson regression will compare rates of ER/urgent care visits between navigator and control participants, using intention to treat principle. Cost analysis of the intervention will be conducted. Thematic analysis will be used to identify perceptions of stakeholders regarding the role of navigators. ETHICS AND DISSEMINATION Ethics approval was obtained from the University of Calgary Conjoint Health Research Ethics Board (REB #162561) and the University of Alberta Health Research Ethics Board (Pro00077325). Our team is composed of diverse stakeholders who are committed to improving transition of care who will assist with dissemination of results. TRIAL REGISTRATION NUMBER NCT03342495.
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Affiliation(s)
- Susan Samuel
- Section of Nephrology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | | | - Kyleigh Schraeder
- Alberta Children's Hospital Research Institute, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Scott Klarenbach
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Greg Guilcher
- Section of Pediatric Oncology and Blood and Marrow Transplant, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Daniele Pacaud
- Section of Endocrinology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Jorge Pinzon
- Section of Adolescent Medicine, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Eddy Lang
- Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gail Andrew
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Lonnie Zwaigenbaum
- Department of Pediatrics, Autism Research Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Shannon Scott
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Kerry McBrien
- Department of Family Medicine, Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Lorraine Hamiwka
- Section of Nephrology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Andrew Mackie
- Division of Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Shulman R, Zenlea I, Shah BR, Clarson C, Harrington J, Landry A, Punthakee Z, Palmert MR, Mukerji G, Austin PC, Parsons J, Ivers N. Testing an audit and feedback-based intervention to improve glycemic control after transfer to adult diabetes care: protocol for a quasi-experimental pre-post design with a control group. BMC Health Serv Res 2019; 19:885. [PMID: 31766999 PMCID: PMC6878686 DOI: 10.1186/s12913-019-4690-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 10/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND When young adults transfer from pediatric to adult diabetes care they are at risk for deterioration of glycemic control, putting them at an increased risk of developing both acute and chronic complications. Despite increased awareness of these risks, there are gaps in care delivery during this vulnerable time and variability in the implementation of recommended transition practice. Audit and feedback (AF) interventions have a positive but variable effect on implementation of best practices. An expert group identified specific suggestions for optimizing the effectiveness of AF interventions. We aim to test an AF-based intervention incorporating these specific suggestions to improve transition practices and glycemic control in the first year after transfer from pediatric to adult diabetes care. METHODS This is a pragmatic quasi-experimental study; a series of three cohort studies (pre-implementation, early-implementation, and post-implementation) to compare the baseline adjusted hemoglobin A1c (HbA1c) in the 12 months after the final pediatric visit in five pediatric diabetes centres within the Ontario Pediatric Diabetes Network in Ontario, Canada. The intervention includes three components: 1) centre-level feedback reports compiling data from chart abstraction, linked provincial administrative datasets, and patient-reported experience measures; 2) webinars for facilitated conversations/coaching about the feedback; and 3) online repository of curated transition resources for providers. The primary outcome will be analyzed using a multivariable linear regression model. We will conduct a qualitative process evaluation to understand intervention fidelity and to provide insight into the mechanisms of action of our results. DISCUSSION There is a need to develop an innovative system-level approach to improve outcomes and the quality of care for young adults with type 1 diabetes during the vulnerable time when they transfer to adult care. Our research team, a collaboration of health services, implementation science, and quality improvement researchers, are designing, implementing, and evaluating an AF-based intervention using recommendations about how to optimize effectiveness. This knowledge will be generalizable to other care networks that aim to deliver uniformly high-quality care in diverse care settings. TRIAL REGISTRATION ClinicalTrials.gov NCT03781973. Registered 13 December 2018. Date of enrolment of the first participant to the trial: June 1, 2019.
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Affiliation(s)
- Rayzel Shulman
- Division of Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada. .,SickKids Research Institute, Toronto, Canada. .,ICES, Toronto, Canada. .,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. .,Department of Pediatrics, University of Toronto, Toronto, Canada.
| | - Ian Zenlea
- Institute for Better Health, Trillium Health Partners, Missisauga, Canada
| | - Baiju R Shah
- ICES, Toronto, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Cheril Clarson
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Jennifer Harrington
- Division of Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Alanna Landry
- Division of Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada.,Markham Stouffville Hospital, Markham, Canada
| | | | - Mark R Palmert
- Division of Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada.,SickKids Research Institute, Toronto, Canada.,Department of Pediatrics, University of Toronto, Toronto, Canada.,Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Geetha Mukerji
- Department of Medicine, University of Toronto, Toronto, Canada.,Women's College Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Peter C Austin
- ICES, Toronto, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Janet Parsons
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Noah Ivers
- ICES, Toronto, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Women's College Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada.,Department of Family Medicine, Women's College Hospital, University of Toronto, Toronto, Canada
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50
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Sandler CN, Garvey KC. A Practice in Maturation: Current Perspectives on the Transition from Pediatric to Adult Care for Young Adults with Diabetes. Curr Diab Rep 2019; 19:126. [PMID: 31728765 DOI: 10.1007/s11892-019-1247-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE OF REVIEW This review of available literature and resources highlights the challenges in transition from pediatric to adult care for young adults with diabetes, summarizes practical recommendations for facilitating the process, and identifies areas for improvement in current transition practice. RECENT FINDINGS Observational studies highlight suboptimal transition preparation counseling, gaps between pediatric and adult care, and increased post-transition hemoglobin A1c and acute care utilization. Studies showing improved outcomes with later age at transition allows for an extended focus on transition preparation with an eye toward developmental maturity. Interventional studies suggest varying benefits of transition coordinators and support programs. The period of transition from pediatric to adult care is a time of in which patients are at high risk for adverse outcomes and loss to follow-up; however, careful attention to planning the process and tracking patient readiness along with skilled care coordination can contribute to transition success. The durability of interventional models, as well as generalizability to varied clinical settings, must be further tested.
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Affiliation(s)
- Courtney N Sandler
- Division of Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA.
- Boston Children's Hospital, 333 Longwood Avenue, Boston, MA, 02115, USA.
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