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Arons A, Tsevat RK, Hotez E, Huang H, Nott R, Ahn H, Mehta N, Nguyen L, Nguyen V, Rebollar AG, Duan S, Ma J. A Quality Improvement Initiative to Improve Health Care Transition Planning at Adolescent Well Visits. Acad Pediatr 2024; 24:973-981. [PMID: 38519016 DOI: 10.1016/j.acap.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/27/2024] [Accepted: 03/15/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE Health care transition (HCT) planning supports adolescents as they move from pediatric to adult health care and is recommended for all youth. HCT planning uptake remains low, with little known about HCT in the adolescent well child check (WCC) setting. We sought to increase rates of HCT planning at WCCs by adapting best practices for HCT from specialty and chronic care. METHODS This quality improvement initiative at 12 to 17-year-old WCCs at four Internal Medicine-Pediatrics primary care clinics, was based on the first three of the "Six Core Elements" of HCT framework and integrated into the electronic health record. Two uptake measures were assessed via chart review after three plan-do-study-act (PDSA) cycles, with two provider surveys and an implementation science analysis further informing interpretation. RESULTS By the final PDSA cycle, the percentage of 14 to 17-year-old WCCs at which HCT planning was discussed and a screening tool completed increased from 5% to 31%, and the percentage of 12 to 13-year-old WCCs at which the HCT policy was discussed increased from 6% to 47%. Provider survey results revealed endorsement of HCT goals, but time and technological barriers, which were further elucidated in the implementation science analysis. CONCLUSIONS This quality improvement initiative increased rates of HCT planning during adolescent WCCs. While limited to three Core Elements and Internal Medicine-Pediatrics clinics, strengths include measures capturing all WCCs, contextualized by provider surveys and an implementation science framework. Lessons from this effort can inform future tailored HCT initiatives at adolescent WCCs.
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Affiliation(s)
- Abigail Arons
- Division of General Pediatrics and Division of General Internal Medicine (A Arons), University of California, San Francisco, Calif.
| | - Rebecca K Tsevat
- Division of General Internal Medicine/Health Services Research (RK Tsevat, E Hotez), David Geffen School of Medicine, University of California, Los Angeles, Calif
| | - Emily Hotez
- Division of General Internal Medicine/Health Services Research (RK Tsevat, E Hotez), David Geffen School of Medicine, University of California, Los Angeles, Calif
| | - Holly Huang
- UCLA David Geffen School of Medicine (H Huang, R Nott, H Ahn, N Mehta, L Nguyen, V Nguyen, and AG Rebollar), Los Angeles, Calif
| | - Rohini Nott
- UCLA David Geffen School of Medicine (H Huang, R Nott, H Ahn, N Mehta, L Nguyen, V Nguyen, and AG Rebollar), Los Angeles, Calif
| | - Hayoung Ahn
- UCLA David Geffen School of Medicine (H Huang, R Nott, H Ahn, N Mehta, L Nguyen, V Nguyen, and AG Rebollar), Los Angeles, Calif
| | - Needhi Mehta
- UCLA David Geffen School of Medicine (H Huang, R Nott, H Ahn, N Mehta, L Nguyen, V Nguyen, and AG Rebollar), Los Angeles, Calif
| | - Lynn Nguyen
- UCLA David Geffen School of Medicine (H Huang, R Nott, H Ahn, N Mehta, L Nguyen, V Nguyen, and AG Rebollar), Los Angeles, Calif
| | - Van Nguyen
- UCLA David Geffen School of Medicine (H Huang, R Nott, H Ahn, N Mehta, L Nguyen, V Nguyen, and AG Rebollar), Los Angeles, Calif
| | - Ariana G Rebollar
- UCLA David Geffen School of Medicine (H Huang, R Nott, H Ahn, N Mehta, L Nguyen, V Nguyen, and AG Rebollar), Los Angeles, Calif
| | - Susan Duan
- Division of General Internal Medicine/Health Services Research (S Duan and J Ma), UCLA Section on Internal Medicine-Pediatrics, Los Angeles, Calif
| | - Janet Ma
- Division of General Internal Medicine/Health Services Research (S Duan and J Ma), UCLA Section on Internal Medicine-Pediatrics, Los Angeles, Calif
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Nowak SA, Reblin M, Fung M, Turley C, Threlkeld K. Multi-level factors linked to young adult primary care transitions: evidence from a state all-payer claims analysis. BMC PRIMARY CARE 2024; 25:230. [PMID: 38926646 PMCID: PMC11200814 DOI: 10.1186/s12875-024-02463-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 06/03/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE Delayed transitions from pediatric to adult primary care leads to gaps in medical care. State all-payer claims data was used to assess multilevel factors associated with timely transition from pediatric to adult primary care. MATERIALS AND METHODS We created a cohort of 4,320 patients aged 17-20 in 2014-2017 continuously enrolled in health insurance 36 months between 2014 and 2019 and attributed to a pediatric provider in months 1-12. We also constructed primary care provider networks identifying links between providers who saw members of the same family. Logistic regression was used to predict adult primary care in months 25-36 on family, provider, and county-level factors. Finally, we modeled the effect of county and network cluster membership on care transitions. RESULTS Male sex, having another family member seeing a pediatrician, and residing in a county with high pediatric care capacity or low adult primary care capacity were associated with lower odds of adult primary care transition. DISCUSSION We investigated factors associated with successful transitions from pediatric to adult primary care. Family ties to a pediatrician and robust county capacity to provide primary care to children were associated with non-transition to adult primary care. CONCLUSION Multiple level factors contribute to non-transition to adult primary care. Understanding the factors associated with appropriate transition can help inform state and national policy.
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Affiliation(s)
- Sarah A Nowak
- Larner College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, VT, 05405, USA.
| | - Maija Reblin
- Larner College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, VT, 05405, USA
| | - Mark Fung
- Larner College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, VT, 05405, USA
| | - Chelsea Turley
- Larner College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, VT, 05405, USA
| | - Kirsten Threlkeld
- Larner College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, VT, 05405, USA
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Ghadiri P, Yaffe MJ, Adams AM, Abbasgholizadeh-Rahimi S. Primary care physicians' perceptions of artificial intelligence systems in the care of adolescents' mental health. BMC PRIMARY CARE 2024; 25:215. [PMID: 38872128 PMCID: PMC11170885 DOI: 10.1186/s12875-024-02417-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/06/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Given that mental health problems in adolescence may have lifelong impacts, the role of primary care physicians (PCPs) in identifying and managing these issues is important. Artificial Intelligence (AI) may offer solutions to the current challenges involved in mental health care. We therefore explored PCPs' challenges in addressing adolescents' mental health, along with their attitudes towards using AI to assist them in their tasks. METHODS We used purposeful sampling to recruit PCPs for a virtual Focus Group (FG). The virtual FG lasted 75 minutes and was moderated by two facilitators. A life transcription was produced by an online meeting software. Transcribed data was cleaned, followed by a priori and inductive coding and thematic analysis. RESULTS We reached out to 35 potential participants via email. Seven agreed to participate, and ultimately four took part in the FG. PCPs perceived that AI systems have the potential to be cost-effective, credible, and useful in collecting large amounts of patients' data, and relatively credible. They envisioned AI assisting with tasks such as diagnoses and establishing treatment plans. However, they feared that reliance on AI might result in a loss of clinical competency. PCPs wanted AI systems to be user-friendly, and they were willing to assist in achieving this goal if it was within their scope of practice and they were compensated for their contribution. They stressed a need for regulatory bodies to deal with medicolegal and ethical aspects of AI and clear guidelines to reduce or eliminate the potential of patient harm. CONCLUSION This study provides the groundwork for assessing PCPs' perceptions of AI systems' features and characteristics, potential applications, possible negative aspects, and requirements for using them. A future study of adolescents' perspectives on integrating AI into mental healthcare might contribute a fuller understanding of the potential of AI for this population.
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Affiliation(s)
- Pooria Ghadiri
- Department of Family Medicine and Faculty of Dental Medicine and Oral Health Sciences, McGill University, 5858 Ch. de la Côte-des-Neiges, Montréal, QC, H3S 1Z1, Canada
- Mila-Quebec AI Institute, Montréal, QC, Canada
| | - Mark J Yaffe
- Department of Family Medicine and Faculty of Dental Medicine and Oral Health Sciences, McGill University, 5858 Ch. de la Côte-des-Neiges, Montréal, QC, H3S 1Z1, Canada
- St. Mary's Hospital Center of the Integrated University Centre for Health and Social Services of West Island of Montreal, Montréal, QC, Canada
| | - Alayne Mary Adams
- Department of Family Medicine and Faculty of Dental Medicine and Oral Health Sciences, McGill University, 5858 Ch. de la Côte-des-Neiges, Montréal, QC, H3S 1Z1, Canada
| | - Samira Abbasgholizadeh-Rahimi
- Department of Family Medicine and Faculty of Dental Medicine and Oral Health Sciences, McGill University, 5858 Ch. de la Côte-des-Neiges, Montréal, QC, H3S 1Z1, Canada.
- Mila-Quebec AI Institute, Montréal, QC, Canada.
- Lady Davis Institute for Medical Research (LDI), Jewish General Hospital, Montréal, QC, Canada.
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Bailey K, Avolio J, Lo L, Gajaria A, Mooney S, Greer K, Martens H, Tami P, Pidduck J, Cunningham J, Munce S, Toulany A. Social and Structural Drivers of Health and Transition to Adult Care. Pediatrics 2024; 153:e2023062275. [PMID: 38084099 DOI: 10.1542/peds.2023-062275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 01/02/2024] Open
Abstract
CONTEXT Youth with chronic health conditions experience challenges during their transition to adult care. Those with marginalized identities likely experience further disparities in care as they navigate structural barriers throughout transition. OBJECTIVES This scoping review aims to identify the social and structural drivers of health (SSDOH) associated with outcomes for youth transitioning to adult care, particularly those who experience structural marginalization, including Black, Indigenous, and 2-spirit, lesbian, gay, bisexual, transgender, queer or questioning, and others youth. DATA SOURCES Medline, Embase, CINAHL, and PsycINFO were searched from earliest available date to May 2022. STUDY SELECTION Two reviewers screened titles and abstracts, followed by full-text. Disagreements were resolved by a third reviewer. Primary research studying the association between SSDOH and transition outcomes were included. DATA EXTRACTION SSDOH were subcategorized as social drivers, structural drivers, and demographic characteristics. Transition outcomes were classified into themes. Associations between SSDOH and outcomes were assessed according to their statistical significance and were categorized into significant (P < .05), nonsignificant (P > .05), and unclear significance. RESULTS 101 studies were included, identifying 12 social drivers (childhood environment, income, education, employment, health literacy, insurance, geographic location, language, immigration, food security, psychosocial stressors, and stigma) and 5 demographic characteristics (race and ethnicity, gender, illness type, illness severity, and comorbidity). No structural drivers were studied. Gender was significantly associated with communication, quality of life, transfer satisfaction, transfer completion, and transfer timing, and race and ethnicity with appointment keeping and transfer completion. LIMITATIONS Studies were heterogeneous and a meta-analysis was not possible. CONCLUSIONS Gender and race and ethnicity are associated with inequities in transition outcomes. Understanding these associations is crucial in informing transition interventions and mitigating health inequities.
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Affiliation(s)
- Katherine Bailey
- Temerty Faculty of Medicine
- Institute of Health Policy, Management and Evaluation
| | | | - Lisha Lo
- Centre for Quality Improvement and Patient Safety
| | - Amy Gajaria
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Margaret and Wallace McCain Centre for Child, Youth, and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sarah Mooney
- Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta, Canada
- Alberta Strategy for Patient Oriented Research Support Unit
- Faculty of Nursing, Grant MacEwan University, Edmonton, Alberta, Canada
| | - Katelyn Greer
- Alberta Strategy for Patient Oriented Research Support Unit
| | - Heather Martens
- Patient and Community Engagement Research (PaCER) Program, University of Calgary, Calgary, Alberta,Canada
- Alberta Health Services, Edmonton, Alberta, Canada
- KickStand, Mental Health Foundation, Edmonton, Alberta, Canada
| | - Perrine Tami
- Public Health and Preventative Medicine, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Sarah Munce
- Rehabilitation Sciences Institute
- Department of Occupational Science and Occupational Therapy
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Alene Toulany
- Temerty Faculty of Medicine
- Institute of Health Policy, Management and Evaluation
- Department of Pediatrics, Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health and Evaluative Sciences, Sickkids Research Institute, Toronto, Ontario, Canada
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Badour B, Bull A, Gupta AA, Mirza RM, Klinger CA. Parental Involvement in the Transition from Paediatric to Adult Care for Youth with Chronic Illness: A Scoping Review of the North American Literature. Int J Pediatr 2023; 2023:9392040. [PMID: 38045800 PMCID: PMC10691897 DOI: 10.1155/2023/9392040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 10/23/2023] [Accepted: 11/11/2023] [Indexed: 12/05/2023] Open
Abstract
With medical advancements and improvements in medical technology, an increasing number of children with chronic conditions survive into adulthood. There is accordant growing interest toward supporting adolescents throughout the transition from paediatric to adult care. However, there is currently a paucity of research focusing on the role that these patients' parents should play during and after the transition to adult care and if maintained parental involvement is beneficial during this transition within a North American context. Accordingly, this scoping review utilized Arksey and O'Malley's five-step framework to consider parental roles during chronically ill children's transition to adult care. APA PsycInfo, CINAHL, EMBASE, MEDLINE, ProQuest, and Scopus were searched alongside advanced Google searches. Thematic content analysis was conducted on 30 articles meeting the following inclusion criteria: (1) published in English between 2010 and 2022, (2) conducted in Canada or the United States, (3) considered adolescents with chronic conditions transitioning to adult care, (4) family being noted in the title or abstract, and (5) patient populations of study not being defined by delays in cognitive development, nor mental illness. Three themes emerged from the literature: the impacts of maintaining parental involvement during transition to adult care for patients, parents experiencing feeling loss of stability and support surrounding the transition of their child's care, and significant nonmedical life events occurring for youths at the time of transition of care. Parents assuming supportive roles which change alongside their maturing child's needs were reported as being beneficial to young peoples' transition processes, while parents who hover over or micromanage their children during this time were found to hinder successful transitions. Ultimately, the majority of reviewed articles emphasized maintained parental involvement as having a net positive impact on adolescents' transitions to adult care. As such, practice and policies should be structured to engage parents throughout the transition process to best support their chronically ill children during this time of change.
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Affiliation(s)
- Bryn Badour
- Faculty of Arts and Science: Health Studies Program, University of Toronto, Toronto, Ontario, Canada M5S 3G3
- National Initiative for the Care of the Elderly (NICE), Toronto, Ontario, Canada M5S 1V4
| | - Amanda Bull
- Faculty of Arts and Science: Health Studies Program, University of Toronto, Toronto, Ontario, Canada M5S 3G3
- National Initiative for the Care of the Elderly (NICE), Toronto, Ontario, Canada M5S 1V4
| | - Abha A. Gupta
- Temerty Faculty of Medicine: Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada M5S 1A8
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada M5G 1X8
- Division of Medical Oncology, University Health Network: Princess Margaret Cancer Centre, Toronto, Ontario, Canada M5G 2C1
| | - Raza M. Mirza
- Faculty of Arts and Science: Health Studies Program, University of Toronto, Toronto, Ontario, Canada M5S 3G3
- National Initiative for the Care of the Elderly (NICE), Toronto, Ontario, Canada M5S 1V4
- Temerty Faculty of Medicine: Translational Research Program, University of Toronto, Toronto, Ontario, Canada M5S 1A8
- Factor-Inwentash Faculty of Social Work: Institute for Life Course and Aging, University of Toronto, Toronto, Ontario, Canada M5S 1V4
| | - Christopher A. Klinger
- Faculty of Arts and Science: Health Studies Program, University of Toronto, Toronto, Ontario, Canada M5S 3G3
- National Initiative for the Care of the Elderly (NICE), Toronto, Ontario, Canada M5S 1V4
- Temerty Faculty of Medicine: Translational Research Program, University of Toronto, Toronto, Ontario, Canada M5S 1A8
- Factor-Inwentash Faculty of Social Work: Institute for Life Course and Aging, University of Toronto, Toronto, Ontario, Canada M5S 1V4
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Splane J, Doucet S, Luke A. Transitioning from paediatric to adult healthcare: Exploring the practices and experiences of care providers. J Child Health Care 2023:13674935231202870. [PMID: 37728067 DOI: 10.1177/13674935231202870] [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] [Indexed: 09/21/2023]
Abstract
Complex paediatric health conditions are increasingly associated with survival into adulthood resulting in more youth with complex care needs (CCN) transitioning from paediatric to adult healthcare. Current transition practices, when present, are disorganized, resulting in health status deterioration and complications due to unmet needs. The aim of this qualitative descriptive study is to develop a broader understanding of the current transition practices and experiences, as well as recommendations of care providers who support youth with CCN in the transition from paediatric to adult healthcare. Fifteen care providers from two Eastern Canadian provinces were interviewed using a semi-structured interview guide. The data collected were analyzed using inductive thematic analysis following the six phases outlined by Braun and Clarke (2006). The findings from this research demonstrate (1) a shortage of care providers, (2) inconsistent timing for transition initiation, and (3) lack of available community resources and services. Participant recommendations include (1) a designated transition coordinator; (2) transition policy implementation; (3) improved collaboration between and across care teams; and (4) the integration of virtual care to facilitate the transition process. The results of this study can potentially improve transition practices and policies and guide future research in this area.
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Affiliation(s)
- Jennifer Splane
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Shelley Doucet
- Department of Nursing & Health Sciences, University of New Brunswick Saint John, Saint John, NB, Canada
- Centre for Research in Integrated Care, University of New Brunswick Saint John, Saint John, NB, Canada
| | - Alison Luke
- Department of Nursing & Health Sciences, University of New Brunswick Saint John, Saint John, NB, Canada
- Centre for Research in Integrated Care, University of New Brunswick Saint John, Saint John, NB, Canada
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Musanje K, Kamya MR, Kasujja R, Hooper N, Katahoire AR, White RG, Kimera E, Getahun M, Sinclair DL, Ojiambo D, Camlin CS. Acceptability of an adapted mindfulness and acceptance-based intervention to support adolescents with HIV: A qualitative study with Ugandan health care providers. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023; 29:160-168. [PMID: 37519920 PMCID: PMC10373499 DOI: 10.1016/j.jcbs.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
While the adaptation of evidence-based psychosocial support tailors the intervention components to the targeted context, minimizing the associated costs of developing new interventions for low-income contexts, the acceptability of such adapted interventions is important for augmenting successful implementation and sustainability. Given that psychosocial support to persons living with HIV is mostly rendered by healthcare providers, their acceptance of adapted interventions before implementation is crucial. This study explored healthcare providers' acceptance of an adapted mindfulness and acceptance-based intervention supporting adolescents with HIV. Ten healthcare providers at two urban clinics in Kampala, Uganda attended a three-day training on using the adapted intervention and gave feedback on its appropriateness during in-depth interviews conducted thereafter. Semi-structured interviews were based on the Theoretical Framework of Acceptability and findings were analyzed abductively within the seven components of the framework. Overall, the adapted intervention was perceived to be acceptable and appropriate for use with adolescents. Benefits included the intervention offering support beyond a focus on adherence to drugs, refocusing adolescents on aspects in their lives that matter most, and being easy to integrate into providers' work processes. Providers however expressed concern about the time the intervention requires and the possibility of increasing their workload. These findings will support further adaptation and implementation.
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Affiliation(s)
- Khamisi Musanje
- Department of Educational, Social and Organizational Psychology, Makerere University, Uganda
- Clinical Epidemiology Unit, Makerere University, Uganda
| | | | - Rosco Kasujja
- Department of Mental Health and Community Psychology, Makerere University, Uganda
| | - Nic Hooper
- School of Psychology, Cardiff University, Wales, UK
| | | | - Ross G. White
- School of Psychology, Queens University, Belfast, Northern Ireland
| | - Emanuel Kimera
- Department of Public Health, Mountain of the Moon University, Uganda
| | - Monica Getahun
- Institute for Global Health Sciences, University of California, San Francisco, USA
| | | | - Deborah Ojiambo
- Department of Mental Health and Community Psychology, Makerere University, Uganda
| | - Carol S. Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences. University of California, San Francisco, USA
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Javadi D, Sacks E, Brizuela V, Finlayson K, Crossland N, Langlois EV, Ziegler D, Chandra-Mouli V, Bonet M. Factors that influence the uptake of postnatal care among adolescent girls: a qualitative evidence synthesis. BMJ Glob Health 2023; 8:e011560. [PMID: 37137533 PMCID: PMC10163540 DOI: 10.1136/bmjgh-2022-011560] [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] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/21/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Adolescent pregnancy is associated with increased risk of maternal and child morbidity and mortality globally. Access to safe, appropriate and affordable antenatal, childbirth and postnatal care (PNC) is essential in mitigating this risk. PNC is an often undervalued, underused, and understudied component of the continuum of maternal health services; however, it provides an important opportunity for adolescent girls to have access to health information and resources as they navigate the transition to motherhood and/or recovery from childbirth. This qualitative evidence synthesis seeks to highlight the experiences and perspectives of adolescent girls and their partners in accessing and using routine PNC. METHODS Papers were selected from a primary review on PNC where a global search of databases was conducted to identify studies with qualitative data focused on PNC utilisation. Within this primary review, a subset of studies focused on adolescents was tagged for subanalysis. A data extraction form drawing on an a priori framework was used to extract data from each study. Review findings were grouped across studies and mapped onto relevant themes, which were then adapted, as appropriate, to best reflect emergent themes from included studies. RESULTS Of 662 papers identified for full text review, 15 were included in this review on adolescents' experiences. Fourteen review findings were mapped onto four themes including: resources and access, social norms, experiences of care, and tailored support needs. CONCLUSION Improving uptake of PNC by adolescent girls requires multipronged approaches in improving availability of and access to adolescent-sensitive maternal health services and reducing feelings of shame and stigma in the postpartum period. Much should be done to address structural barriers to access, but tangible steps to improving the quality and responsiveness of available services can be taken immediately. PROSPERO REGISTRATION NUMBER CRD42019139183.
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Affiliation(s)
- Dena Javadi
- Social and Behavioral Sciences, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Emma Sacks
- Department of International Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Kenneth Finlayson
- Research in Childbirth and Health (ReaCH) Unit, School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Nicola Crossland
- Research in Childbirth and Health (ReaCH) Unit, School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Etienne V Langlois
- Partnership for Maternal, Newborn & Child Health (PMNCH), World Health Organization, Geneva, Switzerland
| | - Daniela Ziegler
- Library, Centre Hospitalier de l'Universite de Montreal, Montreal, Québec, Canada
| | - Venkatraman Chandra-Mouli
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Mercedes Bonet
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Toulany A, Gorter JW, Harrison M. A call for action: Recommendations to improve transition to adult care for youth with complex health care needs. Paediatr Child Health 2022; 27:297-309. [PMID: 36016593 PMCID: PMC9394635 DOI: 10.1093/pch/pxac047] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 01/07/2022] [Indexed: 11/12/2022] Open
Abstract
Youth with complex health care needs, defined as those requiring specialized health care and services for physical, developmental, and/or mental health conditions, are often cared for by paediatricians and paediatric specialists. In Canada, the age at which provincial/territorial funders mandate the transfer of paediatric care to adult services varies, ranging between 16 and 19 years. The current configuration of distinct paediatric and adult care service boundaries is fragmentary, raising barriers to continuity of care during an already vulnerable developmental period. For youth, the lack of care integration across sectors can negatively impact health engagement and jeopardize health outcomes into adulthood. To address these barriers and improve transition outcomes, paediatric and adult care providers, as well as family physicians and other community partners, must collaborate in meaningful ways to develop system-based strategies that streamline and safeguard care for youth transitioning to adult services across tertiary, community, and primary care settings. Flexible age cut-offs for transfer to adult care are recommended, along with considering each youth's developmental stage and capacity as well as patient and family needs and circumstances. Specialized training and education in transitional care issues are needed to build capacity and ensure that health care providers across diverse disciplines and settings are better equipped to accept and care for young people with complex health care needs.
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Affiliation(s)
- Alene Toulany
- Canadian Paediatric Society, Adolescent Health Committee, Ottawa, Ontario, Canada
| | - Jan Willem Gorter
- Canadian Paediatric Society, Adolescent Health Committee, Ottawa, Ontario, Canada
| | - Megan Harrison
- Canadian Paediatric Society, Adolescent Health Committee, Ottawa, Ontario, Canada
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Doucet S, Splane J, Luke A, Asher KE, Breneol S, Pidduck J, Grant A, Dionne E, Scott C, Keeping‐Burke L, McIsaac J, Gorter JW, Curran J. Programmes to support paediatric to adult healthcare transitions for youth with complex care needs and their families: A scoping review. Child Care Health Dev 2022; 48:659-692. [PMID: 35170064 PMCID: PMC9543843 DOI: 10.1111/cch.12984] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/17/2022] [Accepted: 02/07/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND An increasing number of children have complex care needs (CCN) that impact their health and cause limitations in their lives. More of these youth are transitioning from paediatric to adult healthcare due to complex conditions being increasingly associated with survival into adulthood. Typically, the transition process is plagued by barriers, which can lead to adverse health consequences. There is an increased need for transitional care interventions when moving from paediatric to adult healthcare. To date, literature associated with this process for youth with CCN and their families has not been systematically examined. OBJECTIVES The objective of this scoping review is to map the range of programmes in the literature that support youth with CCN and their families as they transition from paediatric to adult healthcare. METHODS The review was conducted in accordance with the Joanna Briggs Institute's methodology for scoping reviews. A search, last run in April 2021, located published articles in PubMed, CINAHL, ERIC, PsycINFO and Social Work Abstracts databases. RESULTS The search yielded 1523 citations, of which 47 articles met the eligibility criteria. A summary of the article characteristics, programme characteristics and programme barriers and enablers is provided. Overall, articles reported on a variety of programmes that focused on supporting youth with various conditions, beginning in the early or late teenage years. Financial support and lack of training for care providers were the most common transition program barriers, whereas a dedicated transition coordinator, collaborative care, transition tools and interpersonal support were the most common enablers. The most common patient-level outcome reported was satisfaction. DISCUSSION This review consolidates available information about interventions designed to support youth with CCN transitioning from paediatric to adult healthcare. The results will help to inform further research, as well as transition policy and practice advancement.
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Affiliation(s)
- Shelley Doucet
- Centre for Research in Integrated CareUniversity of New BrunswickSaint JohnNew BrunswickCanada
| | - Jennifer Splane
- Centre for Research in Integrated CareUniversity of New BrunswickSaint JohnNew BrunswickCanada,Faculty of HealthDalhousie UniversityHalifaxNova ScotiaCanada
| | - Alison Luke
- Centre for Research in Integrated CareUniversity of New BrunswickSaint JohnNew BrunswickCanada
| | - Kathryn E. Asher
- Centre for Research in Integrated CareUniversity of New BrunswickSaint JohnNew BrunswickCanada
| | - Sydney Breneol
- School of NursingDalhousie UniversityHalifaxNova ScotiaCanada
| | | | - Amy Grant
- Nova Scotia Health AuthorityHalifaxNova ScotiaCanada
| | - Emilie Dionne
- St. Mary's Research Centre & Family MedicineMcGill UniversityMontrealQuebecCanada
| | | | - Lisa Keeping‐Burke
- Department of Nursing and Health SciencesUniversity of New BrunswickSaint JohnNew BrunswickCanada
| | - Jessie‐Lee McIsaac
- Faculty of Education and Department of Child and Youth StudyMount Saint Vincent UniversityHalifaxNova ScotiaCanada
| | - Jan Willem Gorter
- Pediatric Rehabilitation MedicineUniversity Medical Centre UtrechtUtrechtThe Netherlands,Department of MedicineMcMaster UniversityHamiltonOntarioCanada
| | - Janet Curran
- School of NursingDalhousie UniversityHalifaxNova ScotiaCanada
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11
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Toulany A, Gorter JW, Harrison ME. Appel à l'action : des recommandations pour améliorer la transition des jeunes ayant des besoins de santé complexes vers les soins aux adultes. Paediatr Child Health 2022; 27:297-309. [PMID: 36016598 PMCID: PMC9394631 DOI: 10.1093/pch/pxac046] [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: 04/28/2021] [Accepted: 01/07/2022] [Indexed: 11/14/2022] Open
Abstract
Les jeunes qui ont des besoins de santé complexes, définis comme ceux qui nécessitent des soins et services spécialisés en raison d'affections physiques, développementales ou mentales, sont souvent traités par des pédiatres et autres spécialistes en pédiatrie. Au Canada, l'âge auquel les bailleurs de fonds provinciaux et territoriaux exigent le transfert des soins pédiatriques aux soins pour adultes varie entre 16 et 19 ans. La délimitation actuelle entre les services de santé pédiatriques et aux adultes est fragmentaire, ce qui entrave la continuité des soins pendant une période déjà vulnérable du développement. Le peu d'intégration des soins entre les domaines peut nuire à l'engagement des jeunes en matière de santé et compromettre leur santé à l'âge adulte. Pour renverser ces obstacles et améliorer les résultats de la transition, les dispensateurs de soins pédiatriques et de soins aux adultes, de même que les médecins de famille et d'autres partenaires communautaires, doivent collaborer de manière satisfaisante à l'élaboration de stratégies systémiques qui rationalisent et préservent les soins aux jeunes en transition vers des soins aux adultes en milieu tertiaire, communautaire et primaire. Il est recommandé de privilégier des limites d'âge flexibles pour effectuer cette transition vers les soins aux adultes et de tenir compte de la phase de développement et de l'aptitude de chaque jeune, ainsi que des besoins et de la situation de chaque patient et de chaque famille. Une formation et un enseignement spécialisés sur les enjeux liés aux soins de transition s'imposent pour renforcer les capacités et s'assurer que les professionnels de la santé des diverses disciplines et des divers milieux soient mieux outillés pour accepter et traiter les jeunes qui ont des besoins de santé complexes.
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Affiliation(s)
- Alene Toulany
- Société canadienne de pédiatrie, comité de la santé de l'adolescent, Ottawa (Ontario)Canada
| | - Jan Willem Gorter
- Société canadienne de pédiatrie, comité de la santé de l'adolescent, Ottawa (Ontario)Canada
| | - Megan E Harrison
- Société canadienne de pédiatrie, comité de la santé de l'adolescent, Ottawa (Ontario)Canada
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12
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Fawcett K, Stimell-Rauch M, Wagh A, Fenster D, Kessler D, DePeter K, Kim JW, Lame M, Sonnett M, Bregstein J. Pediatric Emergency Physicians’ Comfort Level Providing Urgent Care for Adults on Telemedicine During the COVID-19 Pandemic: Experience at an Academic Medical Center. Cureus 2022; 14:e26145. [PMID: 35891853 PMCID: PMC9303847 DOI: 10.7759/cureus.26145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/29/2022] Open
Abstract
Objective: Our objectives were to assess the comfort level of pediatric emergency physicians (PEPs) providing urgent care to adult patients on telemedicine (APOTM) when redeployed during the coronavirus disease 2019 (COVID-19) pandemic, how it changed over time, and what resources were helpful. Materials and methods: We conducted a retrospective pre-post cross-sectional survey of PEPs providing urgent care to APOTM with COVID-19 symptoms during the COVID-19 surge from March 12, 2020, to June 12, 2020 (the "care period") at two academic pediatric emergency departments in New York City. A retrospective chart review was also conducted. We include data on demographics of PEPs and adult patients; comfort level of PEPs providing urgent care to APOTM with COVID-19 symptoms pre- and post-three-month care period and effective resources. Results: Sixty-five PEPs provided urgent care to 1515 APOTM with COVID-19 symptoms during the care period. Pre-pandemic, 22/43 (51%) of responders feared caring for APOTM; 6/43 (14%) were comfortable. At the end of the care period, 25/42 (58%) of the responders stated they were comfortable caring for these patients. Factors associated with increased comfort level were: increased volume of patients over time, treatment algorithms, group support via electronic communication, and real-time back-up by a general emergency medicine (GEM) physician. Reduced medicolegal liability was also cited. Conclusion: With minimal additional training and resources, PEPs can increase their comfort to provide urgent care to APOTM with COVID-19 symptoms. As future pandemics may disproportionately affect certain patient populations (adults versus pediatrics), interventions such as treatment algorithms, group support via emails and texts, and sub-specialty backup should be incorporated into redeployment plans for urgent care telemedicine programs. Future research is needed to determine the adaptability of other medical specialties to cross-cover a different specialty from their own if needed.
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13
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Current challenges and opportunities in the care of patients with fibrodysplasia ossificans progressiva (FOP): an international, multi-stakeholder perspective. Orphanet J Rare Dis 2022; 17:168. [PMID: 35436894 PMCID: PMC9014788 DOI: 10.1186/s13023-022-02224-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 02/06/2022] [Indexed: 11/24/2022] Open
Abstract
Background Fibrodysplasia ossificans progressiva (FOP) is an ultra-rare, disabling genetic disorder characterized by congenital malformations of the great toes and progressive heterotopic ossification of soft and connective tissues. Assiduous attention to the unmet needs of this patient community is crucial to prevent potential iatrogenic harm and optimize care for individuals with FOP. Objective To gather international expert opinion and real-world experience on the key challenges for individuals with FOP and their families, highlight critical gaps in care, communication, and research, and provide recommendations for improvement. Methods An international group of expert clinicians, patients and patient advocates, caregivers and representatives from the international FOP community participated in a virtual, half-day meeting on 22 March 2021 to discuss the key unmet needs of individuals with FOP. Results Individuals with FOP often face the frustration of long diagnostic journeys, the burden of self-advocacy and the navigation of novel care pathways. Globally, patients with FOP are also confronted with inequities in access to diagnosis and specialist care, and consequently, unequal access to registries, clinical trials, and essential support from patient associations. Organizations such as the International FOP Association, the International Clinical Council on FOP, and national FOP organizations work to provide information, facilitate access to expert clinical guidance, nurture patient empowerment, fund FOP research and/or foster meaningful collaborations with the research community. The non-profit Tin Soldiers Global FOP Patient Search program aims to identify and provide a pathway to diagnosis and care for individuals with FOP, particularly in underserved communities. Such global initiatives and the increasingly widespread use of telemedicine and digital platforms offer opportunities to improve vital access to care and research. Conclusions This multi-stakeholder perspective highlights some of the unmet needs of individuals with FOP and their families. Regional and international organizations play an important role in improving the quality of life of those they reach in the global FOP community. However, globally, fundamental issues remain around raising awareness of FOP among healthcare professionals, identifying individuals with FOP, reducing time to diagnosis, and ensuring access to best practice in care, support, and clinical research. Medical writing support was industry-sponsored. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02224-w.
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14
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Gray W, Dorriz P, Kim H, Partain L, Benekos E, Carpinelli A, Zupanc M, Grant K, Weiss M. Adult Provider Perspectives on Transition and Transfer to Adult Care: A Multi-Specialty, Multi-Institutional Exploration. J Pediatr Nurs 2021; 59:173-180. [PMID: 33932647 DOI: 10.1016/j.pedn.2021.04.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/20/2021] [Accepted: 04/20/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE To identify barriers that transcend multiple adult care specialties and identify potential solutions. DESIGN AND METHODS Twenty-one adult care providers practicing in the specialty areas of internal medicine, family medicine, gastroenterology, endocrinology, and neurology participated in one of six semi-structured focus group interviews. Data were coded and analyzed according to the Socio-ecological Model of Adolescent/Young Adult Readiness for Transition (SMART). RESULTS Three themes and one subtheme emerged from the data. These fell within the beliefs/expectations, knowledge, access/insurance, and relationships (subtheme) domains of the SMART model. Family beliefs/expectations regarding the provider role, difficulty accessing reliable information, and limited access to mental health and behavioral providers reportedly affect providers' ability to provide optimal health care. CONCLUSIONS Adult providers identified several barriers affecting their ability to care for newly transferred patients. Increased education of families and improved methods of communication between providers were recommended. Barriers related to access and insurance are common and require larger systems-level collaborations between health care systems and payor sources. PRACTICAL IMPLICATIONS Some recommendations (e.g., educating families on the distinct roles of the PCP vs. specialist, highlighting new treatment opportunities in adult care, conveying trust and endorsing the new provider), represent concrete steps pediatric providers can immediately take to improve transfer. Other steps will require forging bridges across the pediatric and adult care world to expand patient access to medical, mental health, and behavioral services.
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Affiliation(s)
- Wendy Gray
- Children's Health of Orange County, Orange, CA, United States of America.
| | - Parasto Dorriz
- Children's Health of Orange County, Orange, CA, United States of America
| | - Hanae Kim
- Children's Health of Orange County, Orange, CA, United States of America
| | - Lauren Partain
- Children's Health of Orange County, Orange, CA, United States of America
| | - Erin Benekos
- Children's Health of Orange County, Orange, CA, United States of America
| | - Anne Carpinelli
- Children's Health of Orange County, Orange, CA, United States of America
| | - Mary Zupanc
- Children's Health of Orange County, Orange, CA, United States of America
| | - Kenneth Grant
- Children's Health of Orange County, Orange, CA, United States of America
| | - Michael Weiss
- Children's Health of Orange County, Orange, CA, United States of America
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15
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Schraeder K, Dimitropoulos G, Allemang B, McBrien K, Samuel S. Strategies for improving primary care for adolescents and young adults transitioning from pediatric services: perspectives of Canadian primary health care professionals. Fam Pract 2021; 38:329-338. [PMID: 33128378 PMCID: PMC8211142 DOI: 10.1093/fampra/cmaa113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Family physicians and other members of the primary health care (PHC) team may be ideally positioned to provide transition care to adolescents and young adults (AYAs; aged 12-25 years) exiting pediatric specialty services. Potential solutions to well-known challenges associated with integrating PHC and specialty care need to be explored. OBJECTIVE To identify strategies to transition care by PHC professionals for AYAs with chronic conditions transitioning from pediatric to adult-oriented care. METHODS Participants were recruited from six Primary Care Networks in Calgary, Alberta. A total of 18 semi-structured individual interviews were completed, and transcribed verbatim. Data were analyzed using a qualitative description approach, involving thematic analysis. RESULTS Participants offered a range of strategies for supporting AYAs with chronic conditions. Our analysis resulted in three overarching themes: (i) educating AYAs, families, and providers about the critical role of primary care; (ii) adapting existing primary care supports for AYAs and (iii) designing new tools or primary care practices for transition care. CONCLUSIONS Ongoing and continuous primary care is important for AYAs involved with specialty pediatric services. Participants highlighted a need to educate AYAs, families and providers about the critical role of PHC. Solutions to improve collaboration between PHC and pediatric specialist providers would benefit from additional perspectives from providers, AYAs and families. These findings will inform the development of a primary care-based intervention to improve transitional care.
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Affiliation(s)
| | - Gina Dimitropoulos
- Faculty of Social Work
- Mathison Centre for Mental Health Research & Education
| | | | - Kerry McBrien
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Susan Samuel
- Department of Pediatrics, Cumming School of Medicine
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16
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Stepien KM, Kieć-Wilk B, Lampe C, Tangeraas T, Cefalo G, Belmatoug N, Francisco R, Del Toro M, Wagner L, Lauridsen AG, Sestini S, Weinhold N, Hahn A, Montanari C, Rovelli V, Bellettato CM, Paneghetti L, van Lingen C, Scarpa M. Challenges in Transition From Childhood to Adulthood Care in Rare Metabolic Diseases: Results From the First Multi-Center European Survey. Front Med (Lausanne) 2021; 8:652358. [PMID: 33738294 PMCID: PMC7962750 DOI: 10.3389/fmed.2021.652358] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/08/2021] [Indexed: 12/11/2022] Open
Abstract
Inherited Metabolic Diseases (IMDs) are rare diseases caused by genetic defects in biochemical pathways. Earlier diagnosis and advances in treatment have improved the life expectancy of IMD patients over the last decades, with the majority of patients now surviving beyond the age of 20. This has created a new challenge: as they grow up, the care of IMD patients' needs to be transferred from metabolic pediatricians to metabolic physicians specialized in treating adults, through a process called “transition.” The purpose of this study was to assess how this transition is managed in Europe: a survey was sent to all 77 centers of the European Reference Network for Hereditary Metabolic Disorders (MetabERN) to collect information and to identify unmet needs regarding the transition process. Data was collected from 63/77 (81%) healthcare providers (HCPs) from 20 EU countries. Responders were mostly metabolic pediatricians; of these, only ~40% have received appropriate training in health issues of adolescent metabolic patients. In most centers (~67%) there is no designated transition coordinator. About 50% of centers provide a written individualized transition protocol, which is standardized in just ~20% of cases. In 77% of centers, pediatricians share a medical summary, transition letter and emergency plan with the adult team and the patient. According to our responders, 11% of patients remain under pediatric care throughout their life. The main challenges identified by HCPs in managing transition are lack of time and shortage of adult metabolic physician positions, while the implementations that are most required for a successful transition include: medical staff dedicated to transition, a transition coordinator, and specific metabolic training for adult physicians. Our study shows that the transition process of IMD patients in Europe is far from standardized and in most cases is inadequate or non-existent. A transition coordinator to facilitate collaboration between the pediatric and adult healthcare teams should be central to any transition program. Standardized operating procedures, together with adequate financial resources and specific training for adult physicians focused on IMDs are the key aspects that must be improved in the rare metabolic field to establish successful transition processes in Europe.
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Affiliation(s)
- Karolina M Stepien
- Adult Inherited Metabolic Diseases, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Beata Kieć-Wilk
- Department of Metabolic Diseases and Diabetes, Krakow University Hospital, Krakow, Poland.,Department of Metabolic Diseases, Medical College, Jagiellonian University, Krakow, Poland
| | - Christina Lampe
- Department of Child Neurology, Center for Rare Diseases Giessen (ZSEGI), Justus-Liebig University, Giessen, Germany
| | - Trine Tangeraas
- Norwegian National Unit for Newborn Screening, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Graziella Cefalo
- Department of Maternal and Child Health, San Paolo Hospital, University of Milan, ASST Santi Paolo e Carlo, Milan, Italy
| | - Nadia Belmatoug
- Referral Center for Lysosomal Diseases, AP-HP Nord, Beaujon Hospital, Paris University, Clichy, France
| | - Rita Francisco
- Portuguese Association for Congenital Disorders of Glycosylation and other Rare Metabolic Diseases, Lisbon, Portugal
| | - Mireia Del Toro
- Pediatric Neurology Department, University Hospital Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Leona Wagner
- German-Speaking Self-Help Group for Alkaptonuria (DSAKU) e.V., Stuttgart, Germany
| | - Anne-Grethe Lauridsen
- International Gaucher Alliance, Dursley, United Kingdom.,Gaucher Association Denmark, Holbaek, Denmark
| | - Sylvia Sestini
- Italian Association of Patients With Alkaptonuria (aimAKU), Siena, Italy
| | - Nathalie Weinhold
- Metabolic Unit, Interdisciplinary Centre for Metabolism: Endocrinology, Diabetes and Metabolism (UP) and Children's Hospital, Charité University Hospital Berlin, Berlin, Germany
| | - Andreas Hahn
- Department of Child Neurology, Justus-Liebig University, Giessen, Germany
| | - Chiara Montanari
- Department of Maternal and Child Health, San Paolo Hospital, University of Milan, ASST Santi Paolo e Carlo, Milan, Italy
| | - Valentina Rovelli
- Department of Maternal and Child Health, San Paolo Hospital, University of Milan, ASST Santi Paolo e Carlo, Milan, Italy
| | - Cinzia M Bellettato
- MetabERN, Regional Coordinating Center for Rare Diseases, Udine University Hospital, Udine, Italy
| | - Laura Paneghetti
- MetabERN, Regional Coordinating Center for Rare Diseases, Udine University Hospital, Udine, Italy
| | - Corine van Lingen
- MetabERN, Regional Coordinating Center for Rare Diseases, Udine University Hospital, Udine, Italy
| | - Maurizio Scarpa
- MetabERN, Regional Coordinating Center for Rare Diseases, Udine University Hospital, Udine, Italy
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17
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Schraeder KE, Barwick M, Cairney J, Carter J, Kurdyak P, Neufeld RWJ, Stewart SL, St Pierre J, Tobon J, Vingilis E, Zaric G, Reid GJ. Re-Accessing Mental Health Care After Age 18: A Longitudinal Cohort Study of Youth Involved with Community-based Child and Youth Mental Health Agencies in Ontario. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2021; 30:12-24. [PMID: 33552169 PMCID: PMC7837527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 10/26/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE About 20-26% of children and youth with a mental health disorder (depending on age and respondent) report receiving services from a community-based Child and Youth Mental Health (CYMH) agency. However, because agencies have an upper age limit of 18-years old, youth requiring ongoing mental health services must "transition" to adult-oriented care. General healthcare providers (e.g., family physicians) likely provide this care. The objective of this study was to compare the likelihood of receiving physician-based mental health services after age 18 between youth who had received community-based mental health services and a matched population sample. METHOD A longitudinal matched cohort study was conducted in Ontario, Canada. A CYMH cohort that received mental health care at one of five CYMH agencies, aged 7-14 years at their first visit (N=2,822), was compared to age, sex, region-matched controls (N=8,466). RESULTS CYMH youth were twice as likely as the comparison sample to have a physician-based mental health visit (i.e., by a family physician, pediatrician, psychiatrists) after age 18; median time to first visit was 3.3 years. Having a physician mental health visit before age 18 was associated with a greater likelihood of experiencing the outcome than community-based CYMH services alone. CONCLUSION Most youth involved in community-based CYMH agencies will re-access services from physicians as adults. Youth receiving mental health services only within community agencies, and not from physicians, may be less likely to receive physician-based mental health services as adults. Collaboration between CYMH agencies and family physicians may be important for youth who require ongoing care into adulthood.
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Affiliation(s)
| | - Melanie Barwick
- The Hospital for Sick Children, Toronto, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - John Cairney
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario
| | - Jeff Carter
- Department of Psychology, Western University, London, Ontario
- Department of Psychiatry, University of Toronto, Toronto, Ontario
- Vanier Children's Services, London, Ontario
| | - Paul Kurdyak
- Department of Psychiatry, University of Toronto, Toronto, Ontario
- Mental Health and Addictions Research Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario
- Center for Addiction and Mental Health, Toronto, Ontario
| | - Richard W J Neufeld
- Department of Psychology, Western University, London, Ontario
- Department of Psychiatry, Western University, London, Ontario
| | - Shannon L Stewart
- Faculty of Education, Western University, London, Ontario
- Children's Health and Therapeutics, Children's Health Research Institute, London, Ontario
| | | | - Juliana Tobon
- Department of Psychiatry and Behavioural Sciences, McMaster University, Hamilton, Ontario
| | - Evelyn Vingilis
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario
- Department of Epidemiology and Biostatistics, Western University, London, Ontario
| | - Gregory Zaric
- Department of Epidemiology and Biostatistics, Western University, London, Ontario
- Department of Management Science, Ivey School of Business, Western University, London, Ontario
| | - Graham J Reid
- Department of Psychology, Western University, London, Ontario
- Children's Health and Therapeutics, Children's Health Research Institute, London, Ontario
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario
- Department of Paediatrics, The University of Western Ontario, London, Ontario
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