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Markwart H, Schmidt S, Thyen U, Ernst G, Muehlan H. Transition competence as an indicator of health outcomes related to transition. Child Care Health Dev 2024; 50:e13142. [PMID: 37353994 DOI: 10.1111/cch.13142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 05/23/2023] [Accepted: 05/30/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Adolescents and young adults (AYAs) with chronic conditions face a transfer, defined as an actual shift from paediatric to adult-oriented health care. Transition competence as the self-perceived knowledge, skills and abilities regarding the transition process was considered extremely useful. AIM This study was designed to investigate the impact of transition competence before and after the transfer on disease-specific quality of life (QoL) and health care satisfaction of AYAs with diabetes. RESULTS In total, a sample of N = 90 AYAs with diabetes self-reported their transition competence, diabetes-specific QoL and satisfaction with care. Multiple linear regressions were used to analyse the impact of transition competence on satisfaction with care and QoL. Transition competence positively influenced the outcomes of satisfaction with care and QoL. CONCLUSION Young adults with diabetes showed higher transition competence scores than adolescents with diabetes.
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Affiliation(s)
- Henriette Markwart
- Department Methods of Community Medicine, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Silke Schmidt
- Department of Health and Prevention, University Greifswald, Greifswald, Germany
| | - Ute Thyen
- Department of Pediatrics and Adolescent Medicine, University of Luebeck, Luebeck, Germany
| | - Gundula Ernst
- Department of Medical Psychology, Medical School Hannover, Hannover, Germany
| | - Holger Muehlan
- Department of Health and Prevention, University Greifswald, Greifswald, Germany
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Wiegmann S, Ernst M, Ihme L, Wechsung K, Kalender U, Stöckigt B, Richter-Unruh A, Vögler S, Hiort O, Jürgensen M, Marshall L, Menrath I, Schneidewind J, Wagner I, Rohayem J, Liesenkötter KP, Wabitsch M, Fuchs M, Herrmann G, Lutter H, Ernst G, Lehmann C, Haase M, Roll S, Schilling R, Keil T, Neumann U. Development and evaluation of a patient education programme for children, adolescents, and young adults with differences of sex development (DSD) and their parents: study protocol of Empower-DSD. BMC Endocr Disord 2022; 22:166. [PMID: 35761280 PMCID: PMC9235086 DOI: 10.1186/s12902-022-01079-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/15/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Differences in sexual development (DSD) are rare diseases, which affect the chromosomal, anatomical or gonadal sex differentiation. Although patient education is recommended as essential in a holistic care approach, standardised programmes are still lacking. The present protocol describes the aims, study design and methods of the Empower-DSD project, which developed an age-adapted multidisciplinary education programme to improve the diagnosis-specific knowledge, skills and empowerment of patients and their parents. METHODS The new patient education programme was developed for children, adolescents and young adults with congenital adrenal hyperplasia, Turner syndrome, Klinefelter syndrome or XX-/or XY-DSD and their parents. The quantitative and qualitative evaluation methods include standardised questionnaires, semi-structured interviews, and participatory observation. The main outcomes (assessed three and six months after the end of the programme) are health-related quality of life, disease burden, coping, and diagnosis-specific knowledge. The qualitative evaluation examines individual expectations and perceptions of the programme. The results of the quantitative and qualitative evaluation will be triangulated. DISCUSSION The study Empower-DSD was designed to reduce knowledge gaps regarding the feasibility, acceptance and effects of standardised patient education programmes for children and youth with DSD and their parents. A modular structured patient education programme with four generic and three diagnosis-specific modules based on the ModuS concept previously established for other chronic diseases was developed. The topics, learning objectives and recommended teaching methods are summarised in the structured curricula, one for each diagnosis and age group. At five study centres, 56 trainers were qualified for the implementation of the training programmes. A total of 336 subjects have been already enrolled in the study. The recruitment will go on until August 2022, the last follow-up survey is scheduled for February 2023. The results will help improve multidisciplinary and integrated care for children and youth with DSD and their families. TRIAL REGISTRATION German Clinical Trials Register, DRKS00023096 . Registered 8 October 2020 - Retrospectively registered.
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Affiliation(s)
- Sabine Wiegmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, and Berlin Institut of Health, SPZ Interdisziplinär, Kinderendokrinologie und -diabetologie, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Martina Ernst
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, and Berlin Institut of Health, SPZ Interdisziplinär, Kinderendokrinologie und -diabetologie, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Loretta Ihme
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, and Berlin Institut of Health, SPZ Interdisziplinär, Kinderendokrinologie und -diabetologie, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Katja Wechsung
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, and Berlin Institut of Health, SPZ Interdisziplinär, Kinderendokrinologie und -diabetologie, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Ute Kalender
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany
| | - Barbara Stöckigt
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany
| | - Annette Richter-Unruh
- Pediatric Endocrinology & Diabetology, St. Josefs Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Sander Vögler
- Pediatric Endocrinology & Diabetology, St. Josefs Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Olaf Hiort
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, University of Lübeck, Lübeck, Germany
| | - Martina Jürgensen
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, University of Lübeck, Lübeck, Germany
| | - Louise Marshall
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, University of Lübeck, Lübeck, Germany
| | - Ingo Menrath
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, University of Lübeck, Lübeck, Germany
| | - Julia Schneidewind
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, University of Lübeck, Lübeck, Germany
| | - Isabel Wagner
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, University of Lübeck, Lübeck, Germany
| | - Julia Rohayem
- Centre for Reproductive Medicine and Andrology, Clinical and Operative Andrology, University Hospital Münster, Münster, Germany
| | | | - Martin Wabitsch
- Universitätsklinikum Ulm, Klinik für Kinder- und Jugendmedizin, Sektion Pädiatrische Endokrinologie und Diabetologie, Hormonzentrum für Kinder und Jugendliche, Ulm, Germany
| | - Malaika Fuchs
- Universitätsklinikum Ulm, Klinik für Kinder- und Jugendmedizin, Sektion Pädiatrische Endokrinologie und Diabetologie, Hormonzentrum für Kinder und Jugendliche, Ulm, Germany
| | - Gloria Herrmann
- Universitätsklinikum Ulm, Klinik für Kinder- und Jugendmedizin, Sektion Pädiatrische Endokrinologie und Diabetologie, Hormonzentrum für Kinder und Jugendliche, Ulm, Germany
| | - Henriette Lutter
- Universitätsklinikum Ulm, Klinik für Kinder- und Jugendmedizin, Sektion Pädiatrische Endokrinologie und Diabetologie, Hormonzentrum für Kinder und Jugendliche, Ulm, Germany
| | - Gundula Ernst
- Department of Medical Psychology, Hannover Medical School, Hannover, Germany
| | - Christine Lehmann
- Förderkreis Schulung chronisch kranker Kinder und Jugendlicher e.V., Berlin, Germany
| | - Martina Haase
- Institute of Clinical Epidemiology and Biometry, Würzburg University, Würzburg, Germany
| | - Stephanie Roll
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany
| | - Ralph Schilling
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany
| | - Thomas Keil
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany
- Institute of Clinical Epidemiology and Biometry, Würzburg University, Würzburg, Germany
- State Institute of Health, Bavarian Health and Food Safety Authority, Erlangen, Germany
| | - Uta Neumann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, and Berlin Institut of Health, SPZ Interdisziplinär, Kinderendokrinologie und -diabetologie, Augustenburger Platz 1, 13353, Berlin, Germany
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Pape L, Ernst G. Health care transition from pediatric to adult care: an evidence-based guideline. Eur J Pediatr 2022; 181:1951-1958. [PMID: 35084548 PMCID: PMC9056438 DOI: 10.1007/s00431-022-04385-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 12/01/2022]
Abstract
For consistent quality of treatment of young people with chronic health care needs, a structured health care transition (HCT) from pediatric medicine to adult medical care is essential. Currently, most countries have no guidelines on HCT based on systematic evidence research. To close this gap, guidance to support HCT was developed in Germany. Twenty-two experts in the management of adolescents and young adults with different chronic conditions and three patient representatives were invited to take part in the guideline group. Based on a systematic literature search recommendations for HCT were drafted. Where evidence was lacking, recommendations were developed using collective expert consensus. The consensus process was independently moderated using a Delphi approach. The final draft was reviewed and endorsed by all major German medical societies. The clinical recommendations provide guidance for all chronic somatic diseases. After assessment of HCT readiness, an individualized plan for HCT should be drawn up. Key elements here are a responsible coordinator, age-adapted patient education, involvement of caregivers, web-based interventions, joint visits, and a structured summary for the receiving physician. The aim is the gradual transfer of responsibility for disease management to the young person themselves. Conclusion: As only a few randomized controlled studies on HCT are available, evidence-based statements are possible for some but not all areas of HCT. However, this guideline may help to develop globally accepted standards. These standards should be established and implemented. The aim should be a reimbursement by individual national health systems to allow appropriate support for young people. What is Known: • Health care transition from pediatric to adult care is primarily organized in local settings, partly based on disease-specific guidelines. •There have been no national guidelines in Germany until now. What is New: • Here we present the general evidence-based guidelines of the German Association of Scientific Medical Societies for health care transition. • These might serve as a blueprint for further national or international health care transition guidelines.
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Affiliation(s)
- Lars Pape
- Society for Transition Medicine, Hannover, Germany
- Children’s Clinic II, Essen University Hospital, Univ. of Duisburg-Essen, Essen, Germany
| | - Gundula Ernst
- Society for Transition Medicine, Hannover, Germany
- Research and Teaching Unit Medical Psychology, Hannover Medical School, Hannover, Germany
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Collette P, Klein LC, Körner LM, Ernst G, Brengmann S, Schäuble J, Habbig S, Weber LT. The individualized, accompanied transition program “TraiN” for adolescent kidney patients – a local initiative. JOURNAL OF TRANSITION MEDICINE 2021. [DOI: 10.1515/jtm-2021-0002] [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
Since the transition from pediatric and adolescent to adult care often proceeds unaccompanied and unplanned, young patients with chronic kidney disease may experience health risks and non-adherence after the transfer. The psychosocial team at the Department of Pediatric Nephrology at the University Hospital of Cologne has therefore developed its local transition program “TraiN” for patients with chronic kidney disease aged 13 years and older. It combines structure and flexibility through predefined content modules that can be individually adapted to the patients, offering continuity and sustainability through a transition contact person. In addition, the family members are offered regular psychological consultations. The timing of the transfer is chosen individually depending on the level of psychosocial and medical transition readiness. The aim of “TraiN” is to strengthen the patients’ transition competence and the responsibility for their disease management and to provide them and their families the best possible support during the transition in order to prevent possible health risks. In the near future, a scientific evaluation will be conducted aiming to determine whether “TraiN” can support young people in their independence and self-reliant disease management.
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Affiliation(s)
- Paula Collette
- Nephrology, Children’s and Adolescent’s Hospital , Faculty of Medicine and University Hospital of Cologne, University of Cologne , Cologne , Germany
| | - Luisa C. Klein
- Nephrology, Children’s and Adolescent’s Hospital , Faculty of Medicine and University Hospital of Cologne, University of Cologne , Cologne , Germany
| | - Lisa M. Körner
- Department of General Pediatrics, Neonatology and Pediatric Cardiology , University Children’s Hospital, Medical Faculty, Heinrich-Heine-University , Düsseldorf , Germany
| | - Gundula Ernst
- Department of Medical Psychology , Hannover Medical School , Hannover , Germany
| | - Sandra Brengmann
- Nephrology, Children’s and Adolescent’s Hospital , Faculty of Medicine and University Hospital of Cologne, University of Cologne , Cologne , Germany
| | - Julian Schäuble
- Nephrology, Children’s and Adolescent’s Hospital , Faculty of Medicine and University Hospital of Cologne, University of Cologne , Cologne , Germany
| | - Sandra Habbig
- Nephrology, Children’s and Adolescent’s Hospital , Faculty of Medicine and University Hospital of Cologne, University of Cologne , Cologne , Germany
| | - Lutz T. Weber
- Nephrology, Children’s and Adolescent’s Hospital , Faculty of Medicine and University Hospital of Cologne, University of Cologne , Cologne , Germany
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Abstract
Cystic fibrosis (CF) is an inherited incurable multi-organ disease. Improvement in treatment approaches over the last 20 years have led to an increased life expectancy where the number of adult patients has doubled and will continue to increase exponentially. Due to the use of new substances which modulate the basic defect, a substantial improvement in the prognosis can be assumed but the existing healthcare structures in Germany do not meet these rising needs. With more than 50% of patients being adults, there are only very few internal medicine centers available. Only approximately one third of the patients are treated in adult health centers. Adolescence in particular is a very vulnerable phase of the disease, the risk of comorbidities is increased and adherence to the very laborious treatment recommendations is as a rule low. While in many other countries transition programs have been evaluated and implemented for more than 20 years, in Germany there have only been rudimentary approaches to transition. Meanwhile investigations are available on the perceptions of adolescents with respect to coping with the disease and their treatment needs, including the perception of the time when the transition process should begin. Successful transition seems to be performed best in combined pediatric and adult centers, with the back-up of an experienced multidisciplinary team of healthcare providers.
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Affiliation(s)
- D Staab
- Klinik für Pädiatrie mit Schwerpunkt Pneumologie, Immunologie und Intensivmedizin, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland.
| | - C Schwarz
- Klinik für Pädiatrie mit Schwerpunkt Pneumologie, Immunologie und Intensivmedizin, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
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