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Tsondai PR, Davies MA, Singtoroj T, Maxwell N, Technau KG, Chokephaibulkit K, Lumbiganon P, Sohn AH. Creating a data collection and management platform to support measurement of adolescent HIV care transition processes within low- and middle-income countries: The GRADUATE project. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002705. [PMID: 39102384 PMCID: PMC11299826 DOI: 10.1371/journal.pgph.0002705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 06/10/2024] [Indexed: 08/07/2024]
Abstract
Few national programs and research cohorts within low- and middle-income countries (LMICs) document transition-related processes and outcomes for adolescents and young adults living with HIV (AYLH) transitioning to adulthood. Between 2017-2020, The Global fRAmework of Data collection Used for Adolescent HIV Transition Evaluation (GRADUATE) project convened a collaborative advisory group to identify key variables and definitions capturing the process, predictors, and outcomes across the transition period. In total, 114 variables identified as essential to measuring AYLH transition-related data were identified and formatted into a GRADUATE Data Exchange Standard (DES), which was added to and harmonized with the existing International epidemiology Databases to Evaluate AIDS (IeDEA) DES. In 2019, the GRADUATE DES was pilot tested at four IeDEA facilities in Malawi, South Africa, and Thailand through a cross-sectional study. Upon comparing the variables to routine medical records, available data were too limited to adequately capture transition-related processes and outcomes. However, additional data collection using GRADUATE tools was feasible and improved completeness. Of the 100 (52% female) AYLH included in the pilot study, 71% had transitioned/transferred to adult care, with 42% transitioning from an adolescent-specific model of care within an integrated family clinic to having their clinic visits scheduled on a different day of the week while 58% transferred from a pediatric facility to one offering adult HIV care. While almost all (94%) had a transition-related discussion with their healthcare providers prior to the transition, we found that 69% (95% CI 49-85%) were somewhat or very satisfied/comfortable with the post-transfer clinic and the staff. Utilization of the GRADUATE DES better characterized AYLH transitioning to adulthood across LMICs, and optimally measured transition preparation activities and outcomes. Utilization of the GRADUATE DES in other settings could facilitate comparisons and identify gaps in the care of transitioning adolescents that need to be addressed.
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Affiliation(s)
- Priscilla R. Tsondai
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Thida Singtoroj
- TREAT Asia/amfAR—The Foundation for AIDS Research, Bangkok, Thailand
| | - Nicola Maxwell
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Karl-Günter Technau
- Faculty of Health Sciences, Department of Paediatrics & Child Health, Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Kulkanya Chokephaibulkit
- Faculty of Medicine Siriraj Hospital, Department of Pediatrics, Mahidol University, Bangkok, Thailand
| | - Pagakrong Lumbiganon
- Faculty of Medicine, Department of Pediatrics, Khon Kaen University, Khon Kaen, Thailand
| | - Annette H. Sohn
- TREAT Asia/amfAR—The Foundation for AIDS Research, Bangkok, Thailand
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Lin SC, Huang MC. Prevalence, trends, and specialized palliative care utilization in Taiwanese children and young adults with life-limiting conditions between 2008 and 2017: a nationwide population-based study. Arch Public Health 2024; 82:99. [PMID: 38961464 PMCID: PMC11221041 DOI: 10.1186/s13690-024-01315-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 06/05/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Previous studies have shown a growing need for pediatric palliative care, but there is a lack of knowledge in many countries concerning prevalence of service use among children and young adults with life-limiting conditions. This study aimed to estimate (1) the annual prevalence of children and young adults with a life-limiting condition, and (2) their specialized palliative care and other healthcare utilization. METHODS Data from the Health and Welfare Data Science Center in Taiwan were used. All children and young adults aged 0-25 years recorded in inpatient or outpatient data, and infants aged < 1 year in death data with a life-limiting condition diagnostic code from 2008 to 2017 were recruited. Poisson regression was used to estimate the crude and adjusted relative risk of prevalence of life-limiting conditions with 95% confidence intervals, adjusted for age and sex, and to evaluate the trend in prevalence of each life-limiting diagnostic groups, in specialized palliative care and other service use. RESULTS Data contained 236,250 individuals with a life-limiting condition, of which oncological and congenital abnormalities were the most common. There was an annualized increase over 10 years in the prevalence of life-limiting conditions of 36.4%, from 45,311 cases (59.4 per 10,000 population) to 52,226 cases (81.0 per 10,000 population), with the highest prevalence in individuals aged 21-25 years. All diagnostic groups showed significant increases in prevalence (p < .001) with the exception of oncology, circulatory, and "other" group. Specialized palliative care services, including family consultation, shared care, home visits have increased in use over time (p < .001), while inpatient hospice has slightly decreased. The highest prevalence of healthcare use was for traditional Chinese medicine (237.1 per 1,000 population in 2017), but this decreased over time (p < .001). CONCLUSIONS Due to a growing trend towards multidisciplinary care, healthcare professionals and policymakers must engage and take action to expand specialized palliative care and integrate delivery of other healthcare services. Traditional Chinese medicine having a decreasing slope, yet still the highest prevalence of use, needs further attention.
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Affiliation(s)
- Shih-Chun Lin
- School of Nursing, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Rd., Sanmin Dist, Kaohsiung, 80708, Taiwan
- Center for Long-Term Care Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Mei-Chih Huang
- Department of Nursing, College of Medicine, National Cheng Kung University, No.1, University Road, East Dist., Tainan, 701401, Taiwan.
- National Tainan Junior College of Nursing, 78, Sec. 2, Minzu Rd., West Central Dist, Tainan, 700007, Taiwan.
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Wolfson S, Patel D, Toto E, Khlevner J, Santucci NR. "An urgent need for transition of care programs for adolescents and young adults with neurogastroenterology and motility disorders". J Pediatr Gastroenterol Nutr 2024; 79:1-5. [PMID: 38623964 PMCID: PMC11216879 DOI: 10.1002/jpn3.12217] [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: 01/16/2024] [Revised: 02/26/2024] [Accepted: 03/02/2024] [Indexed: 04/17/2024]
Abstract
Transition of Care for Adolescents and Young Adults (AYA) with Neurogastroenterology & Motility (NGM) Disorders.
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Affiliation(s)
- Sharon Wolfson
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Dhiren Patel
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cardinal Glennon Children’s Medical Center, Saint Louis University School of Medicine, St Louis, Missouri, USA
| | - Erin Toto
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Julie Khlevner
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian Morgan Stanley Children’s Hospital, New York, New York, USA
| | - Neha R. Santucci
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
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Weaver M, McCormick A. Healthy transition: Roadmap for young adults with Down syndrome to adulthood. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2024; 196:e32065. [PMID: 37746749 DOI: 10.1002/ajmg.c.32065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/10/2023] [Accepted: 09/12/2023] [Indexed: 09/26/2023]
Abstract
Healthcare transition is the purposeful and planned process for preparing young adults with Down syndrome for an adult oriented healthcare system. Significant gaps of a delayed, incomplete, siloed and decentered transition can be avoided when transition is approached in a longitudinal and holistic manner. Young adults with Down syndrome are specifically vulnerable to these gaps as the combination of intellectual differences and healthcare complexity leads to the need for a process that allows for appropriate preparation to develop the skills and process for an appropriate. To establish a successful transition care plan, the six core elements of policy, tracking, readiness, planning, transfer of care, and complete transition will compose the scaffolding of the transition process and address these gaps in care. A comprehensive tool kit including policy statements, healthcare transition tracking forms, the TRAQ tool, and template portable medical summaries will operationalize those elements and counteract any gaps in the transition process.
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Affiliation(s)
- Maya Weaver
- University of Delware, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
| | - Andrew McCormick
- Division of Pediatric Hospital Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
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Fishman LN, Ding J. Optimizing the Transition and Transfer of Care in Pediatric Inflammatory Bowel Disease. Gastroenterol Clin North Am 2023; 52:629-644. [PMID: 37543405 DOI: 10.1016/j.gtc.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2023]
Abstract
Health care transition from pediatric to adult care has been identified as a priority in the field of medicine, especially for those with chronic illnesses such as inflammatory bowel disease (IBD). Although there is no universally accepted model of preparing the pediatric patient for transfer to adult care, transition care is best accomplished in a structured and consistent manner. The authors highlight concepts for optimizing the transition of care for patients with IBD, which include setting expectations throughout adolescence with the gradual nurturing of self-management skills, preparing and assessing of readiness for transfer, and enacting a successful transfer to adult care.
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Affiliation(s)
- Laurie N Fishman
- Division of Gastroenterology and Nutrition, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Julia Ding
- Division of Gastroenterology and Hepatology, Boston University School of Medicine, 72 East Concord Street, Boston, MA 02118, USA
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Lara-Macaraeg BR, Cardinal A, Bermejo BG. Transition readiness of adolescents to adult health care. Front Pediatr 2023; 11:1204019. [PMID: 37587976 PMCID: PMC10426738 DOI: 10.3389/fped.2023.1204019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/10/2023] [Indexed: 08/18/2023] Open
Abstract
Background Transition in health care is a process wherein adolescents gradually prepare for and shift towards care in the adult system. An initial assessment of the readiness of these adolescents is fundamental in providing appropriate health services for them. This paper aims to determine the readiness of adolescent patients towards transitioning to adult care. Methods This is a prospective cross-sectional study utilizing an interviewer-guided modified Transition Readiness Assessment Questionnaire (TRAQ). Sixty-three adolescents ages 15 to 18 years seen in the Pediatric Outpatient Department (OPD) of a tertiary hospital in Baguio City from July 1 to October 31, 2020 were enrolled. Frequency and percentages were used to describe the demographic data; while mean score and standard deviation determined readiness based on a Likert scale. One-way ANOVA was utilized to determine association between factors and readiness to transition. Results For all domains of TRAQ, the mean score was 3.64, implying that they are not yet ready to transition. 49.2% belong to General Pediatrics. 44.4% belong to the Igorot ethnic groups. Most are still in High school, and majority of their parents finished High School level. Furthermore, the P-values were more than 0.05 for all variables suggesting no association between readiness to transition and the identified factors in this study. Discussion This study showed that adolescents who had both acute and chronic illnesses, were not yet ready to transition. Provision of a platform for assisting the adolescents in their assumption of bigger roles/responsibilities for their own health care is necessary to ensure proper transitioning to adult health care.
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Affiliation(s)
| | - Avegail Cardinal
- Department of Pediatrics, Baguio General Hospital and Medical Center, Baguio, Philippines
| | - Berith Grace Bermejo
- Department of Pediatrics, Baguio General Hospital and Medical Center, Baguio, Philippines
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Majidi S, Roberts AJ, Suerken CK, Reboussin BA, Malik FS, Marcovina SM, Corathers S, Reynolds K, Imperatore G, Wadwa RP, Pihoker C. Health Care Transition to Adult Care in Type 1 Diabetes: Associations With Student and Employment Status-The SEARCH for Diabetes in Youth Study. Clin Diabetes 2023; 41:510-517. [PMID: 37849515 PMCID: PMC10577504 DOI: 10.2337/cd22-0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Successful transition from a pediatric to adult diabetes care provider is associated with reduced ambulatory diabetes care visits and increased acute complications. This study aimed to determine whether the degree of independence in diabetes care and the rate of acute complications after transition to adult diabetes care were associated with individuals' student or employment status. Nonstudents were found to be less likely than students to be independent with diabetes care, and employed nonstudents were at lower risk of diabetic ketoacidosis than unemployed nonstudents. Additional support may be needed for young adults who are not students or are unemployed to improve independence and reduce the risk for acute complications.
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Affiliation(s)
- Shideh Majidi
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of Endocrinology, Children’s National Hospital, Washington, DC
| | - Alissa J. Roberts
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Cynthia K. Suerken
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Beth A. Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Faisal S. Malik
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | | | - Sarah Corathers
- Division of Endocrinology, Cincinnati Children’s Hospital, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Kristi Reynolds
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Giuseppina Imperatore
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - R. Paul Wadwa
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
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Rhee H, Choi Y, Tumiel-Berhalter L. Transition readiness in middle and older adolescents with asthma and associated factors: a descriptive study. J Asthma 2023; 60:991-999. [PMID: 36040871 PMCID: PMC10011012 DOI: 10.1080/02770903.2022.2119864] [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: 05/30/2022] [Revised: 08/04/2022] [Accepted: 08/29/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Asthma is the leading chronic health condition in adolescents, yet little is known about adolescents' readiness to transition into adult-focused care. This study examines transition readiness in middle and late adolescents with asthma. METHODS This cross-sectional descriptive study was conducted in 2019 with 41 adolescents (16-20 years old) with asthma. Transition readiness was measured with the 20-item Transition Readiness Assessment Questionnaire (TRAQ), which comprises five subscales. RESULTS Slight majorities of the sample comprised females (58.5%) and minority adolescents (56%). The sample's overall mean score on the TRAQ was 3.89 (±0.63; possible range 1-5). Managing daily activities was associated with talking with providers subscale (r = 0.36; p < 0.01), but not with other TRAQ subscales. Females reported greater scores for managing medications than did males, with mean = 4.2 vs. 3.6 (t = -2.15, p = 0.04). Transition readiness did not differ by race or health insurance type. However, scores on arranging transportation to medical appointments were lower among minority adolescents than whites (4.17 vs. 4.8, t = 2.56, p = 0.01). Better asthma control was associated with higher scores on talking with providers (r = -0.42; p < 0.01), but not with other subscale domains. CONCLUSIONS Overall transition readiness is suboptimal in middle to late adolescents with asthma. Adolescents' capacity to manage daily activities is not a valid indicator of transition readiness in disease self-management. It is important to consider gender, race, and asthma control in understanding transition readiness in adolescents with asthma.
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Affiliation(s)
- Hyekyun Rhee
- University of Texas at Austin School of Nursing, 1710 Red River St. Austin, TX 78712
| | - Yuri Choi
- University of Rochester School of Nursing, 601 Elmwood Ave, Box SON, Rochester, NY 14642
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Knowledge, Attitudes, and Practices of Allergists/Immunologists Regarding Transition of Care for Primary Immunodeficiency Patients. J Clin Immunol 2023; 43:595-603. [PMID: 36454452 DOI: 10.1007/s10875-022-01415-1] [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: 08/15/2022] [Accepted: 11/25/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE Only some allergists/immunologists provide care throughout the lifespan despite their training. Although transition of care (TOC) guidelines exist, research on provider perspectives on TOC for pediatric primary immunodeficiency (PID) patients is lacking. We aimed to characterize knowledge, attitudes, and practices and establish clinician needs using a needs assessment survey. METHODS The 15-min online survey was adapted from an existing rheumatology TOC survey and was emailed to the American Academy of Allergy Asthma and Immunology (AAAAI) and Clinical Immunology Society (CIS) members. Our primary hypothesis was that both AAAAI and CIS providers report being underprepared for TOC and would express interest in TOC resources and consensus. RESULTS Forty-nine of 1250 eligible AAAAI and 67 of 698 eligible CIS participants completed the survey (4.8% vs 11.3% participation rate). Many (53.1% vs 59.7%) respondents transition their own patients but also retain adult patients (59.2% vs 52.2%). Many accepted transition patients (85.7% vs 92.5%). In total, 24.1% of respondents did not have a TOC policy while 18.9% have an informal policy. Only 25.0% were satisfied with their current practices while 43.9% agreed that a consensus statement would be useful. CONCLUSION Despite a small sample size and high rate of unanswered questions, our findings show that TOC remains overlooked in our specialty and that providers want and need additional training and resources. There is a clear need to develop and evaluate the effectiveness of evidence-based TOC guidelines, resources, and best practices for PID patients.
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Quimby D, Conn BM, Ellis TT, Iverson E. The process of capacity-building for pediatric subspecialty providers to address the needs of adolescents and young adults with chronic illness. Int J Adolesc Med Health 2023; 35:89-99. [PMID: 33161385 DOI: 10.1515/ijamh-2020-0216] [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: 08/25/2020] [Accepted: 10/18/2020] [Indexed: 11/15/2022]
Abstract
Approximately 12% of adolescents in the USA live with a chronic health condition. Although youth with chronic illness visit healthcare providers more than healthy peers, pediatric subspecialty providers are less likely to address developmentally relevant concerns (e.g., reproductive health) with adolescents and young adults (AYA), particularly youth of color and/or youth in low-income communities. Despite the documented need for increased training, there remains a general lack of knowledge about pediatric subspecialty providers' training needs related to building their capacity to provide developmentally appropriate care to their adolescent and young adult patients. The present study describes an overall process for capacity-building to address the needs of diverse AYA patients with chronic medical conditions, built upon data representing key stakeholders and staff from 14 specialty care departments collected via quantitative surveys and focus groups. We describe the development of trainings for pediatric subspecialty providers from a large, urban, pediatric tertiary care center to address the health and psychosocial-related concerns of AYA living with chronic illness. We highlight valuable lessons from the capacity-building process in terms of increasing the ability of providers in a major pediatric healthcare center to provide developmentally appropriate care for AYA living with chronic illness. Finally, based on the results of our study, we provide recommendations on how to employ such a process in similar pediatric hospital settings.
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Affiliation(s)
- Dakari Quimby
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Bridgid M Conn
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tierra T Ellis
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Ellen Iverson
- Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Ekbom K, Lajic S, Falhammar H, Nordenström A. Transition Readiness in Adolescents and Young Adults Living With Congenital Adrenal Hyperplasia. Endocr Pract 2023; 29:266-271. [PMID: 36693541 DOI: 10.1016/j.eprac.2023.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/12/2023] [Accepted: 01/12/2023] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Congenital adrenal hyperplasia (CAH) refers to a group of genetic disorders that affect cortisol biosynthesis and the need for glucocorticoid treatment is lifelong. The complexities of CAH can greatly affect teenage life and the transition from pediatric to adult care. The aim was to assess transition readiness and the impact on quality of life (QoL) as well as medication adherence rates in adolescents and young adults with CAH. METHODS Prospective assessment of transition readiness was conducted through standardized questionnaires for adolescents and young adults (aged 16-35 years). Four open-ended questions on self-care were summarized in adolescents (aged 18-19 years) and their parents. Transition readiness was assessed using a modified CAH specific questionnaire: "Transition preparation and readiness to transfer from pediatric to adult care" with a cutoff level of >25 defined as good transition readiness. Measurement of QoL was performed using Rand 36. Medication adherence rate was measured using the self-reported questionnaire Adherence Starts with Knowledge. RESULTS Thirty-eight adolescents and young adults with CAH were included in the study. Transition readiness was classified as good in 26 (68%) of the participants. Good transition readiness was more frequent in participants with good medication adherence rates. A general linear model analysis showed a good transition readiness affected QoL by increasing QoL scores. CONCLUSION Self-reported transition readiness was found in the majority of adolescents and young adults with CAH. A good medication adherence rate was associated with a better transition readiness and a good transition readiness was associated with increased QoL scores.
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Affiliation(s)
- Kerstin Ekbom
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Department of Paediatric Endocrinology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
| | - Svetlana Lajic
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Department of Paediatric Endocrinology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Henrik Falhammar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Nordenström
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Department of Paediatric Endocrinology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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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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Rhee H, Batek L, Wallace-Farquharson T, Tumiel-Berhalter L. Are Mid to Late Adolescents with Asthma Ready for Transition of Care? A Qualitative Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1573. [PMID: 36291509 PMCID: PMC9600616 DOI: 10.3390/children9101573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/05/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022]
Abstract
This qualitative descriptive study explores experiences and perspectives of mid-to-late adolescents about growing up with asthma, and the roles of parents and providers as they transition. Purposeful sampling was used to recruit and enroll adolescents aged 16-20 years with asthma. Forty-one adolescents participated in a focus group or individual interview, and content analysis was conducted to analyze the data. The mean age of participants was 17.7 years, the majority (56%) of whom were Black. Themes that emerged included concerns about becoming an adult with asthma and its self-management, parental involvement, and communication with providers. Adolescents felt burdened by asthma, few considered becoming adults with asthma, and their future outlook was pessimistic with concerns related to worsening symptoms, inadequacy in symptom self-management and limitations on career choices due to asthma. Deficiencies in self-management were noted, parents still played major roles in adolescents' asthma care, and transition of care was seldom discussed with the providers. Mid-to-late adolescents with asthma are inadequately prepared for transition of care, and parents and providers insufficiently engage adolescents in the preparation. Parent, provider, and adolescent partnership is critical to achieve adolescent readiness for independence in asthma management and to ensure proper asthma care continuity post transition.
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Affiliation(s)
- Hyekyun Rhee
- School of Nursing, University of Texas at Austin, 1710 Red River St., Austin, TX 78712, USA
| | - Lindsay Batek
- School of Nursing, University of Rochester, 601 Elmwood Ave., Box SON, Rochester, NY 14642, USA
| | | | - Laurene Tumiel-Berhalter
- Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, 77 Goodell St., Buffalo, NY 14203, USA
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14
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Abstract
Liver transplantation (LT) for children results in excellent short- and long-term patient and graft survival. LT is a lifesaving procedure in children with acute or chronic liver disease, hepatic tumors, and select genetic metabolic diseases in which it can significantly improve quality of life. In this article, the authors discuss the unique aspects of pediatric LT, including the indications, appropriate patient selection and evaluation, allocation of organs, transplant surgery including the use of variant grafts, posttransplant care including immunosuppression management, prognosis, and transition of care.
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Affiliation(s)
- Sara Kathryn Smith
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Johns Hopkins School of Medicine, 600 N Wolfe Street, Baltimore, MD 21287, USA.
| | - Tamir Miloh
- Department of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Miami, Highland Professional Building, 1801 Northwest 9th Avenue, Miami, FL 33136, USA
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15
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Claahsen - van der Grinten HL, Speiser PW, Ahmed SF, Arlt W, Auchus RJ, Falhammar H, Flück CE, Guasti L, Huebner A, Kortmann BBM, Krone N, Merke DP, Miller WL, Nordenström A, Reisch N, Sandberg DE, Stikkelbroeck NMML, Touraine P, Utari A, Wudy SA, White PC. Congenital Adrenal Hyperplasia-Current Insights in Pathophysiology, Diagnostics, and Management. Endocr Rev 2022; 43:91-159. [PMID: 33961029 PMCID: PMC8755999 DOI: 10.1210/endrev/bnab016] [Citation(s) in RCA: 176] [Impact Index Per Article: 88.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Indexed: 11/19/2022]
Abstract
Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive disorders affecting cortisol biosynthesis. Reduced activity of an enzyme required for cortisol production leads to chronic overstimulation of the adrenal cortex and accumulation of precursors proximal to the blocked enzymatic step. The most common form of CAH is caused by steroid 21-hydroxylase deficiency due to mutations in CYP21A2. Since the last publication summarizing CAH in Endocrine Reviews in 2000, there have been numerous new developments. These include more detailed understanding of steroidogenic pathways, refinements in neonatal screening, improved diagnostic measurements utilizing chromatography and mass spectrometry coupled with steroid profiling, and improved genotyping methods. Clinical trials of alternative medications and modes of delivery have been recently completed or are under way. Genetic and cell-based treatments are being explored. A large body of data concerning long-term outcomes in patients affected by CAH, including psychosexual well-being, has been enhanced by the establishment of disease registries. This review provides the reader with current insights in CAH with special attention to these new developments.
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Affiliation(s)
| | - Phyllis W Speiser
- Cohen Children’s Medical Center of NY, Feinstein Institute, Northwell Health, Zucker School of Medicine, New Hyde Park, NY 11040, USA
| | - S Faisal Ahmed
- Developmental Endocrinology Research Group, School of Medicine Dentistry & Nursing, University of Glasgow, Glasgow, UK
| | - Wiebke Arlt
- Institute of Metabolism and Systems Research (IMSR), College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Department of Endocrinology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Richard J Auchus
- Division of Metabolism, Endocrinology, and Diabetes, Departments of Internal Medicine and Pharmacology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Henrik Falhammar
- Department of Molecular Medicine and Surgery, Karolinska Intitutet, Stockholm, Sweden
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
| | - Christa E Flück
- Pediatric Endocrinology, Diabetology and Metabolism, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Leonardo Guasti
- Centre for Endocrinology, William Harvey Research Institute, Bart’s and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Angela Huebner
- Division of Paediatric Endocrinology and Diabetology, Department of Paediatrics, Universitätsklinikum Dresden, Technische Universität Dresden, Dresden, Germany
| | - Barbara B M Kortmann
- Radboud University Medical Centre, Amalia Childrens Hospital, Department of Pediatric Urology, Nijmegen, The Netherlands
| | - Nils Krone
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Department of Medicine III, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Deborah P Merke
- National Institutes of Health Clinical Center and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD 20892, USA
| | - Walter L Miller
- Department of Pediatrics, Center for Reproductive Sciences, and Institute for Human Genetics, University of California, San Francisco, CA 94143, USA
| | - Anna Nordenström
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Pediatric Endocrinology, Karolinska University Hospital, Stockholm, Sweden
| | - Nicole Reisch
- Medizinische Klinik IV, Klinikum der Universität München, Munich, Germany
| | - David E Sandberg
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI 48109, USA
| | | | - Philippe Touraine
- Department of Endocrinology and Reproductive Medicine, Center for Rare Endocrine Diseases of Growth and Development, Center for Rare Gynecological Diseases, Hôpital Pitié Salpêtrière, Sorbonne University Medicine, Paris, France
| | - Agustini Utari
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Stefan A Wudy
- Steroid Research & Mass Spectrometry Unit, Laboratory of Translational Hormone Analytics, Division of Paediatric Endocrinology & Diabetology, Justus Liebig University, Giessen, Germany
| | - Perrin C White
- Division of Pediatric Endocrinology, UT Southwestern Medical Center, Dallas TX 75390, USA
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16
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Clinical profile and multidisciplinary needs of patients with neuromuscular disorders transitioning from paediatric to adult care. Neuromuscul Disord 2021; 32:206-212. [DOI: 10.1016/j.nmd.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 09/19/2021] [Accepted: 12/08/2021] [Indexed: 11/15/2022]
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17
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Bailey K, Lee S, de Los Reyes T, Lo L, Gorter JW, Toulany A. Quality indicators for transition from paediatric to adult care for adolescents with chronic physical and mental illness: protocol for a systematic review. BMJ Open 2021; 11:e055194. [PMID: 34725083 PMCID: PMC8562538 DOI: 10.1136/bmjopen-2021-055194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Transition from paediatric to adult care is a complex process, which poses significant challenges for adolescents with chronic physical and mental illnesses. For many, transfer to adult care is associated with poor health and psychosocial outcomes. Quality indicators to evaluate transition to adult care are needed to benchmark and compare performance across conditions and health systems. This systematic review aims to identify quality indicators for successful transition to adult care which can be applied across chronic physical and/or mental illnesses. METHODS Published literature will be searched using MEDLINE, Embase and CINHAL from earliest available date to July 2021. Grey literature will be searched using the Grey Matters tool. Using a set of inclusion/exclusion criteria, two independent reviewers will screen titles and abstracts, followed by full-text review. Disagreements will be resolved by a third reviewer. Study selection and data extraction will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Study appraisal will be completed using the Appraisal of Guidelines for Research and Evaluation for Quality Indicators instrument. Extracted quality indicators will be categorised into a conceptual framework. ETHICS AND DISSEMINATION Results from this review will offer novel insights into quality indicators that may be used to measure and evaluate transition success across conditions, which will be disseminated via a Canadian transition collaborative, workshops and peer-reviewed publication. Extracted quality indicators will be further prioritised in a Delphi study with patients, caregivers and providers. This is a critical step in developing a core set of metrics to evaluate transitions to adult care. Ethics approval is not required as this review will identify and synthesise findings from published literature. PROSPERO REGISTRATION NUMBER CRD42020198030.
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Affiliation(s)
- Katherine Bailey
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Lee
- Department of Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Department of Adolescent Medicine, Monash Children's Hospital, Clayton, New South Wales, Australia
| | - Thomas de Los Reyes
- Department of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lisha Lo
- Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
| | - Jan Willem Gorter
- CanChild Centre for Childhood Disability Research, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Alene Toulany
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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18
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Wright S, Conn BM, Shahinian M, Keyllian C, Tanaka D, Iverson E. Finding MyVOICE: A Mixed-Methods Examination of Health Outcomes of Young Adults with Chronic Illness Transitioning from Pediatric to Adult Health Care. J Pediatr Health Care 2021; 35:610-620. [PMID: 34325977 DOI: 10.1016/j.pedhc.2021.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/03/2021] [Accepted: 06/10/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION This study examines health use outcomes of young adults with chronic illness following participation in a transition program and identifies variables that impact outcomes. METHOD A sample of 119 ethnically diverse, low-income young adults (mean age = 21.8 years) was interviewed 6 months post-transition. Chi-square tests and logistic regression analyses examined the relationship between variables and outcomes. Responses to open-ended questions provided context to findings. RESULTS Primary care and insurance linkage were significantly higher for patients enrolled in a fully-formed clinic than patients enrolled early in the clinic's development. Patients with multiple diagnoses reported significantly more hospitalizations and specialty care engagement. Hospitalizations and possession of medical records differed significantly by subspecialty. Visit number predicted hospitalizations after accounting for subspecialty, but not after accounting for the number of conditions. DISCUSSION This study highlights the impact of disease type and severity on post-transition outcomes following participation in a transition program serving socially and medically complex patients.
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Alkawari H. Down Syndrome Children, Malocclusion Characteristics and the Need for Orthodontic Treatment Needs (IOTN): A Cross-Sectional Study. CHILDREN 2021; 8:children8100888. [PMID: 34682153 PMCID: PMC8534961 DOI: 10.3390/children8100888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022]
Abstract
The purpose of the present study was to assess the characteristics of malocclusion and determine the orthodontic treatment needs of a group of children with Down syndrome. The study group comprised 23 children aged 10–14 years with Down syndrome who were attending special schools. A clinical examination was performed to measure several parameters that assessed malocclusion as well as classifications based on the Index of Orthodontic Treatment Need (IOTN-DC). When the dental health component (DHC) of the IOTN-DC was considered, results showed that a high percentage of children involved in the current study needed orthodontic treatment (81.9%). Moreover, 59.1% showed Angle’s class-III malocclusion compared to 36.4% who showed class I. However, the differences between the IOTN-DC values for the boys and girls were not statistically significant (p > 0.05). The present study has concluded that a higher percentage of children, suffering from Down syndrome, had very severe malocclusion; therefore, treatment can be considered mandatory. Similarly, more than three-fourths of the children with Down syndrome had visited a dental clinic at least once during their life. However, 30.4% of the children’s mothers have mentioned that they had not visited any orthodontic clinic. Therefore, there is a need to develop awareness and knowledge among the parents of children suffering from Down syndrome.
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Affiliation(s)
- Huda Alkawari
- Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, Riyadh 4545, Saudi Arabia
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20
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VanZant JS, McCormick AA. Health care transition for individuals with Down syndrome: A needs assessment. Am J Med Genet A 2021; 185:3019-3027. [PMID: 34165882 DOI: 10.1002/ajmg.a.62403] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/28/2021] [Accepted: 06/12/2021] [Indexed: 11/06/2022]
Abstract
Transition to adulthood is a multifaceted process that requires integration of numerous domains within a young person's life, including their health care. For children with special health care needs, the transition process can be markedly more difficult to navigate. This is especially true for children with Down syndrome (DS) who receive fewer transition planning services. The aim of this needs assessment was to identify current trends, potential gaps, and areas for targeted intervention within the current transition landscape for individuals with DS. We utilized DS-Connect, a National Institutes of Health (NIH) funded family/self-advocate survey repository, as a platform to recruit respondents to the "Transition to Adulthood" survey. Sixty-five respondents (64 parents and 1 caregiver) completed the survey. Responses indicated that 42% of respondents reported comfort in the transition process, but 5% or less reported completing one of the core transition outcomes: transition readiness assessment, portable medical summary, or written transition plan. These findings translated across other domains of respondents' lives. While many individuals with DS and their caregivers are aware of the transition process, there appears to be a disconnect between the introduction of transition concepts and an actualization of transition outcomes necessary for success.
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Affiliation(s)
- Jordan Seth VanZant
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Andrew A McCormick
- Down Syndrome Center of Western Pennsylvania, Pittsburgh, Pennsylvania, USA
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21
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Nadarajah A, Dimitropoulos G, Grant C, Webb C, Couturier J. Impending Transition From Pediatric to Adult Health Services: A Qualitative Study of the Experiences of Adolescents With Eating Disorders and Their Caregivers. Front Psychiatry 2021; 12:624942. [PMID: 34122164 PMCID: PMC8187588 DOI: 10.3389/fpsyt.2021.624942] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 04/22/2021] [Indexed: 02/04/2023] Open
Abstract
Background: There is a dearth of research that identifies pediatric to adult health care transition practices that yield positive outcomes for young people with eating disorders (EDs). Further, adolescent and caregiver perspectives are poorly understood and underrepresented in the literature. The purpose of this study, focused on the impending transition from pediatric to adult health services, was twofold: (a) to identify adolescent and caregiver perspectives of barriers and facilitators of a successful transition for adolescents with EDs; and (b) to understand adolescent and caregiver suggestions of interventions for a successful transition. Design/Method: We recruited five adolescents with EDs who were about to be transferred out of pediatric care as well as their caregivers. We conducted a qualitative study in accordance with the principles of interpretive description. Through conducting semi-structured, in-depth interviews with adolescents and caregivers, we investigated their knowledge about health system transitions and anticipated experiences. We identified participants' perceptions of barriers and facilitators regarding a successful transition, as well as their recommendations to improve the transfer of care. Results: Participants possessed a limited understanding of transition processes despite the fact that they were about to be transferred to adult care. From our analyses, the following themes were identified as barriers during the transition process: re-explaining information to adult healthcare providers, lack of professional support while waiting for uptake into the adult health system, and late timing of transition of care discussions. Both adolescents and caregivers expressed that involvement of parents and the pediatric healthcare team helped to facilitate a successful transfer of care. In addition, participants expressed that the implementation of a Transition Coordinator and Transition Passport would be helpful in facilitating a seamless transfer between systems of care. Discussion: These findings demonstrate a significant gap in the system and highlight the importance of developing interventions that facilitate a successful transition. The themes that emerged from this study can inform the development of interventions to facilitate a coordinated transition from pediatric to adult health services for adolescents with EDs.
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Affiliation(s)
| | | | - Christina Grant
- Department of Pediatrics, McMaster Children's Hospital, Hamilton, ON, Canada
| | - Cheryl Webb
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Jennifer Couturier
- Department of Pediatrics, McMaster Children's Hospital, Hamilton, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
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22
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Smoothing the transition of adolescents with CF from pediatric to adult care: Pre-transfer needs. Arch Pediatr 2021; 28:257-263. [PMID: 33863608 DOI: 10.1016/j.arcped.2021.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 09/24/2020] [Accepted: 03/16/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION In France, the cystic fibrosis (CF) care pathway is performed in 45 CF centers, the life expectancy of patients has steadily increased, but to date there are no national recommendations for the transition from pediatric to adult care. The transition to an adult CF center still raises questions about the relevance of its organizational arrangements. The "SAFETIM need" study aimed to identify the organizational needs both of patients and of parents before the transfer to an adult CF center. METHODS This was a prospective, observational, multicenter study conducted between July 2017 and December 2018, involving the three CF centers of a regional network in southeastern France. Each adolescent registered with the center and his or her parents were interviewed individually, on the same day, during the 6 months leading up to transfer. They participated in semi-structured interviews during one of their routine consultations at the CF center. The interview manual, based on literature reviews and targeting national recommendations, was tested and validated by the national CF therapeutic education group (GETheM). All interviews were transcribed and checked by two different people, and analyzed by two researchers individually. The results were classified by topic according to content categorization. RESULTS Overall, 43 adolescents and 41 parents were interviewed, respectively, who were followed up by CF centers: 14% (n=6) in a mixed CF center (pediatric and adult); 19% (n=8) and 67% (n=29), respectively, in two different pediatric CF centers. Adolescents were between 16 and 19 years old. For adolescents, the average interview time was 5.11min. (standard deviation [SD]: 3.8min; minimum: 2.53min; maximum: 17.14min). For parents, the average interview time was 7.99min (SD: 3.56min, minimum: 3.43min; maximum: 22.50min). DISCUSSION Our study enquired only about the preparation and organization of the transfer. We identified three areas of actions matching the needs of adolescents and parents before transfer. The first one is to anticipate team change to prepare follow-up in their future CF center: acquire new skills, consider the future CF center according to the adolescent's curriculum, be involved in the transition process. The second area is to accompany the upcoming change. The care team could help by providing information and support during the start of teenagers' transition toward autonomy. And parents were aware that the CF center change will reverse roles. They must provide their own knowledge and manage the ambivalence of this as well as letting go. The third one is to announce the transition process and functioning of the future adult CF center, because the transition would require time to find their place (patients and parents) with the new team. CONCLUSION The "SAFETIM needs" pre-transfer study results show that we can identify the main criteria to be developed and strengthened, to promote a smooth, high-quality transition from pediatric to adult CF care for patients in France. For most patients, the transition cannot be prepared at the last minute. Caregivers need to develop specific skills in adolescent and young adult care and follow-up. Each team must consider the transition as a normal part of the patient care cycle. While it must be structured, some flexibility must be allowed so as to give everyone the chance to be prepared and to personalize the care.
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Semalulu T, McColl J, Alam A, Thomas S, Herrington J, Gorter JW, Cellucci T, Garner S, Heale L, Matsos M, Beattie KA, Batthish M. The transition from pediatric to adult rheumatology care through creating positive and productive patient-provider relationships: an opportunity often forgotten. JOURNAL OF TRANSITION MEDICINE 2021. [DOI: 10.1515/jtm-2021-0001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
The transition of patients with a chronic rheumatic disease from pediatric to adult care has been characterized by poor medical and patient-centered outcomes due to the lack of comprehensive transition programs and the paucity of evidence to guide practitioners. We describe a multidisciplinary transition program, data assessing patients’ preparedness for transition and perception of care providers, and the association between these outcomes.
Content
Patients aged 14–19 with childhood-onset systemic lupus erythematosus (cSLE) or juvenile idiopathic arthritis (JIA) were recruited from Rheumatology Transition Clinics and Young Adult Clinics at a single institution. Participants completed the TRANSITION-Q, which assesses healthcare self-management skills as a proxy for transition readiness, and the Consultation and Relational Empathy Scale (CARE) questionnaire, which measures patients’ perception of their providers’ care and empathy.
Summary
Among 63 participants, 87% had JIA (mean age 16.5 years). Age was the only patient characteristic positively associated with TRANSITION-Q scores. CARE scores revealed overwhelmingly positive interactions between patients and healthcare team members. TRANSITION-Q and CARE scores were positively correlated.
Outlook
The transition from pediatric to adult rheumatology care should be recognized as an opportunity to impact the trajectories of patients entering adult care where the patient-provider relationship may play an important role.
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Affiliation(s)
- Teresa Semalulu
- Division of Rheumatology, Department of Medicine , McMaster University , Hamilton , Canada
| | - Jeanine McColl
- Department of Pediatrics , McMaster University , Hamilton , Canada
| | | | | | - Julie Herrington
- Division of Rheumatology , Department of Pediatrics , McMaster University , Hamilton , Canada
| | - Jan Willem Gorter
- Department of Pediatrics and Director of CanChild Centre for Childhood Disability Research, Division of Physical Medicine and Rehabilitation, McMaster University , Hamilton , Canada
| | - Tania Cellucci
- Division of Rheumatology , Department of Pediatrics , McMaster University , Hamilton , Canada
| | - Stephanie Garner
- Division of Rheumatology, Department of Medicine , McMaster University , Hamilton , Canada
| | - Liane Heale
- Division of Rheumatology , Department of Pediatrics , McMaster University , Hamilton , Canada
| | - Mark Matsos
- Division of Rheumatology, Department of Medicine , McMaster University , Hamilton , Canada
| | - Karen A. Beattie
- Division of Rheumatology, Department of Medicine , McMaster University , Hamilton , Canada
| | - Michelle Batthish
- Division of Rheumatology , Department of Pediatrics , McMaster University , Hamilton , Canada
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Chisolm DJ, Keedy HE, Dolce M, Chavez L, Abrams MA, Sanders L. Do health literacy disparities explain racial disparities in family-centered care for youths with special health care needs? PATIENT EDUCATION AND COUNSELING 2021; 104:887-895. [PMID: 32994106 PMCID: PMC7997812 DOI: 10.1016/j.pec.2020.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 09/09/2020] [Accepted: 09/15/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To explore the relationship among youth health literacy, parental health literacy, and family-centered care (FCC) for youth with special health care needs (YSHCN) and assess potential racial disparities. METHODS HL and FCC were assessed in 486 Medicaid-enrolled YSHCN (ages 12-18) and their healthcare-responsible parent/caregiver. Analyses assessed racial differences in HL and FCC for parents and youth using logistic regression. RESULTS Half of youth and over 80 percent of parents had adequate HL (REALM score ≥62). Adequate HL was significantly lower in African Americans (AA) for both YSHCN and parents. Only 57 % of parents and 29 % of YSHCN reported FCC. AA YSHCN reported significantly lower levels of FCC compared to White YSHCN. AA parents trended lower for FCC compared to Whites, though the disparity was not significant. AA youth and parents had significantly lower odds of reporting that doctors spent enough time with them compared to Whites. CONCLUSION Results suggest that AA and those with less than adequate health literacy experience lower FCC, however the relationship between race and health literacy does not explain the racial disparity in FCC. PRACTICAL IMPLICATIONS Provider time spent focused on HL may not reduce the racial disparity in FCC, but opportunities for improvement exist.
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Affiliation(s)
- Deena J Chisolm
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA; Division of Health Services Management and Policy, The Ohio State University, Columbus, OH, USA.
| | - Hannah E Keedy
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
| | - Millie Dolce
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
| | - Laura Chavez
- The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
| | - Mary Ann Abrams
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA.
| | - Lee Sanders
- Department of Pediatrics, Stanford University, Palo Alto, CA, USA.
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Tye SK, Kandavello G, Wan Ahmadul Badwi SA, Abdul Majid HS. Challenges for Adolescents With Congenital Heart Defects/Chronic Rheumatic Heart Disease and What They Need: Perspectives From Patients, Parents and Health Care Providers at the Institut Jantung Negara (National Heart Institute), Malaysia. Front Psychol 2021; 11:481176. [PMID: 33584393 PMCID: PMC7873049 DOI: 10.3389/fpsyg.2020.481176] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 12/16/2020] [Indexed: 11/29/2022] Open
Abstract
Objectives This study aimed to describe the experiences and challenges faced by adolescents with moderate and severe congenital heart defects (CHD) or Chronic Rheumatic Heart Disease (CRHD) and to determine their needs in order to develop an Adolescent Transition Psychoeducational Program. Methods The study involved seven adolescents with moderate to severe CHD/CRHD, six parents, and four health care providers in Institute Jantung Negara (National Heart Institute). Participants were invited for a semi-structured interview. Qualitative data were analyzed through the Atlas.ti 7 program using triangulation methods. Results/conclusions We identified five themes concerning the experience and challenges of adolescents relating to: (1) emotional/psychological issues; (2) the progress of the illness; (3) relationship issues; (4) future preparation; and, (5) school and community. These themes were identified together with eleven subcategories. The staff expressed support for the development of the Adolescent Transition Psychoeducational Program and adolescents with CHD/CRHD and their parents were willing to participate in the program if their schedule allowed. Their suggestions to improve the program were classified into six categories, with two main themes, (1) the self-management of illness in life and the future; and, (2) social support. In conclusion, the findings from the situation analysis act as a basis for a conceptual framework that will contribute to the development of an Adolescent Transition Psychoeducational Program that aims to empower adolescents with CHD/CRHD, enabling them to manage challenges during the transition phase between childhood and adulthood.
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Affiliation(s)
- Sue Kiat Tye
- Department of Psychology, International Islamic University Malaysia, Selayang, Malaysia.,Institut Jantung Negara (National Heart Institute), Kuala Lumpur, Malaysia
| | - Geetha Kandavello
- Institut Jantung Negara (National Heart Institute), Kuala Lumpur, Malaysia
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Yu JA, McKernan G, Hagerman T, Schenker Y, Houtrow A. Most Children With Medical Complexity Do Not Receive Care in Well-Functioning Health Care Systems. Hosp Pediatr 2021; 11:183-191. [PMID: 33408158 PMCID: PMC7831373 DOI: 10.1542/hpeds.2020-0182] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To describe the access of children with medical complexity (CMC) to well-functioning health care systems. To examine the relationships between medical complexity status and this outcome and its component indicators. PATIENTS AND METHODS Secondary analysis of children in the National Survey of Children's Health combined 2016-2017 data set who received care in well-functioning health systems. Secondary outcomes included this measure's component indicators. The χ2 analyses were used to examine associations between child and family characteristics and the primary outcome. Adjusted multivariable logistic regression was used to examine relationships between medical complexity status and primary and secondary outcomes. Using these regression models, we examined the interaction between medical complexity status and household income. RESULTS CMC accounted for 1.6% of the weighted sample (n = 1.2 million children). Few CMC (7.6%) received care in a well-functioning health care system. CMC were significantly less likely than children with special health care needs (CSHCN) (odds ratio, 0.3) of meeting criteria for this primary outcome. Attainment rates for secondary outcomes (families feeling like partners in care; receives care within a medical home; received needed health care) were significantly lower among CMC than CSHCN. Family income was significantly associated with likelihood of meeting criteria for primary and secondary outcomes; however, the relationships between medical complexity status and our outcomes did not differ by income level. CONCLUSIONS CMC are less likely than other CSHCN to report receiving care in well-functioning health care systems at all income levels. Further efforts are necessary to better adapt current health care systems to meet the unique needs of CMC.
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Affiliation(s)
- Justin A Yu
- Divisions of Pediatric Hospital Medicine and Palliative and Supportive Care,
- Departments of Pediatrics and
| | - Gina McKernan
- Physical Medicine and Rehabilitation
- Department of Physical Medicine and Rehabilitation, Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Health Care System, Pittsburgh, Pennsylvania
| | - Thomas Hagerman
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
| | - Yael Schenker
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, and
| | - Amy Houtrow
- Division of Pediatric Rehabilitation Medicine, Department of Physical Medicine and Rehabilitation
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Fremion E, Madey R, Staggers KA, Morrison-Jacobus M, Laufman L, Castillo H, Castillo J. Factors associated with self-management independence and quality of life for adolescents and young adults with spina bifida engaged in a guideline-based transition clinic. J Pediatr Rehabil Med 2021; 14:631-641. [PMID: 34657852 DOI: 10.3233/prm-200758] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To determine characteristics associated with self-management independence and quality of life (QOL) among adolescents and young adults with spina bifida (AYASB) engaged in a spina bifida (SB) health care transition clinic. METHODS During SB transition visits, Eighty-eight AYASB ages 14-20 completed the Adolescent/Young Adult Self-management and Independence Scale II Self-Report/SB (AMIS II-SR/SB), scores ranging from 1-7 with 7 indicating full independence in activities, and the QUAlity of Life Assessment in Spina bifida for Teens (QUALAS-T), which has two subscales, family/independence (QFI) and bowel/bladder (QBB), with scores ranging from 0-100 with 100 indicating maximal QOL score. Demographic and clinical variables were collected from the electronic medical record. RESULTS The baseline AMIS II-SR/SB score was 3.3 (SD 1.0). Baseline scores for QUALAS-T QFI and QBB subscales were 73.8 (SD 19.9) and 63.8 (SD 25.8). Older age was associated with a higher baseline AMIS II-SR/SB score (p = 0.017). Over time, AMIS II-SR/SB total significantly improved (p < 0.001), but QFI and QBB did not. AYASB not on chronic intermittent catheterization (CIC) and those using urethral CIC significantly improved in AMIS II-SR/SB total scores (p = 0.001), but those using abdominal channel CIC did not. CONCLUSION Baseline bladder management method was associated with self-management improvement for AYASB engaged in a SB-specific transition clinic.
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Affiliation(s)
- Ellen Fremion
- Transition Medicine, Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA.,Spina Bifida Transition Clinic, Texas Children's Hospital, Houston, TX, USA
| | | | - Kristen A Staggers
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | | | - Larry Laufman
- Transition Medicine, Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Heidi Castillo
- Developmental Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Jonathan Castillo
- Developmental Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
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28
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Sarkar M, Brady CW, Fleckenstein J, Forde KA, Khungar V, Molleston JP, Afshar Y, Terrault NA. Reproductive Health and Liver Disease: Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 2021; 73:318-365. [PMID: 32946672 DOI: 10.1002/hep.31559] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/08/2020] [Indexed: 12/11/2022]
Affiliation(s)
- Monika Sarkar
- University of California, San Francisco, San Francisco, CA
| | | | | | | | | | - Jean P Molleston
- Indiana University and Riley Hospital for Children, Indianapolis, IN
| | - Yalda Afshar
- University of California, Los Angeles, Los Angeles, CA
| | - Norah A Terrault
- Keck School of Medicine, University of Southern California, Los Angeles, CA
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29
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Jarvis SW, Roberts D, Flemming K, Richardson G, Fraser LK. Transition of children with life-limiting conditions to adult care and healthcare use: a systematic review. Pediatr Res 2021; 90:1120-1131. [PMID: 33654285 PMCID: PMC8671088 DOI: 10.1038/s41390-021-01396-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Improved survival has led to increasing numbers of children with life-limiting conditions transitioning to adult healthcare services. There are concerns that transition may lead to a reduction in care quality and increases in emergency care. This review explores evidence for differences in health or social care use post- versus pre-transition to adult services. METHODS MEDLINE, EMBASE, CINAHL, PsychINFO and Social Science Citation Index were searched. Studies published in English since 1990 including individuals with any life-limiting condition post- and pre-transition and reporting a health or social care use outcome were included. Data were extracted and quality assessed by one reviewer with 30% checked by an independent reviewer. RESULTS Nineteen papers (18 studies) met the inclusion criteria. There was evidence for both increases and decreases (post- versus pre-transition) in outpatient attendance, inpatient admissions, inpatient bed days and health service costs; for increases in Emergency Department visits and for decreases in individuals receiving physiotherapy. CONCLUSIONS Evidence for changes in healthcare use post- versus pre-transition is mixed and conflicting, although there is evidence for an increase in Emergency Department visits and a reduction in access to physiotherapy. More high-quality research is needed to better link changes in care to the transition. IMPACT Evidence for changes in healthcare use associated with transition to adult services is conflicting. Emergency Department visits increase and access to physiotherapy decreases at transition. There are marked differences between care patterns in the United States and Canada.
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Affiliation(s)
- Stuart W. Jarvis
- grid.5685.e0000 0004 1936 9668Martin House Research Centre, University of York, York, UK
| | - Daniel Roberts
- grid.413991.70000 0004 0641 6082Leeds Children’s Hospital, Leeds, UK
| | - Kate Flemming
- grid.5685.e0000 0004 1936 9668Department of Health Sciences, University of York, York, UK
| | - Gerry Richardson
- grid.5685.e0000 0004 1936 9668Centre for Health Economics, University of York, York, UK
| | - Lorna K. Fraser
- grid.5685.e0000 0004 1936 9668Martin House Research Centre, University of York, York, UK
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30
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Abstract
Without a structure to address healthcare transition, adolescents and young adults with neurological disorders are likely to have disruptions in their care that result in a higher need for emergency care and hospitalization. There are numerous obstacles to implementing the existing transition guidelines: adequate numbers of skilled and willing adult providers, patient and family anxiety about transfer, changes in health insurance, inadequate reimbursement, and inefficient communication systems to pave the path for a smooth transition. The aim of this article is to provide practical information about developing a transition program, as well as a potential clinical model for transitioning care.
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Affiliation(s)
- Mary L Zupanc
- Department of Neurology and Pediatrics, Pediatric Comprehensive Epilepsy Program, University of California-Irvine, Children's Hospital of Orange County, Orange, CA..
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31
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Fortune J, Murphy P, Merchant N, Kerr C, Kroll T, Walsh A, Norris M, Lavelle G, Ryan J. Transition from child-centred to adult-oriented healthcare systems for young people with neurodisability: a scoping review protocol. HRB Open Res 2020; 3:61. [PMID: 33215059 PMCID: PMC7656277 DOI: 10.12688/hrbopenres.13095.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2020] [Indexed: 12/15/2022] Open
Abstract
Background: The transition from child-centred to adult-oriented healthcare is a challenging time for young people with neurodisability. As the prevalence of neurodisability increases, greater numbers of young people will eventually transfer to the adult healthcare system. While there is a growing recognition of the importance of providing quality, transitional care, little is known about how to manage and optimise this process for young people with neurodisability. The objective of this scoping review is to examine and map existing literature related to the transition from child-centred to adult-oriented healthcare systems for young people with neurodisability. Methods: Systematic literature searches of OVID MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane Library and Web of Science will be conducted from inception to present. A structured iterative search of grey literature will be conducted. This review will consider all study designs examining the transition from child to adult health services in neurodisability. Two reviewers will independently screen each retrieved title and abstract and assess full-text articles against the inclusion criteria to determine eligibility. Data will be extracted and synthesised quantitatively and qualitatively. The process and reporting will follow PRISMA-ScR guidelines. Conclusion: This review will provide a broad and systematically mapped synthesis of the extent and nature of the available published and unpublished literature on transition from child-centred to adult-oriented healthcare systems in neurodisability. The results will be used to determine gaps in the current evidence base in order to prioritise areas for future research.
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Affiliation(s)
- Jennifer Fortune
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Paul Murphy
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Nabil Merchant
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire Kerr
- Queen's University Belfast, Belfast, Northern Ireland, UK
| | | | - Aisling Walsh
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | | | - Jennifer Ryan
- RCSI University of Medicine and Health Sciences, Dublin, Ireland.,Brunel University London, London, England, UK
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32
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Seaborg K, Wang X, Olson C, Felton EA. Pediatric to Adult Transitions of Ketogenic Dietary Therapy for Epilepsy. J Child Neurol 2020; 35:896-900. [PMID: 32698640 PMCID: PMC9927826 DOI: 10.1177/0883073820938587] [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] [Indexed: 11/16/2022]
Abstract
Ketogenic therapy is now an accepted treatment for pediatric and adult patients with medically refractory epilepsy.1-3 However, young adults treated with a ketogenic diet face unique challenges when transitioning to adult neurology providers.4 The variable acceptance of dietary therapy, paucity of nutritionists and adult neurology providers educated in dietary therapy, and lack of insurance coverage for dietary education may interfere with transition to adult care. In addition, patients in this life stage may just begin to independently seek medical care, cook meals, and manage medications, making strict dietary limitations difficult.4 In this worldwide study, we surveyed 191 pediatric and adult neurology providers who prescribe ketogenic dietary therapy for epilepsy. Our response rate was 39% with a total of 74 valid surveys received. Our goal was to identify perceived barriers that inhibit effective transition and successful continuation of dietary therapy during transition to adult care. We found that dietary therapy is a more accepted treatment of intractable epilepsy in children (84%) than adults (17%) in all geographic areas. Although half of pediatric neurology providers (50%) transition their young adult patients on dietary therapy to adult providers, only 23% have a documented transition plan or a formal transition protocol. Most (87%) pediatric providers who prescribe the ketogenic diet feel the lack of sufficient adult providers who prescribe dietary therapy as a barrier to transitioning adolescent and young adult patients.
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Affiliation(s)
- Kristin Seaborg
- Department of Neurology, University of Wisconsin–Madison, Madison, WI, USA
| | - Xing Wang
- Department of Biostatistics and Medical Informatics, University of Wisconsin–Madison, Madison, WI, USA
| | - Clara Olson
- University of Wisconsin–Madison, Madison, WI, USA
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Le Roux E, Mellerio H, Jacquin P, Bourmaud A, Guilmin-Crépon S, Faye A, Matheron S, Boulkedid R, Alberti C. Practical generic guidelines for paediatric-to-adult transition for adolescents with chronic disease. Eur J Public Health 2020; 29:442-448. [PMID: 30535247 DOI: 10.1093/eurpub/cky258] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The last 20 years have seen many attempts to improve transition to adult healthcare for adolescents with chronic disease, but there is currently no established consensus on generic practices. Our goal was to identify relevant and pragmatic guidelines for transition practice for each step of this process (before, during and after transfer), applicable to a wide range of chronic illnesses and health services, via a participatory approach involving all the key stakeholders. METHODS We conducted interviews and a literature review to elaborate a questionnaire for use in an online 2-round Delphi survey. The survey panel included 36 French health and social professionals from different care settings, and young adults and parents with an experience of healthcare transition related to all types of chronic disease. RESULTS The survey consensus identified 19 items on feasibility and relevance criteria, which form the guidelines. It is composed of five practices to be adopted during preparation in paediatrics, seven practices in the active phase of transition and seven in adult care. Two guidelines achieved complete consensus: having a longer consultation for the first appointment with the adult doctor, and keeping the same adult doctor throughout follow-up. A further 36 items met the criterion of relevance, but were deemed unfeasible. CONCLUSIONS Taking into account all stakeholder views and the real-world applicability of care practices enabled us to elaborate consensual guidelines whose implementation requires no additional health service resources.
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Affiliation(s)
- Enora Le Roux
- Unité ECEVE UMR 1123, Université Paris Diderot-Sorbonne Paris Cité, INSERM, Paris, France
| | - Hélène Mellerio
- Unité ECEVE UMR 1123, Université Paris Diderot-Sorbonne Paris Cité, INSERM, Paris, France
| | - Paul Jacquin
- Service de Médecine de l'Adolescent, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
| | - Aurélie Bourmaud
- Unité ECEVE UMR 1123, Université Paris Diderot-Sorbonne Paris Cité, INSERM, Paris, France.,CIC-EC, Unité INSERM CIC 1426, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
| | - Sophie Guilmin-Crépon
- Unité ECEVE UMR 1123, Université Paris Diderot-Sorbonne Paris Cité, INSERM, Paris, France.,CIC-EC, Unité INSERM CIC 1426, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
| | - Albert Faye
- Unité ECEVE UMR 1123, Université Paris Diderot-Sorbonne Paris Cité, INSERM, Paris, France.,Service de Pédiatrie Générale, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
| | - Sophie Matheron
- Unité IAME UMR 1137, Université Paris Diderot-Sorbonne Paris Cité, INSERM, Paris, France.,Service des Maladies Infectieuses et Tropicales, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France
| | - Rym Boulkedid
- Unité ECEVE UMR 1123, Université Paris Diderot-Sorbonne Paris Cité, INSERM, Paris, France.,CIC-EC, Unité INSERM CIC 1426, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
| | - Corinne Alberti
- Unité ECEVE UMR 1123, Université Paris Diderot-Sorbonne Paris Cité, INSERM, Paris, France.,CIC-EC, Unité INSERM CIC 1426, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
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Jones GL, Hickam T, Wellman C, Modrcin A, Abdelmoity A, Le Pichon JB. Transition to Adult Care in Youth with Epilepsy: One Center's Experience with a Transition Program and Its Integration within Telemedicine. JOURNAL OF PEDIATRIC EPILEPSY 2020. [DOI: 10.1055/s-0040-1716826] [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
AbstractNeurology patients often have disorders that require life-long care and ongoing treatment. The transition of pediatric neurology patients to adult neurology care, particularly in epilepsy, is an evolving concept that is recognized as important for patients and families. Children's Mercy Hospital, Kansas City has an established transition program that has been integrated into the neurology clinic as a part of standard care. Our experience and utilization of a transition program has provided our patients with a unique opportunity, empowering them to navigate their own care and create a seamless transition to adult neurology. Through a collaboration with the American Academy of Pediatrics and the Department of Health Resources and Services Administration, we have proposed a practice model designed to create a medical home for children and youth with epilepsy in rural underserved areas of Kansas. One of the core end points of this study is transition of care for youth with epilepsy using telemedicine. In this article, we describe our experience with a transition program for epilepsy patients and describe the very early implementation of this program to a telemedicine transition program designed for underserved rural populations.
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Affiliation(s)
- Gina L. Jones
- Department of Pediatric Neurology, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Teresa Hickam
- Transition Program, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Courtney Wellman
- Neurology Clinic, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Ann Modrcin
- Department of Pediatric Rehabilitation, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Ahmed Abdelmoity
- Department of Pediatric Neurology, Children's Mercy Hospital, Kansas City, Missouri, United States
| | - Jean-Baptiste Le Pichon
- Department of Pediatric Neurology, Children's Mercy Hospital, Kansas City, Missouri, United States
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35
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Cheak-Zamora N, Petroski G, La Manna A, Beversdorf D, Farmer J. Validation of the Health-Related Independence for Young Adults with Autism Spectrum Disorder Measure- Caregiver Version. J Autism Dev Disord 2020; 51:2036-2046. [PMID: 32892234 DOI: 10.1007/s10803-020-04690-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Little is known about Young adults with Autism Spectrum Disorder (YA-ASD) health, healthcare and safety needs. This study describes the validation of a health care transition measure for YA-ASD, the Health-Related Independence (HRI). We collected data from caregivers (n = 490) at five Autism Treatment Network sites and compared the psychometric properties of HRI to the gold standard (STARx) and other validated measures. A Confirmatory Factor Analysis and item culling resulted in 30 items addressing six subscales. Content, criterion, and construct validity and internal consistency indicated high validity and reliability for the scale and subscales. HRI is a validated caregiver-report measure of YA-ASD's self-management, safety, and transition skills. This novel measure will be a useful tool in clinics, intervention development, and research.
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Affiliation(s)
- Nancy Cheak-Zamora
- Department of Health Professions, School of Health Professions, University of Missouri, 510 Clark Hall, Columbia, MO, 65211, USA.
| | - Greg Petroski
- Department of Health Management and Informatics, School of Medicine, University of Missouri, Columbia, USA
| | - Anna La Manna
- Department of Social Work, University of Missouri, Columbia, USA
| | - David Beversdorf
- Department of Radiology, Neurology and Psychology, School of Medicine, University of Missouri, Columbia, USA
| | - Janet Farmer
- School of Health Professions, University of Missouri, Columbia, USA
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36
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Barrio Cortes J, Suárez Fernández C, Bandeira de Oliveira M, Muñoz Lagos C, Beca Martínez MT, Lozano Hernández C, del Cura González I. Chronic diseases in the paediatric population: Comorbidities and use of primary care services. An Pediatr (Barc) 2020. [DOI: 10.1016/j.anpede.2019.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Miyoshi Y, Yorifuji T, Shimizu C, Nagasaki K, Kawai M, Ishiguro H, Okada S, Kanno J, Takubo N, Muroya K, Ito J, Horikawa R, Yokoya S, Ozono K. A nationwide questionnaire survey targeting Japanese pediatric endocrinologists regarding transitional care in childhood, adolescent, and young adult cancer survivors. Clin Pediatr Endocrinol 2020; 29:55-62. [PMID: 32313373 PMCID: PMC7160455 DOI: 10.1297/cpe.29.55] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 01/20/2020] [Indexed: 11/25/2022] Open
Abstract
Existing guidelines recommend long-term follow-up of childhood cancer survivors (CCS).
However, in Japan, transitional care for CCS has not been established. To ascertain the
current status in Japan, and to cultivate a better understanding, a questionnaire survey
was conducted on transitional care in CCS, and adolescent and young adult (AYA) cancer
survivors. Questionnaires were distributed to 183 councilors (137 institutions) of the
Japanese Society for Pediatric Endocrinology. A total of 131 responses, representative of
174 councilors, were obtained. The response rate was 95%. Among the respondents, 91% had
experience in medical care for cancer patients, while 63% had experience in transitional
care; however, the number of patients referred to adult clinics was small. Further, 89%
acknowledged the availability of adult endocrinologists who were willing to accept these
patients; although their numbers were insufficient. Pediatric endocrinologists highlighted
difficulties in medical examinations concerning infertility, obesity, pregnancy/delivery,
and gonadal dysfunction, in that order. Staff and time shortages were listed as some of
the challenges faced by medical staff, while multisystem morbidity was listed for
patients. This nationwide questionnaire survey revealed that Japanese pediatric
endocrinologists require cooperation between related departments and collaborative
infrastructure to develop transitional care for cancer survivors.
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Affiliation(s)
- Yoko Miyoshi
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan.,Childhood Cancer Survivor Committee of the Japanese Society for Pediatric Endocrinology
| | - Tohru Yorifuji
- Childhood Cancer Survivor Committee of the Japanese Society for Pediatric Endocrinology.,Division of Pediatric Endocrinology and Metabolism, Children's Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Chikako Shimizu
- Department of Breast and Medical Oncology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Keisuke Nagasaki
- Childhood Cancer Survivor Committee of the Japanese Society for Pediatric Endocrinology.,Division of Pediatrics, Department of Homeostatic Regulation and Development, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masanobu Kawai
- Childhood Cancer Survivor Committee of the Japanese Society for Pediatric Endocrinology.,Department of Pediatric Gastroenterology, Nutrition and Endocrinology, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Hiroyuki Ishiguro
- Childhood Cancer Survivor Committee of the Japanese Society for Pediatric Endocrinology.,Department of Pediatrics, Isehara Kyodo Hospital, Kanagawa, Japan
| | - Satoshi Okada
- Childhood Cancer Survivor Committee of the Japanese Society for Pediatric Endocrinology.,Department of Pediatrics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Junko Kanno
- Childhood Cancer Survivor Committee of the Japanese Society for Pediatric Endocrinology.,Department of Pediatrics, Tohoku University Hospital, Sendai, Japan
| | - Noriyuki Takubo
- Childhood Cancer Survivor Committee of the Japanese Society for Pediatric Endocrinology.,Department of Pediatrics, Juntendo University Hospital, Tokyo, Japan
| | - Koji Muroya
- Childhood Cancer Survivor Committee of the Japanese Society for Pediatric Endocrinology.,Department of Endocrinology and Metabolism, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Junko Ito
- Childhood Cancer Survivor Committee of the Japanese Society for Pediatric Endocrinology.,Department of Pediatrics, Toranomon Hospital, Tokyo, Japan
| | - Reiko Horikawa
- Childhood Cancer Survivor Committee of the Japanese Society for Pediatric Endocrinology.,Division of Endocrinology and Metabolism, National Center for Child Health and Development, Tokyo, Japan
| | - Susumu Yokoya
- Childhood Cancer Survivor Committee of the Japanese Society for Pediatric Endocrinology.,Thyroid and Endocrine Center, Fukushima Medical University, Fukushima, Japan
| | - Keiichi Ozono
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
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Improving Care Transitions to Drive Patient Outcomes: The Triple Aim Meets the Four Pillars. Prof Case Manag 2020; 24:297-305. [PMID: 31580296 DOI: 10.1097/ncm.0000000000000387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of this article is to examine how case managers can support positive outcomes during care transitions by focusing on the goals of the Triple Aim () and Coleman's Four Pillars (). Case managers can play a pivotal role to ensure high-quality transitions by assessing patients and identifying those who are at high risk; coordinating care and services among providers and settings; reconciling medications; and facilitating education of patients and their support systems to improve self-management. These activities are congruent with an underlying value of case management as defined by the Code of Professional Conduct for Case Managers: "improving client [i.e., patient] health, wellness and autonomy through advocacy, communication, education, identification of service resources, and service facilitation" (). CASE MANAGEMENT PRIMARY PRACTICE SETTINGS Case managers across health or human services must assess for, identify, and understand the vulnerability of patients during care transitions and must adopt best practices to support successful care transitions. This includes case managers in acute care, primary care, rehabilitation, home health, community-based, and other settings. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE Two frameworks that support care transitions are the Triple Aim of improving the individual's experience of care, advancing the health of populations, and reducing the costs of care (), and Coleman's "Four Pillars" of care transition activities of medication management, patient-centered health records, follow-up visits with providers and specialists, and patient knowledge about red flags that indicate worsening conditions or drug reactions (). From a case management perspective, these approaches and their goals are interrelated. As an advocate for the individual and at the hub of the care team, the professional case manager engages in important activities such as facilitating communication across multiple providers and care settings, arranging "warm handoffs," undertaking medication reconciliation, and engaging in follow-up, particularly with high-risk patients. To support successful transitions of care, case managers must adopt best practices and advocate within their organizations for systematic approaches to care transitions to improve outcomes.
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Barrio Cortes J, Suárez Fernández C, Bandeira de Oliveira M, Muñoz Lagos C, Beca Martínez MT, Lozano Hernández C, Del Cura González I. [Chronic diseases in the paediatric population: Comorbidities and use of primary care services]. An Pediatr (Barc) 2020; 93:183-193. [PMID: 32178966 DOI: 10.1016/j.anpedi.2019.12.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 12/04/2019] [Accepted: 12/17/2019] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Adjusted morbidity groups (AMG) are being used in the stratification of chronic patients in Primary Care (PC). The aim of this study was to describe the characteristics, prevalence of comorbidities, and use of PC services by chronic paediatric patients as well as to analyse factors associated with the weight of complexity according to AMG. PATIENTS AND METHODS A cross-sectional study conducted on patients <18 years-old from a basic health area, classified as chronic according to the AMG of the Madrid Primary Care computerised clinical records. Sociodemographic and clinical-care variables were collected, as well as the use of services in PC. Univariate, bivariate and linear regression analysis were performed. RESULTS A total of 2,961 patients<18 years were included, of whom 423 (15.7%) were identified as chronic, and 408 (96.5%) were low risk patients. Their mean age was 9.5 (SD=4.7) years, and 54.1% were male. The mean of chronic diseases was 1.1 (SD=0.4) and 11.3% had multiple morbidity. The most prevalent diseases were asthma (6.1%), attention deficit hyperactivity disorder (ADHD) (1.8%), and obesity (1.4%). The mean number of visits to the paediatrician was 4.9 (SD=6.3). Age<5 years-old (Coefficient B [CB]=2.6, 95% CI=2.1, 3.1), number of chronic diseases (CB=1.6, 95% CI=1.1; 2.1), and annual contacts with PC (CB=0.1, 95% CI=0.06; 0.11) were associated with greater complexity weight. CONCLUSIONS A significant number of patients with chronic diseases were found in the paediatric population. The most prevalent diseases were asthma, ADHD, and obesity. The use of PC services was high. The greatest complexity corresponded to nursing and pre-school age, multiple morbidity, and higher number of contacts with PC.
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Affiliation(s)
- Jaime Barrio Cortes
- Programa de Doctorado en Medicina y Cirugía, Universidad Autónoma de Madrid, Madrid, España; Unidad de Apoyo a la Investigación, Gerencia Asistencial de Atención Primaria, Madrid, España.
| | - Carmen Suárez Fernández
- Servicio de Medicina Interna, Hospital Universitario de la Princesa, Madrid, España; Departamento de Medicina, Universidad Autónoma de Madrid, Madrid, España
| | | | | | - María Teresa Beca Martínez
- Servicio de Medicina Preventiva, Hospital Virgen de la Salud, Complejo Hospitalario de Toledo, Toledo, España
| | - Cristina Lozano Hernández
- Unidad de Apoyo a la Investigación, Gerencia Asistencial de Atención Primaria, Madrid, España; Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Madrid, España
| | - Isabel Del Cura González
- Unidad de Apoyo a la Investigación, Gerencia Asistencial de Atención Primaria, Madrid, España; Red de Investigación en Servicios Sanitarios en Enfermedades Crónicas (REDISSEC), Madrid, España; Área de Medicina Preventiva y Salud Pública, Universidad Rey Juan Carlos, Madrid, España
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Callinan J, Coyne I. Arts-based interventions to promote transition outcomes for young people with long-term conditions: A review. Chronic Illn 2020; 16:23-40. [PMID: 30003798 DOI: 10.1177/1742395318782370] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives To conduct a systematic review of arts-based interventions promoting transition from paediatric to adult services for young people (Note: The term young people refers to adolescents and young adults.) with long-term conditions and to explore their effectiveness. Interventions Arts-based interventions included studies of young people who were actively participating in the intervention rather than passive observers. Visual arts interventions included film/video production, time-based media, photography, animation, sculpture, audio, installation, sound recordings, painting, textiles, print, mixed media, multimedia. Arts-based interventions included creative writing, poetry, dance, choreography and storytelling. Main outcome measures We included all outcome measures relevant to transition and any chronic condition. These included: self-care knowledge and skills, autonomy, continuity of care, adherence to treatment and attendance at appointments. Results Seven studies reported arts-based interventions promoting outcomes that are relevant to transition. These studies showed that arts-based interventions may influence young people with long-term conditions self-esteem, confidence and self-expression. The findings must be treated with caution as the evidence was weak with studies using qualitative measures and of poor methodological quality. Conclusions There is a need for further research of arts-based interventions for children and adolescents with long-term conditions that incorporate objective measurements or validated tools to assess outcomes relevant to the transition process.
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Affiliation(s)
- J Callinan
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - I Coyne
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
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Hobart CB, Phan H. Pediatric-to-adult healthcare transitions: Current challenges and recommended practices. Am J Health Syst Pharm 2020; 76:1544-1554. [PMID: 31532501 DOI: 10.1093/ajhp/zxz165] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE An overview of the pediatric-to-adult healthcare transition (HCT) process, including stakeholders, challenges, and fundamental components that present opportunities for pharmacists and pharmacy technicians, is provided. SUMMARY Pediatric-to-adult HCT programs should be longitudinal in nature, be patient focused, and be coproduced by patients, caregivers, and care team members. Educational components of HCT programs should include knowledge and skills in disease state management and self-care; safe and effective use of medications, as well as other treatment modalities; and healthcare system navigation, including insurance issues. Interprofessional involvement in HCT is encouraged; however, roles for each discipline involved are not clearly delineated in current guidelines or literature. Possible influencing elements in achieving successful pediatric-to-adult HCT outcomes include those that are related to patient and/or caregiver factors, clinician awareness, availability of resources, and ability to achieve financial sustainability. CONCLUSION The use of structured pediatric-to-adult HCT programs is currently recommended to optimize patient and health-system outcomes. Given the importance of medication-related knowledge and healthcare system navigation skills to successful care transitions, there are opportunities for pharmacists and pharmacy technicians to contribute to HCT programs.
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Affiliation(s)
- Catherine B Hobart
- Department of Clinical and Administrative Sciences, College of Pharmacy, Larkin University, Miami, FL
| | - Hanna Phan
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, and Department of Pediatrics, College of Medicine, University of Arizona, Tucson, AZ
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Ballantyne M, Orava T, Bernardo S, McPherson AC, Church P, Fehlings D, Cohen E. An Environmental Scan of Parent-focused Transition Practices between Neonatal Follow-up and Children's Rehabilitation Services. Dev Neurorehabil 2020; 23:113-120. [PMID: 31431098 DOI: 10.1080/17518423.2019.1657199] [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: 10/26/2022]
Abstract
Purpose: Identify parent-focused transition practices for parents of children born preterm/acutely ill when transitioning from Neonatal Follow-Up Programs (NFUP) to Children's Treatment Centers or Networks (CTCN).Methods: NFUP and CTCN health-care providers participated in an online survey and qualitative interviews. Quantitative data were analyzed using descriptive statistics and qualitative data underwent conventional content analysis.Results: 60 participants (17 sites) from diverse health disciplines completed the survey, and 14 (from 11 of 17 sites) participated in a follow-up interview. Enablers to transition included knowledgeable practitioners, shared services, and family engagement; although not present across all sites. Barriers commonly reported were a lack of time, understanding of roles, and parent engagement.Conclusion: Research study findings highlight the need to improve and bridge NFUP to CTCN parent-focused transition practices. Recommendations for next actions steps include improved cross-sector communication, bridging sectors through enhanced service provision, and moving from information provision to family engagement.
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Affiliation(s)
- Marilyn Ballantyne
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Taryn Orava
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Stephanie Bernardo
- Neonatal/Pediatric Intensive Care Unit, SickKids Hospital, Toronto, Canada
| | - Amy C McPherson
- University of Toronto, Toronto, Canada.,Bloorview Research Institute, Toronto, Canada
| | - Paige Church
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Darcy Fehlings
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Eyal Cohen
- University of Toronto, Toronto, Canada.,The Hospital for Sick Children, Toronto, Canada
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Transitioning youth to adult age also through health services. Epidemiol Psychiatr Sci 2020; 29:e88. [PMID: 31915105 PMCID: PMC7214703 DOI: 10.1017/s2045796019000842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Williams-Reade JM, Tapanes D, Distelberg BJ, Montgomery S. Pediatric Chronic Illness Management: A Qualitative Dyadic Analysis of Adolescent Patient and Parent Illness Narratives. JOURNAL OF MARITAL AND FAMILY THERAPY 2020; 46:135-148. [PMID: 30725488 DOI: 10.1111/jmft.12377] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In pediatric chronic illness, little is known about the relational interactions between adolescent patients, parents, and illnesses and how they influence self-management of illness. We conducted interviews with 32 individuals (16 dyads) representing adolescents diagnosed with a chronic illness and their primary parent who had been referred to a psychosocial treatment program for challenges with illness management. Interviews were conducted individually and analyzed dyadically using grounded theory to better understand the relational processes that may be contributing to illness management difficulties. Results include a theory of patient-parent illness responses and how parental illness meanings play a role in adolescent self-management. Results can be used to better understand and treat family relational patterns that may be influencing pediatric illness management challenges.
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45
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Wiemann CM, Graham SC, Garland BH, Hergenroeder AC, Raphael JL, Sanchez-Fournier BE, Benavides JM, Warren LJ. Development of a Group-Based, Peer-Mentor Intervention to Promote Disease Self-Management Skills Among Youth With Chronic Medical Conditions. J Pediatr Nurs 2019; 48:1-9. [PMID: 31195183 DOI: 10.1016/j.pedn.2019.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 05/19/2019] [Accepted: 05/19/2019] [Indexed: 01/17/2023]
Abstract
STUDY PURPOSE The purpose of this paper is to describe the development of a group-based peer-mentor intervention to enhance knowledge/skills of transition-age youth (TAY) from three clinical services (gastroenterology, renal or rheumatology) at a large children's hospital in order to facilitate transition from pediatric to adult healthcare. DESIGN AND METHODS Using a multi-modal, iterative approach, the structure/content of the intervention was based on peer-reviewed literature; surveys/interviews conducted with TAY, families, and adult and pediatric providers; principles of Self-Determination Theory and motivational interviewing; and guided by a logic model. A TAY community advisory board helped interpret the information and develop the intervention. RESULTS The resulting intervention has eight sessions led by peer mentors (young adults who have successfully transitioned to adult healthcare, who are trained to use a motivational interviewing approach) covering topics such as goal setting; understanding my diagnosis; organizing personal, health & insurance information; characteristics of a good provider; filling/refilling prescriptions; and mental well-being. The TAY community advisory board recommended holding two sessions on each of four Saturdays, using interactive group activities to make it fun, and creating a written complimentary manual for caregivers. CONCLUSIONS A TAY community advisory board was instrumental in developing an innovative peer-mentor intervention to promote the development of specific skills TAY require to manage their disease within adult healthcare. PRACTICE IMPLICATIONS Although the intervention was developed with extensive stakeholder input, a next step is to evaluate the intervention with respect to how well it fits the broader membership in the target population.
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Affiliation(s)
- Constance M Wiemann
- Section of Adolescent Medicine & Sports Medicine, Department of Pediatrics, Baylor College of Medicine, TX, USA.
| | - Sarah C Graham
- Section of Adolescent Medicine & Sports Medicine, Department of Pediatrics, Baylor College of Medicine, TX, USA
| | - Beth H Garland
- Section of Adolescent Medicine & Sports Medicine, Department of Pediatrics, Baylor College of Medicine, TX, USA.
| | - Albert C Hergenroeder
- Section of Adolescent Medicine & Sports Medicine, Department of Pediatrics, Baylor College of Medicine, TX, USA.
| | - Jean L Raphael
- Center for Child Health Policy and Advocacy, Department of Pediatrics, Baylor College of Medicine, TX, USA.
| | - Blanca E Sanchez-Fournier
- Section of Adolescent Medicine & Sports Medicine, Department of Pediatrics, Baylor College of Medicine, TX, USA.
| | - Jacqueline M Benavides
- Section of Adolescent Medicine & Sports Medicine, Department of Pediatrics, Baylor College of Medicine, TX, USA.
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46
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Hart LC, Patel-Nguyen SV, Merkley MG, Jonas DE. An Evidence Map for Interventions Addressing Transition from Pediatric to Adult Care: A Systematic Review of Systematic Reviews. J Pediatr Nurs 2019; 48:18-34. [PMID: 31220801 DOI: 10.1016/j.pedn.2019.05.015] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/20/2019] [Accepted: 05/22/2019] [Indexed: 11/28/2022]
Abstract
PROBLEM Adolescents and young adults with chronic illnesses continue to face barriers as they transition from pediatric to adult care. An evidence map can help to identify gaps in the transition literature to determine targets for future research. ELIGIBILITY CRITERIA We searched PubMed, CINAHL, PsycInfo, and Cochrane for systematic reviews published through February 2018. Eligible reviews included at least one comparative study testing a youth-focused intervention for improving transition with at least one quantitative health-related outcome reported. SAMPLE We identified 431 unique reviews in our search, and 37 reviews (containing 71 eligible primary studies) met inclusion criteria. RESULTS Most reviews (20 of 37) summarized some aspect of transition across diagnoses. Type 1 diabetes was the most common diagnosis studied (7 of 37 reviews and 24 of 71 primary studies). Only 14 of 71 primary studies focused on care after transfer to adult care. CONCLUSIONS The literature on interventions to improve transition to adult care has focused on a limited number of diagnoses, most commonly Type 1 diabetes. Common pediatric conditions, such as asthma, have not been studied with regard to transition. Efforts have been mainly targeted on transition preparation, with less focus on transition needs after transfer to adult care. IMPLICATIONS There is a need for transition research focused on common pediatric conditions and transition needs after transfer to adult care.
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Affiliation(s)
- Laura C Hart
- Nationwide Children's Hospital, Columbus, OH, United States of America; The Ohio State University College of Medicine, Departments of Pediatrics and Medicine, United States of America; The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, United States of America.
| | | | | | - Daniel E Jonas
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, United States of America; University of North Carolina at Chapel Hill, Department of Medicine, United States of America.
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47
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Smaldone A, Manwani D, Green NS. Greater number of perceived barriers to hydroxyurea associated with poorer health-related quality of life in youth with sickle cell disease. Pediatr Blood Cancer 2019; 66:e27740. [PMID: 30941907 PMCID: PMC6538386 DOI: 10.1002/pbc.27740] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/28/2019] [Accepted: 03/12/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Despite medical benefits, hydroxyurea adherence in adolescents is often poor. As part of a baseline assessment of 28 youth (10-18 years) parent dyads who participated in a 6-month feasibility trial to improve hydroxyurea adherence, we measured the relationship between greater barriers to adherence and health-related quality of life (HRQL) from youth and parent perspectives. PROCEDURE Barriers were measured using the Adolescent and Parent Medication Barriers Scales with nine hydroxyurea items added. Barriers reported by ≥25% of the sample were considered common. Generic and disease-specific HRQL were measured by PedsQL and PedsQL Sickle Cell Disease modules. Data were analyzed using descriptive statistics, Cronbach alpha, Spearman correlation coefficients, and paired t tests. RESULTS Fifty-six subjects (28 dyads) participated. Youth reported greater barriers compared with parents (5.0 ± 3.9 and 3.5 ± 3.2; P = 0.03), with >80% of respondents reporting ≥1 barriers. Twelve barriers were reported by ≥25% of adolescents, whereas six were reported by ≥25% of parents. Of these, only two were common to both dyad members. Approximately one-third of youth had generic and disease-specific HRQL scores that fell at or below cutoff scores, suggesting being at risk for impaired HRQL. Greater barriers were inversely associated with poorer generic (parent r = -0.43, P = 0.03; youth r = -0.44, P < 0.001) and disease-specific HRQL (parent r = -0.53, P = 0.005; youth r = -0.53, P < 0.001). CONCLUSIONS Hydroxyurea barriers were frequently reported but differed by dyad members' perspective. Greater barriers were associated with poorer generic and disease-specific HRQL. To reduce barriers to hydroxyurea in youth with sickle cell disease, perspectives of both dyad members should be addressed.
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Affiliation(s)
- Arlene Smaldone
- Columbia University School of Nursing, New York, New York
- College of Dental Medicine, Columbia University Medical Center, New York, New York
| | - Deepa Manwani
- Department of Pediatrics, Albert Einstein College of Medicine, New York, New York
| | - Nancy S. Green
- Department of Pediatrics, Columbia University Medical Center, New York, New York
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Vion Genovese V, Perceval M, Buscarlet-Jardine L, Pinsault N, Gauchet A, David V, Durieu I, Llerena C. [Quality criteria for the transition to adult care in French CF centers - results from the SAFETIM APP study?]. Rev Mal Respir 2019; 36:565-577. [PMID: 31208888 DOI: 10.1016/j.rmr.2019.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 01/15/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION SAFETIM-APP compiled an inventory of professional practice in the 45 French cystic fibrosis reference centres (CFRC), between February 2015 and December 2016, related to the transition of adolescents with cystic fibrosis to adult centres. METHOD This multicentre cross-sectional study addressed the modalities of the transition in CFRCs and proposed a list of items that could be used to establish quality criteria. Quantitative analysis of the criteria and a qualitative analysis of the transition procedure were carried out. RESULTS A total of 77% of the CFRCs that were contacted took part. Transition lasted 3 to 5 years and began at around 15 years of age. Nine criteria were described as fundamental, including: collaboration between teams, taking adolescence into account, having a time for adolescents to speak with the physician alone, defining a program including therapeutic education, involving the family, accompanying the parents. Seven additional criteria were noted to be important, including: re-announcing the diagnosis, identifying a common thread (caregiver) accompanying the family, scheduling adult follow-up from paediatrics onwards, visiting the adult department, organizing a formal departure/reception time, initiating the process early enough, identifying indicators to evaluate practices. CONCLUSION The transition processes in place in CFRCs can be improved by implementing the use of these quality criteria systematically.
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Affiliation(s)
- V Vion Genovese
- CRCM pédiatrie-UTEP, CHU de Grenoble Alpes, GETHEM, université de Grenoble-Alpes ThEMAS TIMC-IMAG (UMR CNRS 5525), hôpital Couple-Enfant, CHU de Grenoble-Alpes, CS 10217, 38043 Grenoble cedex 9, France.
| | - M Perceval
- Filière muco CFTR, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
| | - L Buscarlet-Jardine
- Réseau EMERAA (ensemble pour la mucoviscidose en Rhone Alpes Auvergne), 39, boulevard Ambroise-Paré, 69008 Lyon, France
| | - N Pinsault
- Université Grenoble-Alpes ThEMAS TIMC-IMAG (UMR CNRS 5525), 621, avenue Centrale, 38400 Saint-Martin-d'Hères, France
| | - A Gauchet
- LIP/PC2S, université Grenoble Alpes, Saint-Martin-d'Hères, 38400 Grenoble, France
| | - V David
- CRCM Nantes, (GETHEM), groupe d'éducation thérapeutique en mucoviscidose, hôpital enfants et adolescents, CHU de Nantes, 7, quai Moncousu, 44093 Nantes cedex 1, France
| | - I Durieu
- CRCM Lyon adultes, HCL Lyon, filière muco CFTR, 69003 Lyon, France
| | - C Llerena
- (GETHEM), CRCM pédiatrie-UTEP, groupe d'éducation thérapeutique en mucoviscidose, CHU de Grenoble Alpes, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
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Twito O, Shatzman-Steuerman R, Dror N, Nabriski D, Eliakim A. The "combined team" transition clinic model in endocrinology results in high adherence rates and patient satisfaction. J Pediatr Endocrinol Metab 2019; 32:505-511. [PMID: 31028713 DOI: 10.1515/jpem-2019-0056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 02/22/2019] [Indexed: 11/15/2022]
Abstract
Background A structured transition process for young adults with chronic medical conditions from pediatric to adult clinics is strongly promoted. However, the most appropriate transition model has not yet been determined. This study evaluated the effect of a "combined team" Endocrinology Transition Clinic model, including a joint meeting with the patient and pediatric and adult endocrinologists, regarding medical treatment, adherence to follow-up and patient satisfaction with the process. Methods Clinical and demographic data of patients admitted to the Endocrinology Transition Clinic were collected. The clinical impact of the transition meeting was evaluated based on treatment modifications and patient adherence to follow-up. Patient satisfaction was evaluated using a questionnaire. Results From September 2014 through November 2018, 107 patients attended the Endocrinology Transition Clinic, 85.0% were females, mean age 19.7 ± 2.2 years (range 16-29), 97.2% were unmarried. The most common endocrine disorders were obesity (41.1%), Hashimoto's thyroiditis (41.1%) and ovarian hyperandrogenism (38.3%). The Transition Clinic visit modified treatment and/or evaluation for 48 (44.8%) patients. Adherence to follow-up in the adult clinic was 82.9% and was not associated with gender (p = 0.366), ethnicity (p = 0.725), age at transition (p = 0.479) or obesity (p = 0.375). Overall satisfaction reported by 65/85 patients was high (86.8%), although higher among patients who were adherent to follow-up (89.4% vs. 65.6%, p = 0.006). Conclusions The "combined team" transition model in endocrinology requires relatively few resources and has considerable clinical impact, high adherence to follow-up and high patient satisfaction rate. Implementing this model at the interface of pediatric and adult endocrinology units, and possibly in other medical fields, is feasible and efficient.
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Affiliation(s)
- Orit Twito
- Department of Endocrinology, Meir Medical Center, 59 Tchernichovsky St., Kfar Saba 44281, Israel.,Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | | | - Nitzan Dror
- Pediatric Endocrinology Unit, Meir Medical Center, Kfar Saba, Israel
| | - Dan Nabriski
- Endocrinology, Diabetes and Metabolism Institute, Meir Medical Center, Kfar Saba, Israel
| | - Alon Eliakim
- Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel.,Pediatric Endocrinology Unit, Meir Medical Center, Kfar Saba, Israel
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50
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Beaufils C, Jacquin P, Dumas A, Limbourg A, Romier M, Larbre JP, Mellerio H, Belot A. Patients' association programs for adolescents and young adults: The JAP study. Arch Pediatr 2019; 26:205-213. [PMID: 30982562 DOI: 10.1016/j.arcped.2019.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 02/13/2019] [Accepted: 03/07/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION A dozen innovative care clinics have recently opened in France to support the transition of adolescents with chronic conditions between pediatric and adult healthcare units through various interventions. Some patients' associations have set up specific programs for adolescents and young adults (AYAs) in order to facilitate the transition process, but they are not well-known among healthcare professionals. Our aim was to describe these programs and to evaluate the quality of their implementation and transferability into transition clinics. MATERIEL AND METHODS We conducted semistructured interviews with representatives of associations that proposed interventions dedicated to AYAs with chronic conditions. We collected quantitative and qualitative data to describe these interventions. Descriptive statistics were run on quantitative data and a thematic analysis of the qualitative data was made. RESULTS A questionnaire was sent to 55 associations, 19 (36%) of them had established programs and were contacted; interviews were conducted with 16 of them. Thirteen were national associations, 11 focused on a specific chronic disease, three supported multiple chronic conditions, and two were available to any AYA with chronic disease. Programs were mainly camps (n=5; from 2days to 3weeks) and workshops (n=5). Educational considerations and hobbies were more frequently discussed when peers were directly involved in the program. Stakeholders were mainly other patients and peers (9/16). Fourteen out of 16 were perceived as successful (perceived improvement in AYA quality of life and/or positive feedback). Twelve out of 16 associations thought that their program could be transferable to transition clinics and all were interested in collaboration. DISCUSSION This work highlights five key points to be considered in the clinical care setting before building programs: unique tailoring and customization, complementarity with existing programs in patients' associations, viability based on peer involvement and evaluation, a common main goal, and using transition clinics' assets to direct AYAs towards the most suitable program.
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Affiliation(s)
- C Beaufils
- Department of pediatric rheumatology, hôpital Femme-Mère-Enfant, hospices civils de Lyon, Claude-Bernard university Lyon 1, university of Lyon, 69677 Lyon, France; Plateforme Pass'Age, hôptial Femme-Mère-Enfant, hospices civils de Lyon, 69677 Lyon, France.
| | - P Jacquin
- Plateforme Ad'venir, adolescent medicine, hôpital Robert-Debré, Assistance publique-Hôpitaux de Paris, 75019 Paris, France; French Clinical Research Group in Adolescent Medicine and Health, 75010 Paris, France
| | - A Dumas
- ECEVE, UMRS 1123, Institut nationale de la recherché médicale (Inserm), université Paris-Diderot, 10, avenue de Verdun, 75010 Paris, France; Center for research in epidemiology and population health (CESP) U1018, Inserm, 94807 Villejuif, France
| | - A Limbourg
- Plateforme Ad'venir, adolescent medicine, hôpital Robert-Debré, Assistance publique-Hôpitaux de Paris, 75019 Paris, France
| | - M Romier
- Plateforme Pass'Age, hôptial Femme-Mère-Enfant, hospices civils de Lyon, 69677 Lyon, France
| | - J-P Larbre
- Plateforme Pass'Age, hôptial Femme-Mère-Enfant, hospices civils de Lyon, 69677 Lyon, France; Rheumatology department, Lyon Sud hospital, hospices civils de Lyon, 69677 Lyon, France
| | - H Mellerio
- Plateforme Ad'venir, adolescent medicine, hôpital Robert-Debré, Assistance publique-Hôpitaux de Paris, 75019 Paris, France; French Clinical Research Group in Adolescent Medicine and Health, 75010 Paris, France; ECEVE, UMRS 1123, Institut nationale de la recherché médicale (Inserm), université Paris-Diderot, 10, avenue de Verdun, 75010 Paris, France
| | - A Belot
- Department of pediatric rheumatology, hôpital Femme-Mère-Enfant, hospices civils de Lyon, Claude-Bernard university Lyon 1, university of Lyon, 69677 Lyon, France; Plateforme Pass'Age, hôptial Femme-Mère-Enfant, hospices civils de Lyon, 69677 Lyon, France
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