Association of Primary Care Continuity With Outcomes Following Transition to Adult Care for Adolescents With Severe Mental Illness

Abstract

Key Points Question Is primary care continuity during the transition from pediatric to adult care services associated with better outcomes in young adulthood for adolescents with severe mental illness? Findings In this population-based cohort study of 8409 adolescents aged 12 to 16 years with severe mental illness, there was a 30% increase in risk of mental health–related hospital admission in young adulthood (age 19-26 years) for those with no primary care physician and a 20% increase for those with discontinuous primary care during transition to adult care compared with continuous care. Meaning For adolescents with severe mental illness, continuity with a primary care physician during transition to adult care was associated with decreased mental health–related hospitalizations and emergency department visits.

Perspectives from primary health care providers on supporting adolescents and young adults with chronic conditions transitioning to adult care: A descriptive qualitative study

“…Very few studies have examined the effectiveness of continuous primary care, or having a family physician "involved from the beginning", on transition outcomes. (53,54) For young children with chronic conditions, (57,58) and older adults,(59) regular attendance in primary care has been linked to improved outcomes (e.g., fewer ED visits). Yet, national survey data in the United States suggests less than 50% of AYAs with a chronic condition have a "regular source of care".…”

“…Yet, national survey data in the United States suggests less than 50% of AYAs with a chronic condition have a "regular source of care". (60-62) A recent Canadian population-based study (53) on AYAs with severe mental illness (i.e., schizophrenia, eating disorder, mood disorder) showed two thirds (65.1%) had "continuous" primary care, or seen by the same physician during transition (12-26 years old); those with discontinuous primary care, and no primary care, had increased rates of mental health-related hospitalizations as young adults. Prior to transfer, pediatrician involvement with AYAs with chronic conditions may be a barrier to continuous primary care, as expressed by our participants.…”

“…AYAs with severe mental illness. (16) Much of the focus in the transition literature has been on transfers between child-and adult-specialists or subspecialists, (17)(18)(19)(20)(21) and not on what happens in primary care. A systematic review of pediatric transition interventions yielded only three studies with a primary care component; (22) none evaluated this component specifically.…”

Perspectives from primary health care providers on supporting adolescents and young adults with chronic conditions transitioning to adult care: A descriptive qualitative study

“…(9) This type of monitoring in PHC has been suggested for AYAs with chronic conditions. (22,(47)(48)(49) Specialist providers often expect AYAs with chronic conditions to encounter barriers to finding "adult-focused" providers willing to meet their general healthcare needs. (19,50,51) In our study, family physician participants were willing to monitor AYAs during the transition period, but this willingness appeared dependent on being involved prior to transfer, or "from the beginning".…”

“…Very few studies have examined the effectiveness of continuous primary care, or having a family physician "involved from the beginning", on transition outcomes. (48,49) For young children with chronic conditions, (52,53) and older adults,(54) regular attendance in primary care has been linked to improved outcomes (e.g., fewer ED visits). Yet, national survey data in the United States suggests less than 50% of AYAs with a chronic condition have a "regular source of care".…”