Experiences of health care transition voiced by young adults with type 1 diabetes: a qualitative study

Abstract

ObjectiveThis qualitative study aimed to explore the experience of transition from pediatric to adult diabetes care reported by posttransition emerging adults with type 1 diabetes (T1D), with a focus on preparation for the actual transfer in care.MethodsTwenty-six T1D emerging adults (mean age 26.2±2.5 years) receiving adult diabetes care at a single center participated in five focus groups stratified by two levels of current glycemic control. A multidisciplinary team coded transcripts and conducted thematic analysis.ResultsFour key themes on the process of transfer to adult care emerged from a thematic analysis: 1) nonpurposeful transition (patients reported a lack of transition preparation by pediatric providers for the transfer to adult diabetes care); 2) vulnerability in the college years (patients conveyed periods of loss to follow-up during college and described health risks and diabetes management challenges specific to the college years that were inadequately addressed by pediatric or adult providers); 3) unexpected differences between pediatric and adult health care systems (patients were surprised by the different feel of adult diabetes care, especially with regards to an increased focus on diabetes complications); and 4) patients’ wish list for improving the transition process (patients recommended enhanced pediatric transition counseling, implementation of adult clinic orientation programs, and peer support for transitioning patients).ConclusionOur findings identify modifiable deficiencies in the T1D transition process and underscore the importance of a planned transition with enhanced preparation by pediatric clinics as well as developmentally tailored patient orientation in the adult clinic setting.

Improving the transition from pediatric to adult diabetes care: the pediatric care provider's perspective in Quebec, Canada

“…This is in contrast to several studies of emerging adults who have reported a lack of purposeful transition preparation 20 and dissatisfaction with the transition process within the pediatric care setting. 3 4 15 Patients with inadequate transition preparation are at a higher risk for gaps >6 months between the last pediatric and first adult care visit.…”

CoYoT1 Clinic: Innovative Telemedicine Care Model for Young Adults with Type 1 Diabetes

“…4,9 The patients in our study reported saving over 6 h from their work or school day by completing their diabetes clinic visit virtually, which may improve adherence with routine diabetes care appointments. Offering the opportunity to interact with healthcare providers via Professionally led support groups have shown potential to improve diabetes self-care behaviors and reduce diabetes distress for young adult patients in their 20s.…”

“…3,4 Additionally, young adults with diabetes have a high risk of diabetic ketoacidosis (DKA), diabetes complications, and diminishing mental health, 1,2,5-8 making them a population in need of support.…”

“…3,4,[9][10][11] Young adults in this transitional stage report feeling dissatisfied with the transfer to adult care and believe their specific needs and diabetes management challenges are not sufficiently addressed in pediatric or adult care settings, 4,12 likely contributing to their disengagement with medical care. Additionally, there is evidence to suggest worsening of glycemic control with the transition to adult care.…”

“…14,15 Additionally, alternative medical care approaches, specifically group visits, also known as shared medical appointments, have successfully increased patient and provider satisfaction, strengthened follow-up rates, and improved outcomes in multiple patient populations. [16][17][18] Furthermore, increasing peer support for young adults with T1D has been suggested as an avenue to improve mental health and adherence with diabetes self-care, 3,4,19 and group visits are an efficient way to incorporate peer support into routine medical care. ''Team Clinic,'' a group clinical care model 20 piloted for adolescents with T1D, was found to be an efficient way to provide developmentally tailored clinical care with the added benefit of peer support.…”