Exploring a black hole: Transition from paediatric to adult care services for youth with diabetes

Pacaud, Danièle; Yale, Jean‐François

doi:10.1093/pch/10.1.31

Cited by 76 publications

(78 citation statements)

References 28 publications

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“…In general, when there is no formal transition program in place, a "loss to follow-up" rate of > 20-25% can be expected in the 2-4 years after discharge from the pediatric center. [6][7][8][9][10][11][12] One study from Finland showed a significant improvement in metabolic control after transition to adult care, although other studies have failed to confirm this. 6 Of note, in a recent health services study of 1,507 adolescents with diabetes undergoing a transition of care at 18 years of age in the Province of Ontario, Canada, we reported two important findings: there was a small but significant increased risk of hospitalization for Adolescents leaving their pediatric team and starting afresh with a new physician and new team were more likely to be hospitalized for DKA than those whose adult team included some of the members of their pediatric team.…”

Section: Studies Of Transition Outcomesmentioning

confidence: 99%

Moving On: Transition of Teens With Type 1 Diabetes to Adult Care

Daneman¹,

Nakhla²

2011

Diabetes Spectrum

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Section: Studies Of Transition Outcomesmentioning

confidence: 99%

Moving On: Transition of Teens With Type 1 Diabetes to Adult Care

Daneman¹,

Nakhla²

2011

Diabetes Spectrum

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“…As a consequence, the concept of transition emerged, defined as a process of "a purposeful planned movement of adolescents and young adults with chronic physical and medical conditions from child-centered to adult-orientated health care systems" [3]. Unfortunately, the transfer to AHC is still often the result of an ad hoc decision, and some adolescents even drop out of the health care system temporarily until they seek help for acute medical problems in the AHC system [17,18,23,30,32]. Such poor transition processes may have significant negative effects on morbidity and mortality in young adults [2,10,17].…”

Section: Ahc Adult Health Carementioning

confidence: 99%

Transition from pediatric to adult health care: expectations of adolescents with chronic disorders and their parents

2010

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The aim of this study was to assess the expectations of adolescents with chronic disorders with regard to transition from pediatric to adult health care and to compare them with the expectations of their parents. A cross-sectional study was carried out including 283 adolescents with chronic disorders, aged 14-25 years (median age, 16.0 years), and not yet transferred to adult health care, and their 318 parents from two university children's hospitals. The majority of adolescents and parents (64%/70%) perceived the ages of 18-19 years and older as the best time to transfer to adult health care. Chronological age and feeling too old to see a pediatrician were reported as the most important decision factors for the transfer while the severity of the disease was not considered important. The most relevant barriers were feeling at ease with the pediatrician (45%/38%), anxiety (20%/24%), and lack of information about the adult specialist and health care (18%/27%). Of the 51% of adolescents with whom the pediatric specialist had spoken about the transfer, 53% of adolescents and 69% of parents preferred a joint transfer meeting with the pediatric and adult specialist, and 24% of these adolescents declared that their health professional had offered this option. In summary, the age preference for adolescents with chronic disorders and their parents to transfer to adult health care was higher than the upper age limits for admission to pediatric health care in many European countries. Anxiety and a lack of information of both adolescents and their parents were among the most important barriers for a smooth and timely transfer according to adolescents and parents. Abstract The aim of this study was to assess the expectations of adolescents with chronic disorders with regard to transition from pediatric to adult health care and to compare them with the expectations of their parents. A cross-sectional study was carried out including 283 adolescents with chronic disorders, aged 14-25 years (median age, 16.0 years), and not yet transferred to adult health care, and their 318 parents from two university children's hospitals. The majority of adolescents and parents (64%/70%) perceived the ages of 18-19 years and older as the best time to transfer to adult health care. Chronological age and feeling too old to see a pediatrician were reported as the most important decision factors for the transfer while the severity of the disease was not considered important. The most relevant barriers were feeling at ease with the pediatrician (45%/38%), anxiety (20%/24%), and lack of information about the adult specialist and health care (18%/ 27%). Of the 51% of adolescents with whom the pediatric specialist had spoken about the transfer, 53% of adolescents and 69% of parents preferred a joint transfer meeting with the pediatric and adult specialist, and 24% of these adolescents declared that their health professional had offered this option. In summary, the age preference for adolescents with chronic disorders and their parents to tra...

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“…Young adults with diabetes, as with any teenage child facing a chronic long term condition, are more vulnerable to the changes of adaptation in care and hence there is greater risk of this care being compromised at a time where they need it most and at a time where the longer term complications (as well as acute) need to be screened and monitored for [32] . One key obstacle identified here is the loss to follow up of these patients.…”

mentioning

confidence: 99%

Challenges of emerging adulthood-transition from paediatric to adult diabetes

Gill

Nayak

Wilkins

et al. 2014

WJD

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Diabetes mellitus is a complex condition with far reaching physical, psychological and psychosocial effects. These outcomes can be significant when considering the care of a youth transferring from paediatric through to adult diabetes services. The art of mastering a smooth care transfer is crucial if not pivotal to optimising overall diabetic control. Quite often the nature of consultation varies between the two service providers and the objectives and outcomes will mirror this. The purpose of this review is to analyse the particular challenges and barriers one might expect to encounter when transferring these services over to an adult care provider. Particular emphasis is paid towards the psychological aspects of this delicate period, which needs to be recognised and appreciated appropriately in order to understand the particular plights a young diabetic child will be challenged with. We explore the approaches that can be positively adopted in order to improve the experience for child, parents and also the multi-disciplinary team concerned with the overall delivery of this care. Finally we will close with reflection on the potential areas for future development that will ultimately aim to improve long-term outcomes and experiences of the young adolescent confronted with diabetes as well as the burden of disease and burden of cost of disease.

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Exploring a black hole: Transition from paediatric to adult care services for youth with diabetes

Cited by 76 publications

References 28 publications

Moving On: Transition of Teens With Type 1 Diabetes to Adult Care

Moving On: Transition of Teens With Type 1 Diabetes to Adult Care

Transition from pediatric to adult health care: expectations of adolescents with chronic disorders and their parents

Challenges of emerging adulthood-transition from paediatric to adult diabetes

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