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Prüfe J, Pape L, Kreuzer M. Barriers to the Successful Health Care Transition of Patients with Kidney Disease: A Mixed-Methods Study on the Perspectives of Adult Nephrologists. CHILDREN 2022; 9:children9060803. [PMID: 35740740 PMCID: PMC9221888 DOI: 10.3390/children9060803] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 05/22/2022] [Accepted: 05/27/2022] [Indexed: 11/16/2022]
Abstract
The transition from paediatric to adult-based health care is a challenging period bearing a high risk of medication nonadherence and transplant loss in adolescents and young adults after kidney transplantation. Successful transition asks for the cooperation of many, not least the adult physicians. Yet little is known about their thoughts and attitudes on the transition. We conducted a cross-sectional mixed-methods study, inviting all nephrologists registered with the German Society of Nephrology. A total of 119/1984 nephrologists answered an online survey, and 9 nephrologists participated in expert interviews on transition experiences and perceived barriers. Interviews were thematically analysed. Based on the results, 30 key statements were listed and returned to participants for a ranking of their relevance. The main themes extracted are (1) available resources, (2) patient-related factors, (3) qualification and (4) preparation of and cooperation with the paediatric setting. In conclusion, it became evident that successful transition faces multiple obstacles. At the least, it asks for time, staff, and money. Rigid structures in health care leave little room for addressing the specific needs of this small group of patients. Transition becomes a topic one wants to and is able to afford.
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Affiliation(s)
- Jenny Prüfe
- Department of Pediatrics II, University Children’s Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany; (L.P.); (M.K.)
- Psychosocial Service, University Children’s Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany
- Correspondence:
| | - Lars Pape
- Department of Pediatrics II, University Children’s Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany; (L.P.); (M.K.)
| | - Martin Kreuzer
- Department of Pediatrics II, University Children’s Hospital Essen, Hufelandstr. 55, 45147 Essen, Germany; (L.P.); (M.K.)
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Colinart-Thomas M, Noël V, Roques G, Gordes-Grosjean S, Abely M, Pluchart C. [From pediatric care to adult medicine: Transition of sickle cell patients, a French monocentric study]. Arch Pediatr 2018. [PMID: 29530458 DOI: 10.1016/j.arcped.2017.12.012] [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: 10/17/2022]
Abstract
Sickle cell disease, a hemoglobin disorder with autosomal recessive transmission, is one of the most common genetic diseases screened in France. Thanks to early management, 95% of sickle cell patients reach adulthood and require transition from pediatric care to adult care. Through a retrospective study of records from serious sickle cell patients over 17 years old, followed in the hematology-oncology pediatric unit of Reims University Hospital Center in France, we analyzed transition conditions, compared pediatric and adult management, and proposed a plan for transition care. As of 1 January 2016, out of 19 sickle cell patients meeting the inclusion criteria, 12 had made the transition from pediatric care to adult medicine. Among the transition group, the transition was proposed by the pediatrician in 92% of cases. The average age of transition was 19.4 years. The time between receiving the information and the last pediatric visit was 2.4 months. Seven out of the 12 patients were informed of their transition during the last pediatric visit. The age of the first adult visit was 20.3 years. There was no alternate or joint consultation. The treatments prescribed during the last pediatric visit were not modified during the first adult visit. The average number of hospitalizations per patient was 2.7 in pediatric care and 3.4 in adult care with a median value of 2 in both groups. Three out of 12 patients died, the average age of death being 26.7 years. Transition is an important milestone in chronic disease patients. More than age, the maturity of the patient must be taken into account. The transition to the adult structure requires early preparation in the teenage years and investment of the adolescent and his family as well as investment of pediatric and adult caregivers. This study points out the need to establish a transition plan within our hospital in collaboration with adult physicians. Continuity of care is necessary to increase the quality of managing patients and cannot be done without a close relationship between pediatric specialists and adult physicians.
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Affiliation(s)
- M Colinart-Thomas
- Unité d'hémato-oncologie pédiatrique, service de pédiatrie A, hôpital américain, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
| | - V Noël
- Service de médecine interne, maladies infectieuses et immunologie clinique, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - G Roques
- Unité d'hémato-oncologie pédiatrique, service de pédiatrie A, hôpital américain, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - S Gordes-Grosjean
- Unité d'hémato-oncologie pédiatrique, service de pédiatrie A, hôpital américain, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - M Abely
- Unité d'hémato-oncologie pédiatrique, service de pédiatrie A, hôpital américain, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France
| | - C Pluchart
- Unité d'hémato-oncologie pédiatrique, service de pédiatrie A, hôpital américain, CHU de Reims, 45, rue Cognacq-Jay, 51092 Reims cedex, France
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Goralski JL, Nasr SZ, Uluer A. Overcoming barriers to a successful transition from pediatric to adult care. Pediatr Pulmonol 2017; 52:S52-S60. [PMID: 28950427 DOI: 10.1002/ppul.23778] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/07/2017] [Indexed: 11/09/2022]
Abstract
As life expectancy for people with cystic fibrosis (CF) has increased dramatically, so has the need for a guided, structured transition from pediatric to adult-focused care. A formalized transition program allows for seamless transfer of patients between providers, helping to ensure continuity of care, and avoid potential declines associated with inconsistent medical care. New CF Center guidelines issued by the CFF strongly recommend that each center establish a transition program for age-appropriate transition to an adult CF clinic. In this article, we explore the remaining barriers to establishing a transition program in a CF Center and offer examples of several successful models. We describe CFF-sponsored and other initiatives that exist to support centers in establishing a transition program and discuss the need for ongoing research in this area.
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Affiliation(s)
- Jennifer L Goralski
- Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Samya Z Nasr
- Department of Pediatrics, University of Michigan Health System, Ann Arbor, Michigan
| | - Ahmet Uluer
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Affdal AO, Moutard ML, Billette de Villemeur T, Duchange N, Hervé C, Moutel G. [A difficult transition from childhood to adult healthcare: the case of epilepsy]. Arch Pediatr 2015; 22:337-42. [PMID: 25727476 DOI: 10.1016/j.arcped.2015.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 11/30/2014] [Accepted: 01/21/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The purpose of this study was to analyze modalities of the transition from pediatric to adult epilepsy care and patients' acquisition of autonomy. METHOD This study was conducted using semidirected interviews composed of three major parts: the patient's criteria of transition toward adult healthcare (factors taken into account, anticipation, the patient's opinion, etc.), conditions (teamwork with the neurologists, transmission of the medical record, continuity of health care, etc.), and the role played by social workers and psychologists. We interviewed 10 doctors belonging to six major Parisian hospital units involved in the monitoring of children and adolescents with epilepsy and working in Pediatric Neurology Departments of the Île-de-France region. RESULTS For most of the doctors, reaching 18 years of age was the major argument taken into account to consider transition to adult care. According to the doctors interviewed, parents are generally worried when their child has to find another doctor (7/10). According to eight out of 10 doctors, the neurologist is selected to take over. The doctors recognize the importance of psychologists and social workers even if they are not always included. The process by which the patient gains autonomy depends a great deal on the role played by the pediatricians and parents, although some parents are very protective. This behavior weakens the patient's capacity for autonomy and it varies according to the degree of his or her physical and/or neurological disabilities. Furthermore, developing autonomy requires interdisciplinary work that is not yet fully in place. CONCLUSION The lack of structures well-adapted to the uniqueness of each patient and the lack of coordination between the various institutions do not favor the acquisition of autonomy. A network that could efficiently respond to the needs of epileptic patients as well as medical care tailored to adolescents would be the answer to this dilemma.
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Affiliation(s)
- A-O Affdal
- Institut international de recherche en éthique biomédicale (IIREB), laboratoire d'éthique médicale et médecine légale, faculté de médecine, université Paris 5, 45, rue des Saints-Pères, 75006 Paris, France.
| | - M-L Moutard
- Service de neuropédiatrie, hôpital Trousseau, 26, rue du Docteur Arnold-Netter, 75012 Paris, France
| | - T Billette de Villemeur
- Service de neuropédiatrie, hôpital Trousseau, 26, rue du Docteur Arnold-Netter, 75012 Paris, France
| | - N Duchange
- Institut international de recherche en éthique biomédicale (IIREB), laboratoire d'éthique médicale et médecine légale, faculté de médecine, université Paris 5, 45, rue des Saints-Pères, 75006 Paris, France
| | - C Hervé
- Institut international de recherche en éthique biomédicale (IIREB), laboratoire d'éthique médicale et médecine légale, faculté de médecine, université Paris 5, 45, rue des Saints-Pères, 75006 Paris, France
| | - G Moutel
- Institut international de recherche en éthique biomédicale (IIREB), laboratoire d'éthique médicale et médecine légale, faculté de médecine, université Paris 5, 45, rue des Saints-Pères, 75006 Paris, France
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Suris JC, Rutishauser C, Akré C. [Does talking about it make a difference? Opinions of chronically ill young adults after being transferred to adult care]. Arch Pediatr 2015; 22:267-71. [PMID: 25649648 DOI: 10.1016/j.arcped.2014.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 09/16/2014] [Accepted: 12/08/2014] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The goal of transition in healthcare for young people with chronic illnesses is to maximize their functioning and potential. The purpose of this pilot study was to assess whether young adults with chronic illnesses found that the transition to adult care was easier when the transition was discussed in advance with their pediatric specialist. METHODS Two groups were created according to whether patients had discussed (n=70) or not (n=22) the transition with their pediatric specialist and compared regarding demographic and health-related variables. All the significant variables at the bivariate level were included in a backward stepwise logistic regression. RESULTS Youth who had discussed the transition were significantly more likely to feel ready for the transfer (72.9% vs 45.5%) and accompanied (58.6% vs 27. %) during transfer, to have consulted their specialist for adults (60.0% vs 31.8%), and seen their doctor without the presence of their parents (70.0% vs 40.9%). At the multivariate level, only feeling accompanied during transfer (adjusted odds ratio (aOR): 3.56) and having consulted their specialist for adults (aOR: 4.14) remained significant. CONCLUSIONS Preparing chronically ill youths for transfer to adult care appears to be beneficial for them. However, transfer is only a small part of the much broader transition that is preparation for adult life. A well-planned transition should allow these young people to reach their full potential.
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Affiliation(s)
- J-C Suris
- Groupe de recherche sur la santé des adolescents, institut de médecine sociale et préventive, centre hospitalier universitaire Vaudois, route de la Corniche 10 (Biopôle 2), 1010 Lausanne, Suisse.
| | - C Rutishauser
- Adolescent medicine unit, university children's hospital, Zurich, Suisse
| | - C Akré
- Groupe de recherche sur la santé des adolescents, institut de médecine sociale et préventive, centre hospitalier universitaire Vaudois, route de la Corniche 10 (Biopôle 2), 1010 Lausanne, Suisse
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Transition from pediatric to adult care after solid organ transplantation. Curr Opin Organ Transplant 2009; 14:526-32. [DOI: 10.1097/mot.0b013e32832ffb2a] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Abstract
Health care transition is a process that involves purposeful, planned efforts to prepare the pediatric patient to move from caregiver-directed care to disease self-management. Acquisition of sufficient disease self-management skills for a complex regimen requires cognitive ability consideration for each patient. Transition programs that involve patients, families, pediatric and adult health care providers, and interdisciplinary collaboration are key to ensuring a successful transfer to adult-focused health services. Tools to measure and diagnose the process of transition and acquisition of disease self-management skills are introduced. An evidence-based transition process requires planning and education, in addition to effective coordination.
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Affiliation(s)
- Maria E Ferris
- Division of Nephrology and Hypertension, UNC Kidney Center at the University of North Carolina, 7021 Burnett Womack, Chapel Hill, NC 27599-7155, USA.
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Peter NG, Forke CM, Ginsburg KR, Schwarz DF. Transition from pediatric to adult care: internists' perspectives. Pediatrics 2009; 123:417-23. [PMID: 19171604 DOI: 10.1542/peds.2008-0740] [Citation(s) in RCA: 213] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The goal was to understand the concerns of adult health care providers regarding transition for young adult patients with childhood-onset conditions. METHODS Internists from the 2000 American Board of Medical Specialties directory were selected randomly. A 2-stage mail survey was conducted from August 2001 to November 2004. In stage 1, providers stated their concerns regarding accepting care of transitioning young adult patients. In stage 2, providers ranked their concerns. RESULTS A total of 241 internal medicine providers were selected for participation. In stage 1, 134 of 241 physicians were eligible to participate, and 67 (50%) of 134 completed stage 1 surveys. In stage 2, 112 physicians were eligible, and 65 (58%) of 112 responded. Concerns elicited in stage 1 were clustered into 6 categories: patient maturity, patient psychosocial needs, family involvement, providers' medical competency, transition coordination, and health system issues. In stage 2, concerns rated highest were lack of training in congenital and childhood-onset conditions, lack of family involvement, difficulty meeting patients' psychosocial needs, needing a superspecialist, lack of adolescent training, facing disability/end-of-life issues during youth and early in the relationship, financial pressures limiting visit time, and families' high expectations. CONCLUSIONS Internists clearly stated the need for better training in congenital and childhood-onset conditions, training of more adult subspecialists, and continued family involvement. They also identified concerns about patients' psychosocial issues and maturity, as well as financial support to care for patients with complex conditions.
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Affiliation(s)
- Nadja G Peter
- Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
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McDonagh JE. Young people first, juvenile idiopathic arthritis second: Transitional care in rheumatology. ACTA ACUST UNITED AC 2008; 59:1162-70. [DOI: 10.1002/art.23928] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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10
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Dabadie A, Troadec F, Heresbach D, Siproudhis L, Pagenault M, Bretagne JF. Transition of patients with inflammatory bowel disease from pediatric to adult care. ACTA ACUST UNITED AC 2008; 32:451-9. [PMID: 18472377 DOI: 10.1016/j.gcb.2008.01.044] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Revised: 01/08/2008] [Accepted: 01/09/2008] [Indexed: 12/11/2022]
Abstract
AIM This study was designed to ascertain the perception of patients (and their parents) followed-up for inflammatory bowel disease (IBD) concerning the transition from pediatric to adult care. PATIENTS AND METHODS Forty-eight youths with IBD who had transited from pediatric to adult care were surveyed. Their age at transition was 17.9+/-0.9 years. Thirty-four patients (71%) had been referred to a gastroenterologist working in the same hospital and, in 27 cases, after having attended a joint pediatric-adult care visit. RESULTS The response rate was 71%. Twenty-nine patients (85%) and 25 parents (74%) felt they were ready to transit into adult care. Seven patients (22%) and 10 parents (32%) were apprehensive about transition to adult gastroenterology. All patients considered the joint medical visit beneficial in terms of transmitting information from their medical records and 93% considered it beneficial for building confidence in the new gastroenterologist. All parents considered the joint medical visit helpful for building the children's confidence in their new doctor. At the time of the survey, 29 patients (85%) were continuing to be followed-up by the same gastroenterologist. CONCLUSION Effective planning, including a joint medical visit, enabled successful, well-coordinated transition to adult medical-care follow-up.
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Affiliation(s)
- A Dabadie
- Département de médecine de l'enfant et de l'adolescent, CHU hôpital Anne-de-Bretagne, 16, boulevard de Bulgarie, B.P. 900347, 35203 Rennes cedex 2, France.
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Abstract
The origin of paediatric rheumatology in the UK mainly lies in adult rheumatology and this has proved invaluable in terms of transition provision, education and training, and collaborative research. The last 5 years have seen adolescent rheumatology gather momentum with the creation of an objective evidence base, a sound foundation for future work addressing the many unanswered questions and hypotheses in the area of transitional care. The aim of this paper is to review the evidence supporting the recent developments in transitional care within rheumatology. Acknowledging the non-categorical nature of transition, the author will also refer to evidence from other chronic illnesses which has informed these developments.
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Affiliation(s)
- Janet E McDonagh
- Department of Paediatric and Adolescent Rheumatology, Institute of Child Health, Birmingham Children's Hospital NHS Trust, Steelhouse Lane, Birmingham B4 6NH, UK.
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Tubiana-Rufi N, Lahaie E, Jacquin P, Guitard-Munnich C, Houdan J, du Pasquier L. Le passage des adolescents diabétiques de la pédiatrie à la médecine pour adultes: être ou ne pas être perdu en transit? Arch Pediatr 2007; 14:659-61. [PMID: 17419029 DOI: 10.1016/j.arcped.2007.02.084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Accepted: 02/27/2007] [Indexed: 11/19/2022]
Affiliation(s)
- N Tubiana-Rufi
- Service d'endocrinologie-diabétologie, Assistance publique-Hôpitaux de Paris, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France.
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Clay OJ, Telfair J. Evaluation of a Disease-Specific Self-Efficacy Instrument in Adolescents with Sickle Cell Disease and its Relationship to Adjustment. Child Neuropsychol 2007; 13:188-203. [PMID: 17364574 DOI: 10.1080/09297040600770746] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The psychometric properties of a disease-specific instrument used to assess self-efficacy in adolescents with sickle cell disease, the Sickle Cell Self-Efficacy Scale, were evaluated in a sample of 131 adolescents ranging from 11 to 19 years of age. This nine-item instrument was associated with a one-item, general self-efficacy question and an item of self-control. After controlling for age, gender, highest grade of education completed, and the number of individuals in the household, high levels of self-efficacy were related to fewer physical, psychological, and total symptoms. Using the stress process framework to examine the relationship between self-efficacy and self-reported symptoms in adolescents may lead to the initiation of effective intervention programs capable of increasing levels of self-efficacy in adolescents. These interventions could lead to better outcomes for adolescents with sickle cell disease. Additional longitudinal investigations are needed to evaluate the ability of self-efficacy to predict adolescent adjustment over time.
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Affiliation(s)
- Olivio J Clay
- Department of Biostatistics, University of Alabama at Birmingham, AL 35294-0022, USA
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Aujoulat I, Simonelli F, Deccache A. Health promotion needs of children and adolescents in hospitals: a review. PATIENT EDUCATION AND COUNSELING 2006; 61:23-32. [PMID: 16533675 DOI: 10.1016/j.pec.2005.01.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2003] [Revised: 01/17/2005] [Accepted: 01/22/2005] [Indexed: 05/07/2023]
Abstract
The concept of health promotion for children and adolescents in hospitals is relatively new, and an international working group within the WHO-network of Health Promoting Hospitals, is currently seeking to establish specific guidelines. An exploratory study based on a literature review was performed in order to identify (i) what are the health promotion needs of children and adolescents when they access the hospital either as patients, as visitors, or as members of their community; and (ii) if there are any recommended strategies to empower children and strengthen their life-skills and participation capacity in the hospital, as recommended by the Ottawa Charter for Health Promotion. The results of this literature review are mainly descriptive of current practices and recommendations regarding organizational issues, health-care providers' practice behavior, health-care providers' skills and training, children's education, education of parents and social environment.
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Affiliation(s)
- Isabelle Aujoulat
- Health and Patient Education Unit RESO, School of Public Health/Health Systems Research, Université Catholique de Louvain, 50 Avenue Mounier, B-1200 Brussels, Belgium.
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Telfair J, Ehiri JE, Loosier PS, Baskin ML. Transition to adult care for adolescents with sickle cell disease: results of a national survey. Int J Adolesc Med Health 2004; 16:47-64. [PMID: 15148858 DOI: 10.1515/ijamh.2004.16.1.47] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective was to present the 'voice' of adolescents with sickle cell disease (SCD) as part of the discussion of transition issues by identifying and documenting their expressed concerns and expectations, as well as what program priorities they perceive would facilitate a smooth transition to adult care. Cross-sectional data were collected by means of structured questionnaire interviews, using standard instruments. A volunteer sample of 172 adolescents with SCD aged 14 years and older still in pediatric care within community-based and medical center SCD programs across the United States was recruited. Statistically significant results indicated the top concerns of adolescents were: lack of information relating to their transition to adult care; fear of leaving the healthcare provider with whom they were already familiar, fear that adult care providers might not understand their needs; belief that an SCD transition program was needed and that it should focus on provider support; information provision about adult care programs; ways to meet adult care providers; and ways to help healthcare providers understand their needs. We conclude that many adolescents with SCD have concerns and fears about their transition to adult care. Based on findings from this study, it is recommended that transition programs address structural and interpersonal issues of adolescents and providers if they are to be successful. Strategies by which this can be achieved are recommended, including the need to encourage, support and provide assistance for peer education, outreach programs and peer-led instructions, since these hold great promise as approaches that are adolescent-centered and adolescent-delivered.
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Affiliation(s)
- Joseph Telfair
- Department of Maternal and Child Health, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd., Suite 320, Birmingham, AL 35294-0022, USA.
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Dommergues JP, Alvin P. [Transition from pediatric to adult care in severe chronic diseases in children]. Arch Pediatr 2003; 10:295-9. [PMID: 12818748 DOI: 10.1016/s0929-693x(03)00041-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Volta C, Luppino T, Street ME, Bernasconi S. Transition from pediatric to adult care of children with chronic endocrine diseases: a survey on the current modalities in Italy. J Endocrinol Invest 2003; 26:157-62. [PMID: 12739744 DOI: 10.1007/bf03345145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We report on a survey carried out in 65 pediatric and adult endocrinological centers concerning: 1) the modalities of the transfer of children with chronic endocrine diseases from pediatricians to adult endocrinologists, 2) opinions and suggestions from physicians of the Centers, and 3) specific details regarding GH deficiency. The main results are: 1) The mean age of transfer is around 18 yr of age. 2) The reasons for the transfer are personal convincement of pediatricians in 47%, administrative reasons in 37% and patient's desire in 16% of cases 3) In the majority of cases a discharge summary is sent by the pediatrician to the endocrinologist often followed by a phone call, whereas 30% of endocrinologists do not send a report back to pediatricians. 4) Less than half of the Centers are satisfied with the modalities of the transfer and the remainder complain about the lack of communication, no common guidelines, and differences in the management of patients. However, all are willing to try to improve this important time for adolescents with chronic diseases. 5) As far as GH deficiency is concerned, the main differences between pediatric and adult endocrinological centers are the different tests used to re-evaluate the diagnosis and the higher doses of GH used by pediatricians to treat young adults. In conclusion, considering the interest and desire of physicians, a structural intervention of the scientific societies to help to overcome problems is highly desirable.
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Affiliation(s)
- C Volta
- Department of Pediatrics, University of Parma, Parma, Italy
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Tsamasiros J, Bartsocas CS. Transition of the adolescent from the children's to the adults' diabetes clinic. J Pediatr Endocrinol Metab 2002; 15:363-7. [PMID: 12008681 DOI: 10.1515/jpem.2002.15.4.363] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The transition of adolescents with type 1 diabetes mellitus (T1DM) from pediatric to adult diabetological care is a critical phase that requires special attention. A considerable proportion of adolescents encounters certain difficulties during this transition, which can negatively affect adjustment and glycemic control. Etiological factors include: (a) the adolescent's separation anxiety elicited by the process of departing from the pediatrician who functions as a secure base in a period of developmental turmoil; (b) certain developmental factors that adversely affect glycemic control and the patient-physician cooperation; (c) the tendency of the adult diabetologist to focus more on medical than on psychosocial components; (d) the lack of the appropriate preparatory work which would: (i) help the adolescent to successfully cope with the difficulties that may arise due to the transition and (ii) make feasible the establishment of the proper pediatrician-adult diabetologist cooperation required for the development of a continuum in diabetological care through which the adolescent's special needs can be best met. Practical propositions about certain basic problem-solving components concerning the transition from the pediatric to adult diabetes clinic are briefly discussed.
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Affiliation(s)
- John Tsamasiros
- Diabetes Center, Department of Pediatrics, Faculty of Nursing, University of Athens, Greece
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