Rayzel Shulman1, Roger Chafe2, Astrid Guttmann3. 1. Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. Electronic address: rayzel.shulman@sickkids.ca. 2. Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland, Canada. 3. Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
Abstract
OBJECTIVES: Individuals living with diabetes often experience gaps in care, poor experiences and acute complications when they transfer from pediatric to adult care. We aimed to describe the structure of diabetes transition care in Ontario and to explore perceptions of barriers to optimal outcomes. METHODS: We conducted a cross-sectional descriptive study of 35 centres in the Pediatric Diabetes Network in Ontario between April and June 2017. We collected survey data about the number of individuals with all diabetes types transferring to adult care, transition practices and providers' perceptions of facilitators of and barriers to optimal transition. RESULTS: All centres completed the survey. In 2015, 631 of 7,485 (8.4%) individuals with all types of diabetes were transferred to adult care. Of those, 28 of 35 (80%) centres (representing 93% of individuals with all diabetes types) referred at least some individuals to adult endocrinologists. There is a range of centre-transition practices (e.g. structured preparation, workshops, combined visits, transition coordinators). Of the 35 centres, 25 (71%) reported conducting at least 1 initiative to improve transition care. Centres reported challenges related to transition preparation, communication with adult teams, adult programs' abilities to meet the needs of young adults and loss to follow up. CONCLUSIONS: Variations in transition practices present a future opportunity to study the relationship between transition approaches and outcomes. The creation of a provincial data infrastructure that extends beyond transfer to adult care and that facilitates sharing among pediatric and adult centres could foster the development of a learning health system designed to improve transition care and outcomes.
OBJECTIVES: Individuals living with diabetes often experience gaps in care, poor experiences and acute complications when they transfer from pediatric to adult care. We aimed to describe the structure of diabetes transition care in Ontario and to explore perceptions of barriers to optimal outcomes. METHODS: We conducted a cross-sectional descriptive study of 35 centres in the Pediatric Diabetes Network in Ontario between April and June 2017. We collected survey data about the number of individuals with all diabetes types transferring to adult care, transition practices and providers' perceptions of facilitators of and barriers to optimal transition. RESULTS: All centres completed the survey. In 2015, 631 of 7,485 (8.4%) individuals with all types of diabetes were transferred to adult care. Of those, 28 of 35 (80%) centres (representing 93% of individuals with all diabetes types) referred at least some individuals to adult endocrinologists. There is a range of centre-transition practices (e.g. structured preparation, workshops, combined visits, transition coordinators). Of the 35 centres, 25 (71%) reported conducting at least 1 initiative to improve transition care. Centres reported challenges related to transition preparation, communication with adult teams, adult programs' abilities to meet the needs of young adults and loss to follow up. CONCLUSIONS: Variations in transition practices present a future opportunity to study the relationship between transition approaches and outcomes. The creation of a provincial data infrastructure that extends beyond transfer to adult care and that facilitates sharing among pediatric and adult centres could foster the development of a learning health system designed to improve transition care and outcomes.
Keywords:
adolescent; diabetes mellitus; diabète sucré; health services; jeune adulte; services de santé; transition to adult care; transition vers les soins pour adultes; young adult
Authors: Rayzel Shulman; Ian Zenlea; Baiju R Shah; Cheril Clarson; Jennifer Harrington; Alanna Landry; Zubin Punthakee; Mark R Palmert; Geetha Mukerji; Peter C Austin; Janet Parsons; Noah Ivers Journal: BMC Health Serv Res Date: 2019-11-25 Impact factor: 2.655
Authors: Anna Lena Brorsson; Ewa-Lena Bratt; Philip Moons; Anna Ek; Elisabeth Jelleryd; Torun Torbjörnsdotter; Carina Sparud-Lundin Journal: BMJ Open Date: 2020-04-14 Impact factor: 2.692