Brooke Allemang1,2, Kate Allan3, Colleen Johnson2,4, Melina Cheong1,4, Patrina Cheung5, Isaac Odame1,6, Richard Ward2,6, Suzan Williams1,6, Geetha Mukerji5,7, Kevin H M Kuo2,6. 1. Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada. 2. Division of Medical Oncology and Hematology, Department of Medicine, University Health Network, Toronto, Ontario, Canada. 3. Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada. 4. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada. 5. Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. 6. Division of Hematology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 7. Women's College Hospital, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Transition from pediatric to adult care is a period of high risk for loss to follow-up, morbidity, and mortality in adolescents and young adults (AYA) with hemoglobinopathies. The purpose of this study was to determine whether a transition program with transition navigator (TN) reduced loss to follow-up and hospitalizations and improved medication adherence and appointment attendance compared with an unstructured transfer. PROCEDURE: A retrospective observational study compared all AYA with hemoglobinopathies who turned 18 one year prior to (n = 51) and one year after (n = 61) the initiation of the transition program. Data from one year prior to last pediatric appointment and one year following first adult appointment were collected from each patient. RESULTS: The transition program with TN reduced loss to follow-up from 29% to 7% (P = 0.034). A greater proportion of patients in the transition cohort maintained or improved adherence to hydroxyurea or iron chelation to ≥4 days/week; exposure to the program was independently associated with such improvement (P = 0.047). A trend toward improvement or maintenance of ≥90% attendance to appointments was observed (P = 0.096). Frequency of hospitalization was not significantly different between the two cohorts (P = 0.985). CONCLUSIONS: A transition program with TN significantly reduced loss to follow-up, and significantly improved and maintained fair to good medication adherence. Further analysis of economic benefit and patient satisfaction will be conducted.
BACKGROUND: Transition from pediatric to adult care is a period of high risk for loss to follow-up, morbidity, and mortality in adolescents and young adults (AYA) with hemoglobinopathies. The purpose of this study was to determine whether a transition program with transition navigator (TN) reduced loss to follow-up and hospitalizations and improved medication adherence and appointment attendance compared with an unstructured transfer. PROCEDURE: A retrospective observational study compared all AYA with hemoglobinopathies who turned 18 one year prior to (n = 51) and one year after (n = 61) the initiation of the transition program. Data from one year prior to last pediatric appointment and one year following first adult appointment were collected from each patient. RESULTS: The transition program with TN reduced loss to follow-up from 29% to 7% (P = 0.034). A greater proportion of patients in the transition cohort maintained or improved adherence to hydroxyurea or iron chelation to ≥4 days/week; exposure to the program was independently associated with such improvement (P = 0.047). A trend toward improvement or maintenance of ≥90% attendance to appointments was observed (P = 0.096). Frequency of hospitalization was not significantly different between the two cohorts (P = 0.985). CONCLUSIONS: A transition program with TN significantly reduced loss to follow-up, and significantly improved and maintained fair to good medication adherence. Further analysis of economic benefit and patient satisfaction will be conducted.
Authors: Jennifer Tsui; Jenna Howard; Denalee O'Malley; William L Miller; Shawna V Hudson; Ellen B Rubinstein; Jeanne M Ferrante; Alicja Bator; Benjamin F Crabtree Journal: BMC Fam Pract Date: 2019-11-28 Impact factor: 2.497
Authors: Czar Louie Gaston; Kathleen Taleon; Ken Barsales; Cesar Dimayuga; Jochrys Estanislao; Pamela Fajardo; Albert Quintos; Donnel Rubio; Edward Wang; Ana Patricia Alcasabas Journal: Asian Pac J Cancer Prev Date: 2021-09-01