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    How to transition adolescents with diabetes from pediatric to adult care

     

    Overall, there was little formality to the transition process. Just 3 facilities used structured transition readiness and self-care skills assessments and regularly updated patient progress. Other facilities may have done these things, but did so informally and without a structured plan, the report notes. Follow-up after transition was also lacking, with only 2 facilities arranging posttransfer assessments.

    Barriers to the transition process included a lack of adult care providers—half of the facilities reported an insufficient number of adult providers—and less flexibility in adult care scheduling. Young adults transitioning from pediatric care to adult care also reported struggling with new and added self-care responsibilities, and adult care providers did not seem to understand or support these patient struggles, according to the study.

    “There was a perception that the quality of pediatric care was better than adult care,” the research team notes. “There was a perception that adult care providers wrongly expected emerging adults to be fully autonomous by the age of 18 years, irrespective of the patient’s developmental stage,” they write. “As a result, if a patient was not fully autonomous or responsible for his or her care, pediatric providers perceived that there were no specific strategies or approaches in place in the adult care setting for support.”

    Follow-up after transition was also lacking, with many facilities reporting a lack of staff to manage both transitions and follow-up. Providers also reported that patients who had to start seeing a provider in a new region also had poor follow-up when compared with those who were able to stay within the same facility or region.

    The most successful programs overlap pediatric and adult care, and transition success was most often measured by a combination of patient satisfaction and regular follow-up.

    Despite the fact that there were few formal transition processes in place, the pediatric providers polled in the study didn’t indicate that the problem was in their practices.

    Next: Newborn with persisten hypoglycemia

    “Pediatric providers did not perceive that their current transition practices at the pediatric care level were unsatisfactory and, in fact, providers felt that barriers to transition care were mainly within the adult care setting,” the report says. “This is in contrast to several studies of emerging adults who have reported a lack of purposeful transition preparation and dissatisfaction with the transition process within the pediatric care setting. . . . The discrepancy between what pediatric providers perceive as adequate transition preparation and what they reported being done for transition preparation is concerning.”

    The difference in the perceptions of pediatric providers and their patients may indicate a lack of knowledge, according to the study, which notes that 68% of US pediatricians say they have not received adequate training on transitioning diabetic care.

    The authors write that skills, self-care, and readiness assessments are key to a successful transition, along with early discussions and a structured plan for making the change. “Our findings highlight the need for a more structured approach to transition care. When emerging adults are supported through the transition period, clinic attendance, adverse outcomes, and loss to follow-ups improve,” they say.

    The study recommends that pediatricians evaluate their current practices for transitioning diabetic patients to adult care. Assessment tools including the Transition Readiness Assessment Questionnaire (TRAQ) or the Am I ON TRAC for Adult Care (ON TRAC) Questionnaire can help providers prepare patients for transition, the study suggests. The research team also recommends increased collaboration between pediatric and adult providers to develop a better system for transitioning young adults, with structured approaches backed by improved education and training for pediatric providers.

    Rachael Zimlich, RN
    Rachael Zimlich is a freelance writer in Cleveland, Ohio. She writes regularly for Contemporary Pediatrics, Managed Healthcare ...

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