Audit of young people with type 1 diabetes transferring from paediatric to adult diabetic services

Abstract

Five years ago a new Young Persons' clinic was set up at the Royal Victoria Hospital, Belfast, to facilitate transfer from paediatric to adult services. Following establishment of the new clinic, this audit was carried out to ascertain attendance of those transferring to adult diabetic clinics, to identify reasons for non‐attendance, and to provide a basis for improving transfer. Outcome measures following transfer were HbA1c and number of failed appointments. Over a two‐year period 33 patients with type 1 diabetes mellitus transferred to the adult diabetic clinics at the Royal Victoria Hospital, and four transferred to other hospitals. Six of those patients supposed to transfer to the adult diabetic clinic at the Royal Victoria Hospital were not seen over the two‐year follow up. Only six patients attended all scheduled appointments. Following transfer, attendance was rated good in 36%, moderate in 33% and poor in 30%. Attendance did not appear to be related to control following transfer. There was an impression of better attendance at the Young Persons' clinic compared to those who transferred to the routine adult clinic. Whilst the new clinic can be considered successful, significant concerns remain about attendance around the time of transfer from paediatric to adult services. Copyright © 2006 John Wiley & Sons, Ltd.

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

“…Table 2 summarizes the major intervention studies. 4,[13][14][15][16][17] In essence, interventions aimed at decreasing loss to follow-up achieve this aim. However, no studies show a better outcome in terms of metabolic control, psychosocial adjustment, complication rates, or other metabolic or medical indicators.…”

Evaluating Continuity During Transfer to Adult Care: A Systematic Review

“…20,22 Attendance at scheduled clinic appointments after transfer, reported in 5 studies (Table 5), was measured as the mean percentage of scheduled appointments attended per year in 2 studies, 6,26 as the proportion of patients attending appointments at 1 year 36 or 2 years, 37 or as the number of failed appointments. 27 One study on diabetes found a trend toward better attendance after structured than after unstructured transition. 26 …”

Measuring the “Triple Aim” in Transition Care: A Systematic Review

“…All 33 studies examined transition in the context of a specific medical condition as opposed to examining transition for all youth with or without chronic conditions. Twelve studies evaluated programs for patient with diabetes mellitus (DM), [15][16][17][18][19][20][21][22][23][24][25][26] 4 for transplant recipients, [27][28][29][30] 3 each for those with arthritis [31][32][33] and sickle cell disease, 34-36 2 for patients with cystic fibrosis, 37,38 and 1 study each for those with cancers, 39 congenital adrenal hyperplasia, 40 HIV, 41 mental health conditions, 42 inflammatory bowel disease, 43 spina bifida, 44 and kidney failure. 45 One study looked at a combination of patients with traumatic brain injury, cerebral palsy, spina bifida, and degenerative muscular disorders.…”

“…Gaps in care, defined as loss to followup over a specified period, 25,40 missed appointments, 19 and the time frame between attendance in pediatric and adult clinics 15 were evaluated in 4 studies.…”