Closing the Gap: Results of the Multicenter Canadian Randomized Controlled Trial of Structured Transition in Young Adults With Type 1 Diabetes

Spaic, Tamara; Robinson, Tracy; Goldbloom, Ellen B; Gallego, Patricia; Hramiak, Irene; Lawson, Margaret L.; Malcolm, Janine; Mahon, Jeffrey L.; Morrison, Deric; Parikh, Amish; Simone, A; Stein, Robert; Uvarov, Artem; Clarson, Cheril

doi:10.2337/dc18-2187

Cited by 64 publications

(60 citation statements)

References 31 publications

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“…Transition needs to be implemented as a joint approach from paediatric and adult services (Box 3). The process is simpler where the allergy service caters for all age groups but a separate AYA transition clinic is still helpful to facilitate a smooth transition care process which addresses the age and developmental specific needs for AYA that has been shown to be successful in different diseases 89‐92 . As most HCP have received only minimal specific training on how to manage this age group, this is likely to require additional staff training in delivering developmentally appropriate health care (Table 6).…”

Section: Discussion Gaps In the Evidence And Future Perspectivesmentioning

confidence: 99%

EAACI Guidelines on the effective transition of adolescents and young adults with allergy and asthma

Roberts

Vazquez‐Ortiz

Knibb

et al. 2020

Allergy

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Adolescent and young adult (AYA) patients need additional support, while they experience the challenges associated with their age. They need specific training to learn the knowledge and skills required to confidently self‐manage their allergies and/or asthma. Transitional care is a complex process, which should address the psychological, medical, educational and vocational needs of AYA in the developmentally appropriate way. The European Academy of Allergy and Clinical Immunology has developed a clinical practice guideline to provide evidence‐based recommendations for healthcare professionals to support the transitional care of AYA with allergy and/or asthma. This guideline was developed by a multidisciplinary working panel of experts and patient representatives based on two recent systematic reviews. It sets out a series of general recommendations on operating a clinical service for AYA, which include the following: (a) starting transition early (11‐13 years), (b) using a structured, multidisciplinary approach, (c) ensuring AYA fully understand their condition and have resources they can access, (d) active monitoring of adherence and (e) discussing any implications for further education and work. Specific allergy and asthma transition recommendations include (a) simplifying medication regimes and using reminders; (b) focusing on areas where AYA are not confident and involving peers in training AYA patients; (c) identifying and managing psychological and socio‐economic issues impacting disease control and quality of life; (d) enrolling the family in assisting AYA to undertake self‐management; and (e) encouraging AYA to let their friends know about their allergies and asthma. These recommendations may need to be adapted to fit into national healthcare systems.

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Section: Discussion Gaps In the Evidence And Future Perspectivesmentioning

confidence: 99%

EAACI Guidelines on the effective transition of adolescents and young adults with allergy and asthma

Roberts

Vazquez‐Ortiz

Knibb

et al. 2020

Allergy

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“…23 Transition trials thus far have been unsuccessful in showing improved follow up rates post transfer. [24][25][26] In the development of tools and strategies to improve diabetes transition care, it is important to have the input of key stakeholders, namely patients and their families, prior to their development and implementation, rather than relying solely on physician or other health care provider's feedback alone. While a few studies have documented the experience of young adult with diabetes, these tend to only include those individuals post-transfer and in a private payer health care setting.…”

Section: Introductionmentioning

confidence: 99%

Youth with diabetes and their parents' perspectives on transition care from pediatric to adult diabetes care services: A qualitative study

Butalia

McGuire

Dyjur³

et al. 2020

Health Science Reports

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Background and Aims When youth with diabetes transition from pediatric to adult diabetes care, they are at high risk for loss to follow up and worsening glucose control. We aimed to gain insight on how to improve the transition of youth with type 1 diabetes from pediatric to adult diabetes care from the patients' and parents' perspective. Methods We conducted focus groups in youth with type 1 diabetes in transition from pediatric to adult diabetes care and their parents, in Calgary, Alberta, between June and August 2014. Eligibility criteria included: (a) type 1 diabetes; (b) aged 15 to 25 years; (c) have or had received care at the pediatric hospital; and, (d) either pre or post‐transfer; or, (e) parents of recently transferred youth. Purposive sampling was used, and the theoretical framework used was the Integrated Behaviour Model. Participants were asked about positive, negative, or challenging experiences related to diabetes and transition, solutions to challenges, and tools and strategies to improve and better support transition. Thematic analysis was conducted after focus groups were recorded and transcribed. Results Three focus groups were conducted: pre‐transfer youth with diabetes (4 females and 3 males; median age 17.5 years, IQR 1.3 years); post‐transfer young adults with diabetes (2 females and 2 males; median age 23.5 years, IQR 1.2 years); and parents of recently transferred young adults with diabetes (n = 3). Main themes were: (a) communication technology; (b) the need for more transition and diabetes education and preparation during transition; and, (c) the importance and need for social and peer support. Conclusion This study describes specific areas that may improve diabetes transfer and transition from pediatric to adult diabetes care. This information can help inform clinical care delivery for transition and the development of programs, strategies, and interventions to improve transition care.

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“…In a Canadian study, structured program for transition was helpful in improving clinical attendance and decreasing diabetes-associated distress. 32) Transition process varied by clinics. 23) Moreover, transition is influenced by psychosocial development of patient and family background.…”

Section: A C C E P T E Dmentioning

confidence: 99%

A national survey of transition from pediatric to adult healthcare providers for adolescents and young adults with type 1 diabetes: perspectives of pediatric endocrinologists in Korea

Kim

Yoo

2021

Ann Pediatr Endocrinol Metab

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Transition from pediatric to adult healthcare for adolescents and young adults with type 1 diabetes (T1D) increases the risk for poor outcomes. This study aimed to describe the circumstances and clinical practice patterns associated with this transition care from a nationwide survey of pediatric endocrinologists in Korea. Methods: An electronic survey regarding healthcare transition of T1D patients was administered to 143 pediatric endocrinologists registered in the Korean Society of Pediatric Endocrinology. Results: Response rate was 50.2% (n = 72). Among responders, 58.3% (n = 42) were females and 70.8% (n = 51) worked in academic medical centers. Main reasons for transfer to adult care were request from a patient or family (69.6%) and age ≥ 18 years (42.0%). Impediments to transition were long-lasting therapeutic relationship (72.9%) and lack of adult specialists in T1D care (62.9%). Communication between pediatric and adult endocrinologists was via non-structured patient summary (68.6%) and telephone or e-mail (27.1%). Responders reported that successful transition requires development of transition protocols (79.2%) and multidisciplinary team approach for transition care (52.8%). Conclusion: Transition care of T1D patients was a challenge to pediatric endocrinologists in Korea. Development of protocols for transition care for healthcare providers and improvement of diabetes self-management skills for patients are needed.

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Closing the Gap: Results of the Multicenter Canadian Randomized Controlled Trial of Structured Transition in Young Adults With Type 1 Diabetes

Cited by 64 publications

References 31 publications

EAACI Guidelines on the effective transition of adolescents and young adults with allergy and asthma

EAACI Guidelines on the effective transition of adolescents and young adults with allergy and asthma

Youth with diabetes and their parents' perspectives on transition care from pediatric to adult diabetes care services: A qualitative study

A national survey of transition from pediatric to adult healthcare providers for adolescents and young adults with type 1 diabetes: perspectives of pediatric endocrinologists in Korea

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