Complex care pathways for children with multiple referrals demonstrated in a retrospective population‐based study

Heggestad, Torhild; Greve, Gottfried; Skilbrei, Birger; Elgen, Irene Bircow

doi:10.1111/apa.15250

Cited by 9 publications

(17 citation statements)

References 24 publications

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“…As reported in a preceding hospital register study of children between 6 and 13 years, more than a third of patients had repeated referrals, and 9% of all patients were referred to both the pediatric department and the child and adolescent mental health services (CAMHS) ( 6 ). The pediatric sub-specialties most often included in such combined referrals were found to be gastroenterology and neurology.…”

Section: Methods/ Designmentioning

confidence: 99%

“…According to the register research ( 6 , 7 ), the initial four criteria were included in the operationalization of inclusion criteria:…”

Section: Methods/ Designmentioning

confidence: 99%

“…Thus, it was reasonable to include both a pediatrician and a psychologist in the team. In our registry study, children with health problems related to gastrointestinal or neurological systems constituted the largest groups ( 6 , 7 ). Thus, colleagues with long experience in gastroenterology and neurology were invited to participate in the professional teams.…”

Section: Methods/ Designmentioning

confidence: 99%

“…Patients “crossing over” between somatic and mental health care seem to be particularly affected. Many of these children end up with multiple referrals to the specialized health services ( 5 , 6 ). Multiple referrals are a conundrum with high risk of unsatisfactory and delayed diagnosis and treatment.…”

Section: Introductionmentioning

confidence: 99%

“…To explore the patterns of specialized care for this patient group, we performed a register study in 2016, concentrating on repeated referrals as suggested by the WHO-definition of complex care ( 6 – 8 ). Our findings demonstrated that over a third of young patients had repeated referrals, and nearly 10 percent were referred to both somatic and mental health care during the observation period of 3 years.…”

Section: Introductionmentioning

confidence: 99%

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Bridging the Gap for Children With Compound Health Challenges: An Intervention Protocol

et al. 2021

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Background: During the last decades, there is a major shift in the panorama of diseases in children and adolescents. More children are referred to the specialized health care services due to less specific symptoms and more complex health challenges. These children are particularly difficult to care for in a “single-disease” oriented system. Our objective was to develop an alternative and more holistic approach better tailored to the complex needs of these children.Method: The target patient population is children between 6 and 13 years with three or more referrals including both the pediatric department and the mental health services. Furthermore, to be included in the project, the child's actual complaints needed to be clinically considered as an unclear or compound condition in need of an alternative approach. This paper describes the process of developing an intervention where a complementary professional team meets the patient and his/her family altogether for 2.5 h. The consultation focus on clarifying the complex symptomatology and on problem solving. The bio-psycho-social model is applied, emphasizing the patient's story as told on the whiteboard. In the dynamic processes of development, piloting, evaluating, and adjusting the components, feed-back from the patients, their families, professional team members, and external team coaches is important.The professional teams include pediatricians, psychologists and physiotherapists. Achieving the transformation from a logistic oriented team where members act separately toward a real complementary team, seems to be a success factor.Discussion: Composing multi-disciplinary and complementary teams was an essential part of the re-designed intervention. Team interaction transforming the professionals from working as a logistic team to act as a complementary team, was one of the important requirements in the process. When re-designing the specialist health service, it is mandatory to anchor all changes among employees as well as the hospital leadership. In addition, it is important to include patient experiences in the process of improvement. Evaluation of long-term outcomes is needed to investigate possible benefits from the new intervention.Trial Registration: Transitioning Young Patients' Health Care Trajectories, NCT04652154. Registered December 3rd, 2020–Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04652154?term=NCT04652154&draw=2&rank=1.

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Section: Methods/ Designmentioning

confidence: 99%

“…According to the register research ( 6 , 7 ), the initial four criteria were included in the operationalization of inclusion criteria:…”

Section: Methods/ Designmentioning

confidence: 99%

Section: Methods/ Designmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Bridging the Gap for Children With Compound Health Challenges: An Intervention Protocol

et al. 2021

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Identifying Risk Factors Associated with Repeated Referrals Within a Pediatric Navigation Program

Koob,

Stuenkel,

Gagnon

et al. 2023

J Community Health

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How can we improve specialist health services for children with multi-referrals? Parent reported experience

Lygre

Thuen

Gjestad

et al. 2020

BMC Health Serv Res

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Background Children with combined mental and somatic conditions pose a challenge to specialized health services. These cases are often characterized by multi-referrals, frequent use of health services, poor clinical and cost effectiveness, and a lack of coordination and consistency in the care. Reorganizing the health services offered to these children seems warranted. Patient reported experiences give important evidence for evaluating and developing health services. The aim of the present descriptive study was to explore how to improve specialist health services for children with multiple referrals for somatic and mental health conditions. Based on parent reported experiences of health services, we attempted to identify key areas of improvement. Methods As part of a larger, ongoing project; “Transitioning patients’ Trajectories”, we asked parents of children with multiple referrals to both somatic and mental health departments to provide their experiences with the services their children received. Parents/guardians of 250 children aged 6–12 years with multi-referrals to the Departments of Pediatrics and Child and Adolescent Mental Health at Haukeland University Hospital between 2013 and 2015 were invited. Their experience was collected through a 14 items questionnaire based on a generic questionnaire supplied with questions from parents and health personnel. Possible associations between overall experience and possible predictors were analyzed using bivariate regression. Results Of the 250 parents invited, 148 (59%) responded. Mean scores on single items ranged from 3.18 to 4.42 on a 1–5 scale, where five is the best possible experience. In the multiple regression model, perception of wait time ( r = .56, CI = .44–.69 / β = 0.16, CI = .05–.28), accommodation of consultations ( r = .71, CI = .62–.80 / β = 0.25, CI = .06–.45 / β = 0.27, CI = .09–.44), providing adequate information about the following treatment ( r = .66, CI = .55–.77 / β = 0.26, CI = .09–.43), and collaboration between different departments at the hospital ( r = .68, CI = .57–.78 / β = 0.20, CI = -.01–.40) were all statistically significantly associated with parents overall experience of care. Conclusions The study support tailored interdisciplinary innovations targeting wait time, accommodation of consultations, communication regarding the following treatment and collaboration within specialist health services for children with multi-referrals to somatic and mental specialist health care services.

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Complex care pathways for children with multiple referrals demonstrated in a retrospective population‐based study

Cited by 9 publications

References 24 publications

Bridging the Gap for Children With Compound Health Challenges: An Intervention Protocol

Bridging the Gap for Children With Compound Health Challenges: An Intervention Protocol

Identifying Risk Factors Associated with Repeated Referrals Within a Pediatric Navigation Program

How can we improve specialist health services for children with multi-referrals? Parent reported experience

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