Current referral practices and adolescent transition to Adult clinic: Setting an agenda

Abstract

Background: The goal of adolescent transition from child to adult care services is to provide uninterrupted, coordinated and developmentally appropriate health care as transfers are made from paediatric to adult clinics. Adolescent transition practices are available but not in Nigeria. This study was carried out to determine current practice of patient referral and adolescent transition practice. Methodology: The study was a cross sectional studies among paediatricians attending the annual paediatric conference, using a self-administered questionnaire. Result: A total of 80 respondents, 33 consultants and 47 paediatric residents were involved. Females were 41 (51.2%) and 39 (48.8%) were males. Mean duration of practice was 12.5±0.75 (range 2-20years). Most respondents practice in urban centre, 91.2%; in public hospitals (96.2%) and many attend to adolescents (80%). Most practice intra-departmental referral (96%) done through verbal communication (46.4%); referral notes (92.8%); or through clinical conference (21.9%). Feedbacks were occasional (76.7%) or maybe verbally given (61.4%).Inter-departmental referral/transfer was through use of referral notes (96.8%), or involved one-on-one discussion (81.0%). Most referred patients are managed independently (64.2%), or may involve clinical conference (30.8%) and grand rounds (31.2%). Adolescent referral is through referral notes (92.3%) with formal discharge (81.6%). Discussions before transfer with the adolescent, and the relatives, occur frequently (91.6% & 92%). Discussions with the receiving physician, adolescents and caregivers occurs much less (37.8%). No written referral policies were available (86.1%) and no existing policy with adolescents transfer was available (66.2%). Mean age of transfer was 16.8±1.8years (range 12-20years); this was determined by hospital (72.9%) or department (71.9%). Informed consent usually requested before transfer(90.7%). Most respondents, (97%), see refused transfer or returning clients. Possible reasons for refusal of transfer are fear (90%); difficulty with new treatment relationship (89.1%); and physician attitude (61.7%). Conclusion:Little or no guidelines exist and a robust adolescent transition protocol is required.