Ecological Factors Predict Transition Readiness/Self-Management in Youth With Chronic Conditions

Javalkar, Karina; Johnson, Meredith A.; Kshirsagar, Abhijit V.; Ocegueda, Sofia; Detwiler, Randal K.; Ferris, Maria

doi:10.1016/j.jadohealth.2015.09.013

Cited by 62 publications

(44 citation statements)

References 18 publications

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“…AYA without insurance and with public insurance are most likely from low-income families. This finding is consistent with previous literature showing that higher household income predicted increased transition readiness[14], and a family income of ≥ 400% of the federal poverty level and possession of private insurance were positively associated with AYA achieving desired transition outcomes[15]. Additionally, we found disparities in HCT skill acquisition between Caucasian AYA and AYA of other races.…”

Section: Discussionsupporting

confidence: 92%

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Chronological age when healthcare transition skills are mastered in adolescents/young adults with inflammatory bowel disease

Stollon¹,

Zhong²,

Ferris³

et al. 2017

WJG

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AIMTo describe the longitudinal course of acquisition of healthcare transition skills among adolescents and young adults with inflammatory bowel diseases.METHODSWe recruited adolescents and young adults (AYA) with inflammatory bowel diseases (IBD), from the pediatric IBD clinic at the University of North Carolina. Participants completed the TRxANSITION Scale™ at least once during the study period (2006-2015). We used the electronic medical record to extract participants’ clinical and demographic data. We used ordinary least square regressions with robust standard error clustered at patient level to explore the variations in the levels and growths of healthcare transition readiness.RESULTSOur sample (n = 144) ranged in age from 14-22 years. Age was significantly and positively associated with both the level and growth of TRxANSITION Scale™ scores (P < 0.01). Many healthcare transition (HCT) skills were acquired between ages 12 and 14 years, but others were not mastered until after age 18, including self-management skills.CONCLUSIONThis is one of the first studies to describe the longitudinal course of HCT skill acquisition among AYA with IBD, providing benchmarks for evaluating transition interventions.

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Section: Discussionsupporting

confidence: 92%

“…We found increased HCT transition skills among female AYA, which is consistent with the previous literature[14]. We also found significantly lower gains in HCT skills among AYA with public insurance and without insurance, when compared to their peers with private insurance.…”

Section: Discussionsupporting

confidence: 92%

Chronological age when healthcare transition skills are mastered in adolescents/young adults with inflammatory bowel disease

Stollon¹,

Zhong²,

Ferris³

et al. 2017

WJG

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“…Furthermore, as the majority of our cohort was male, the results may not generalize to disease populations with a more equal gender distribution. 15 Although the literature suggests that there may be gender-based differences in self-management among youth with chronic conditions, due to our small sample size, we were unable to compare the transition experience and outcomes based on gender in the present study 28 . It is important to note that participants were asked about their disease through an open-ended question without prompts, which may have had an impact on the depth of the answers received.…”

Section: Discussionmentioning

confidence: 89%

Transition From Pediatric to Adult Care by Young Adults With Chronic Granulomatous Disease: The Patient's Viewpoint

Margolis

Wiener

Pao

et al. 2017

Journal of Adolescent Health

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Purpose Children with chronic illnesses are living longer, prompting health care provider attention to the transition from pediatric to adult care. Transition of care is successful when youth are independent in managing their health. The aims of this study were to identify the strengths and barriers to transition from pediatric to adult care and to determine strategies that could enhance the transition process. Methods A survey was administered via a structured interview to 33 young adult participants (19 to 27 years of age), living with Chronic Granulomatous Disease (CGD) all of whom transitioned from pediatric to adult care. The participants were predominately male (88%) and Caucasian (73%). Topics covered in the survey included understanding of disease and treatment, adherence, advance care planning, and barriers to transition. Data was analyzed using a conventional content analysis approach. Results Seventy-six percent of the participants did not understand their disease process and only fifty percent understood their prophylactic medication regimen. Seventy-five percent of participants perceived their transition as uneventful. Ninety-four percent were independent in self-management skills such as making appointments and ninety percent in refilling prescriptions. More than half of the participants thought that the transition process needed improvement. Specific suggestions to create a practical approach to transition were offered. Conclusions Gaps in disease-related knowledge and transition planning were identified by adolescents and young adults living with CGD. The findings suggest the need for enhancing the transition process utilizing interdisciplinary collaboration to develop a transition policy and program.

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“…Other factors contributing to risk of loss to follow‐up include gender, with male patients more likely to be lost to follow‐up. This may be the result of female patients having a higher transition readiness and consequently being less likely to drop out of care . The other possibility is that gender is a proxy for educational attainment, as other studies have found that males are more likely to drop out of high school, which is associated with higher risk of loss to follow‐up .…”

Section: Discussionmentioning

confidence: 99%

Surgeon crossover between pediatric and adult centers is associated with decreased rate of loss to follow‐up among adolescent renal transplantation recipients

Hung

Williams

Bababekov

et al. 2019

Pediatric Transplantation

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The risk of adverse outcomes for pediatric renal transplant patients is highest during the transition from pediatric to adult care. While there have been many studies focus on graft failure and death, loss to follow‐up likely plays a large role in patient outcomes. We hypothesize patients are lost to follow‐up during this transition period and that patients transplanted at pediatric centers with a closely affiliated adult center (AFFs) are less likely to suffer from fragmentation of care and become lost to follow‐up. AFFs were defined as those pediatric centers whose transplant surgeons were also on staff at an adult center and were identified using center websites. We included patients undergoing renal transplantation at <=18 years of age and had data for the entire transition period on the Scientific Registry of Transplant Recipients (n = 6,762, 92.3% in 95 AFFs). 32% of patients were lost to follow‐up. On regression, patients transplanted at AFF were 33% less likely to be lost to follow‐up compared with those from non‐AFF (OR 0.67 CI 0.54‐0.82, P < 0.01). The proportion of patients lost to follow‐up during the transition period is remarkably high, but lower among recipients transplanted at AFFs. Poor follow‐up may be mitigated by improving integration of care.

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Ecological Factors Predict Transition Readiness/Self-Management in Youth With Chronic Conditions

Cited by 62 publications

References 18 publications

Chronological age when healthcare transition skills are mastered in adolescents/young adults with inflammatory bowel disease

Chronological age when healthcare transition skills are mastered in adolescents/young adults with inflammatory bowel disease

Transition From Pediatric to Adult Care by Young Adults With Chronic Granulomatous Disease: The Patient's Viewpoint

Surgeon crossover between pediatric and adult centers is associated with decreased rate of loss to follow‐up among adolescent renal transplantation recipients

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