Paediatric to adult healthcare transition in resource-limited settings: a narrative review

Abstract

BackgroundAgeing into adulthood is challenging at baseline, and doing so with a chronic disease can add increased stress and vulnerability. Worldwide, a substantial care gap exists as children transition from care in a paediatric to adult setting. There is no current consensus on safe and equitable healthcare transition (HCT) for patients with chronic disease in resource-denied settings. Much of the existing literature is specific to HIV care. The objective of this narrative review was to summarise current literature related to adolescent HCT not associated with HIV, in low-income and middle-income countries (LMICs) and other resource-denied settings, in order to inform equitable health policy strategies.MethodsA literature search was performed using defined search terms in PubMed and Cumulative Index to Nursing and Allied Health Literature databases to identify all peer-reviewed studies published until January 2020, pertaining to paediatric to adult HCT for adolescents and young adults with chronic disease in resource-denied settings. Following deduplication, 1111 studies were screened and reviewed by two independent reviewers, of which 10 studies met the inclusion criteria. Resulting studies were included in thematic analysis and narrative synthesis.ResultsTwelve subthemes emerged, leading to recommendations which support equitable and age-appropriate adolescent care. Recommendations include (1) improvement of community health education and resilience tools for puberty, reproductive health and mental health comorbidities; (2) strengthening of health systems to create individualised adolescent-responsive policy; (3) incorporation of social and financial resources in the healthcare setting; and (4) formalisation of institution-wide procedures to address community-identified barriers to successful transition.ConclusionLimitations of existing evidence relate to the paucity of formal policy for paediatric to adult transition in LMICs for patients with childhood-onset conditions, in the absence of a diagnosis of HIV. With a rise in successful treatments for paediatric-onset chronic disease, adolescent health and transition programmes are needed to guide effective health policy and risk reduction for adolescents in resource-denied settings.

Adolescent nursing consultation: an important excerpt from care provided by nurses in a Brazilian state

“…Currently, transition programs aimed at preparing adolescents as early as possible exist, developing independence and self-care (from 12 years of age), monitoring the transition process, assessing transition readiness, planning for the transition by identifying adolescents' priorities, especially for decision-making from the age of 16 onwards, transference and integration into adult care and completion of transference (19)(20)(21)(22)(23)(24) . In the absence of such program established in the institution, nurses should be aware of their existence to adapt some activities, whenever possible, and assist in this extremely important process.…”

La consulta de enfermería para adolescentes: una parte importante de los cuidados prestados por los profesionales de enfermería en un estado brasileño

“…En la actualidad, existen programas de transición dirigidos a preparar a los adolescentes lo antes posible, desarrollar la independencia y el autocuidado (a partir de los 12 años), supervisar el proceso de transición, evaluar la preparación para la transición, planificar la transición identificando las prioridades de los adolescentes, especialmente para la toma de decisiones a partir de los 16 años, la transferencia y la integración en la atención de los adultos y la finalización de la transferencia (19)(20)(21)(22)(23)(24) .…”

Patient and provider perceptions of a community‐based accompaniment intervention for adolescents transitioning to adult HIV care in urban Peru: a qualitative analysis

“…Research on the factors affecting care transition among ALHW is rapidly expanding [ 11 , 12 , 13 , 14 , 15 , 16 , 17 ], though data are primarily from Africa, the United States and Europe. Interventions that are individualized, youth‐friendly, collaborative between youth and medical providers, and responsive to mental/psychosocial needs are consistently noted [ 18 , 19 , 20 , 21 , 22 , 23 ].…”