Preparing Patients for Transfer of Care: Practices of Primary Care Pediatricians

Abstract

Comprehensive transition planning by pediatric providers is essential for successful transition into adulthood and transfer to adult medical health care settings. Yet, little is known about the level and type of transition planning and preparation provided by pediatric primary care providers. This study examined the range of transition services provided in primary care pediatric centers. Primary care pediatricians across two states in the Midwest were mailed an anonymous survey designed to examine the transition practices of community pediatricians. A response rate of 38.4% was obtained. Most endorsed transferring patients to adult care at age 18 or older, and using patient chronological age, health status, and patient relationship with pediatric provider as criteria to gauge transfer time. About 60% of responders provide preparation to patients before transition, usually by providing a list of adult providers or by transferring medical records. Few responders provide additional type of transition or transfer planning. Many primary care pediatricians provide transition planning, yet there is high variability in the degree of transition planning provided and 40% of pediatricians provide no such support to their patients. Transition planning is also largely limited to providing referrals and transferring medical records. Study findings support the need for outreach efforts so that all youth receive the needed education and resources to successfully transition and transfer to adult health care.

Transition care for young adults with complex chronic conditions exiting pediatric care: Implications for primary care providers.

“…For the purpose of this paper, preparedness refers to the state of being prepared for health care transition. This was a frequent theme identified in nine of the final twelve studies: three of the qualitative studies (Aldiss et al, 2015;Okumura et al, 2015;Syverson et al, 2016), three of the quantitative studies (Maddux et al, 2015;Rutishauser et al, 2014;Chung et al, 2017), and all three of the systematic reviews (Betz et al, 2013;Gabriel et al, 2017;Nehring et al, 2015). Preparation was recognized by young adults (Aldiss et al, 2015;Betz et al, 2013;Gabriel et al, 2017;Maddux et al, 2015;Okumura et al, 2015;Rutishauser et al, 2014;Syverson et al, 2016) This theme is supported by two sub-themes which emerged as factors influencing transition preparation in both young adults and health care providers; anticipatory guidance and health promotion for patients, and health care provider training and proficiency.…”

“…More specifically these were grounded theory (Aldiss et al, 2015; Okumura, Saunders, & Rehm, 2015) and descriptive (Berens & Peacock, 2014;Syverson, McCarter, He, D'Angelo, & Tuchman, 2016) methodologies to generate data. From the remaining eight studies, five were quantitative using a range of approaches; time-series (Ciccarelli, Brown, Gladstone, Woodward, & Swigonski, 2014;McManus et al, 2014), cross-sectional (Rutishauser, Sawyer, & Ambresin, 2014), and surveys (Chung, Jasien, & Maslow, 2017;Maddux, Ricks, & Bass, 2015). Three systematic reviews completed between 1995-2016 were included (Betz et al, 2013;Gabriel et al, 2017;Nehring et al, 2015).…”

“…In order to ensure that the findings were applicable to the Canadian health system, the geographical nature of each study was considered. Seven (58%) of the individual studies included in this paper were conducted in the United States (Berens & Peacock, 2014;Chung et al, 2017;Ciccarelli et al, 2014;Maddux et al, 2015;McManus et al, 2014;, Syverson et al, 2016, one (7%) was conducted in Switzerland (Rutishauser et al, 2014), and one (7%) was conducted in the United Kingdom (Aldiss et al, 2015). The three (25%) systematic reviews (Betz et al, 2013;Gabriel et al, 2017;Nehring et al, 2015) included data from all of these countries, as well as Canada, Hong Kong, and Japan.…”

“…Anticipatory guidance and health promotion refer to information given by the health care provider to young adults and their families in order to prepare them for the expectations of transition (Aldiss et al, 2015;Betz et al, 2013), encourage independence of their own care (Syverson et al, 2016), and promote optimal health outcomes (Maddux et al, 2015). This may include details about health care transition, information about the young adults' condition, and the development of self-management skills.…”

“…Anticipatory guidance and health promotion for patients. Seven studies identified the need for improved transition preparation, planning, and support for young adults with complex chronic conditions (Aldiss et al, et al, 2015;Betz et al, 2013;Gabriel et al, 2017;Maddux et al, 2015;Okumura et al, 2015;Rutishauser et al, 2014;Syverson et al, 2016).…”