Transition care continuity promotes long‐term retention in adult care among young adults with sickle cell disease

Abstract

Background/objectives Care continuity prevents increased health care utilization and mortality during transition from pediatric to adult care. Our program employs a co‐located care delivery model, in which pediatric provider involvement continues during young adulthood. We tested the hypothesis that individuals who participated in the co‐located model have greater retention in adult care compared to those who only received pediatric transition services. Methods This study consisted of 311 youth with SCD (51.4% male; 63.0% HbSS/HbSβ0‐thalassemia) who transferred to adult care from 2007 to 2017. Retention was defined as continuation with an adult provider for ≥12 or ≥24 months post‐pediatric care. Logistic regression estimated the association between co‐location status and retention at 12 and 24 months. Logistic regression and t‐tests were used to evaluate potential predictors of retention in adult care. Results Individuals who participated in the co‐location model were 1.9 times more likely to remain in adult care 12 (95% CI: 1.01, 3.47) and 24 (95% CI: 1.01, 3.70) months post‐pediatric care compared to those who did not participate. Individuals with HbSS/HbSβ0‐thalassemia were 1.9 times more likely to be retained at 12 months compared to those with HbSC/HbSβ+‐thalassemia/HbS/HPFH (95% CI: 1.12, 3.09). For every clinic encounter in the last 2 years of pediatric care, the odds of being retained at least 24 months after initiating adult care increased 1.1 times (95% CI: 1.02, 1.13). Conclusions Continuity of providers from pediatric to adult care may increase long‐term retention in adult care. Longitudinal monitoring of adult outcomes is critical to identifying the efficacy of transition services.

Current state and influencing factors of social alienation in patients with stress urinary incontinence

“…An integrated care approach involving hospitals, communities and families can be employed to engage caregivers and provide patients with more care and companionship. 23 Encouraging patients to bravely communicate their inner feelings to their caregivers, rebuilding emotional connections and helping patients cope with the emotional distress, guilt and low self-esteem caused by urinary incontinence can gradually enhance their social adaptability. 24 Other concurrent diseases Urinary incontinence is one of the five major chronic diseases that pose a significant threat to women's physical and mental health.…”