Transitioning Asthma Care From Adolescents to Adults

Nanzer, AM; Lawton, Adam; d’Ancona, G; Gupta, Atul

doi:10.1016/j.chest.2021.05.019

Cited by 15 publications

(7 citation statements)

References 49 publications

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“…The issue of transitioning asthma care from adolescents to adults is of major importance as the risk of respiratory morbidity increases in adulthood [69]. A recent review also found that once patients are transferred to adult medicine, limited knowledge of their condition, limited understanding of how to manage related symptoms and comorbidities, and limited comprehension of medical indications often persist [70]. Similarly, the burden of non-specific chronic LBP has implications for both ageing employees and employers.…”

Section: Discussionmentioning

confidence: 99%

Barriers to accessing health care for people with chronic conditions: a qualitative interview study

Schwarz¹,

Schmidt

Bobek

et al. 2022

BMC Health Serv Res

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Background There is a growing interest in redesigning healthcare systems to increase access to and coordination across care settings for people with chronic conditions. We aim to gain a better understanding of the barriers faced by (1) children with chronic bronchial asthma, (2) adults with non-specific chronic back pain, and (3) older people with pre-existing mental illness/es in Austria’s fragmented social health insurance system. Methods Using a qualitative design, we conducted semi-structured interviews face-to-face and by telephone with health service providers, researchers, experts by experience (persons with lived/ personal experience, i.e., service users, patient advocates or family members/carers), and employees in public health administration between July and October 2019. The analysis and interpretation of data were guided by Levesque’s model of access, a conceptual framework used to evaluate access broadly according to different dimensions of accessibility to care: approachability, acceptability, availability and accommodation, affordability, and appropriateness. Results The findings from the 25 expert interviews were organised within Levesque’s conceptual framework. They highlight a lack of coordination and defined patient pathways, particularly at the onset of the condition, when seeking a diagnosis, and throughout the care process. On the supply side, patterns of poor patient-provider communication, lack of a holistic therapeutic approach, an urban-rural divide, strict separation between social care and the healthcare system and limited consultation time were among the barriers identified. On the demand side, patients’ ability to perceive a need and to subsequently seek and reach healthcare services was an important barrier, closely linked to a patient’s socio-economic status, health literacy and ability to pay. Conclusions While studies on unmet needs suggest a very low level of barriers to accessing health care in the Austrian context, our study highlights potential ‘invisible’ barriers. Barriers to healthcare access are of concern for patients with chronic conditions, underlining existing findings about the need to improve health services according to patients’ specific needs. Research on how to structure timely and integrated care independent of social and economic resources, continuity of care, and significant improvements in patient-centred communication and coordination of care would be paramount.

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Section: Discussionmentioning

confidence: 99%

Barriers to accessing health care for people with chronic conditions: a qualitative interview study

Schwarz¹,

Schmidt

Bobek

et al. 2022

BMC Health Serv Res

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show abstract

“…Young adults with asthma often experience discontinuity in their asthma care (e.g., fewer or no follow-ups, long lapse in prescription medications) as they transition from adolescence to adulthood [ 4 , 5 , 6 , 7 ]. Although the extent to which such discontinuity directly contributes to asthma-related morbidity or quality of life in young adults remains largely unknown, increased high-acuity emergency visits and associated costs among young adults with a chronic condition including asthma have been documented after transfer from pediatric to adult care [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Are Mid to Late Adolescents with Asthma Ready for Transition of Care? A Qualitative Study

et al. 2022

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This qualitative descriptive study explores experiences and perspectives of mid-to-late adolescents about growing up with asthma, and the roles of parents and providers as they transition. Purposeful sampling was used to recruit and enroll adolescents aged 16–20 years with asthma. Forty-one adolescents participated in a focus group or individual interview, and content analysis was conducted to analyze the data. The mean age of participants was 17.7 years, the majority (56%) of whom were Black. Themes that emerged included concerns about becoming an adult with asthma and its self-management, parental involvement, and communication with providers. Adolescents felt burdened by asthma, few considered becoming adults with asthma, and their future outlook was pessimistic with concerns related to worsening symptoms, inadequacy in symptom self-management and limitations on career choices due to asthma. Deficiencies in self-management were noted, parents still played major roles in adolescents’ asthma care, and transition of care was seldom discussed with the providers. Mid-to-late adolescents with asthma are inadequately prepared for transition of care, and parents and providers insufficiently engage adolescents in the preparation. Parent, provider, and adolescent partnership is critical to achieve adolescent readiness for independence in asthma management and to ensure proper asthma care continuity post transition.

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“…The implication for nondata saturation is lack of content validity. However, since a lot of the experiences and themes are representative and in agreement with current literature, it can be assumed that the interview data is a valid presentation of lived experience which can be compared with the transition process for other chronic conditions 21–23 . In addition, the recruitment was online and in a nonclinical setting.…”

Section: Discussionmentioning

confidence: 76%

“…This may require specialized support during transition processes to understand and plan what this advocate role may look like, without it infringing on the young person's rights and desire to develop their own identity. 20 Yet, the most successful transitions are those where the young person and their family is prepared, 5,6 so therefore, identification and, if necessary, parental integration is recommended to prepare all for transition.…”

Section: The Parent As Continued Advocatementioning

confidence: 99%

Experiences of UK‐based adult transition services for interstitial lung disease in childhood: “There's a lot less cushioning”

Gilbert

Bennett

Brown

et al. 2023

Pediatric Pulmonology

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Interstitial lung disease in childhood (chILD) is rare and no longer purely a childhood issue as many survive into adulthood, and so have to transition from pediatric to adult healthcare services. Transition is a significant life event that has the potential to impact on physical and mental health outcomes. The European Respiratory Society (ERS) statement on chILD transition highlighted the lack of standardised transition services for chILD transition resulting in a haphazard process. This qualitative study explores how young people and parents in the United Kingdom experienced transition from paediatric to adult healthcare services for chILD. Participants (n = 7) were recruited from chILD patient organisations and online communities. We focused on the experience of transition exploring if there were any information packs or support provided for the transition. Such support may be generic, such as “Ready Steady Go” which provides a systematic approach to transition and disease‐specific literature. These latter have not been developed for ILD. Data were analysed by constructivist grounded theory. We present a lived experience of transition with themes of lack of transition preparation and planning, challenges of adapting to adult services, and a changing healthcare scene. Due to the complexity of chILD, parents discussed their need to remain, in part, as an advocate for the young person. Respondents provided recommendations for how transition could be improved along with tips for young people who are new to the transition process, which include educating oneself about the condition, learning medical terminology, and reaching out for support.

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Transitioning Asthma Care From Adolescents to Adults

Cited by 15 publications

References 49 publications

Barriers to accessing health care for people with chronic conditions: a qualitative interview study

Barriers to accessing health care for people with chronic conditions: a qualitative interview study

Are Mid to Late Adolescents with Asthma Ready for Transition of Care? A Qualitative Study

Experiences of UK‐based adult transition services for interstitial lung disease in childhood: “There's a lot less cushioning”

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