Transition from paediatric to adult care: What about the healthy ones?
OBJECTIVE: To compare the characteristics of and use of the healthcare system by healthy youths depending on whether they had discussed transition to adult health care with their paediatrician or not.
METHODS: Data were drawn from the fourth wave of the GenerationFRee study (2018–2019) conducted in the 11 post-mandatory schools of the canton of Fribourg, Switzerland. The sample included 931 young people (mean age 19.4 years). Participants were categorised into three groups: those who had discussed transition with their p ediatrician (n = 176; 19%), those who had not (n = 286; 31%) and those who did not know (n = 469; 50%). Analyses were stratified by gender through bivariate analysis and post-hoc tests with a Bonferroni-type adjustment.
RESULTS: The majority of participants did not know whether or not they had discussed transition. Across all groups, it was found that youths met their primary care physician at a higher rate through family. Meeting with the primary care physician through the paediatrician occurred at a higher rate when youths had discussed transition. Girls with a below average socioeconomic status and boys with advanced puberty onset were more likely to have discussed transition.
CONCLUSION: Our results show that youths are not well informed about the transition process. However, youths who have discussed transition appear to be more involved with the healthcare system as they are more likely to have a primary care provider. In order to avoid discontinuity of care, professionals should approach transition to adult care systematically with all their patients.
- Blum RW, Garell D, Hodgman CH, Jorissen TW, Okinow NA, Orr DP, et al. Transition from child-centered to adult health-care systems for adolescents with chronic conditions. A position paper of the Society for Adolescent Medicine. J Adolesc Health. 1993 Nov;14(7):570–6. https://doi.org/10.1016/1054-139X(93)90143-D
- Rosen DS. Transition of young people with respiratory diseases to adult health care. Paediatr Respir Rev. 2004 Jun;5(2):124–31. https://doi.org/10.1016/j.prrv.2004.01.008
- Cooley WC, Sagerman PJ American Academy of Pediatrics American Academy of Family Physicians American College of Physicians; Transitions Clinical Report Authoring Group. Supporting the health care transition from adolescence to adulthood in the medical home. Pediatrics. 2011 Jul;128(1):182–200. https://doi.org/10.1542/peds.2011-0969
- Nair M, Baltag V, Bose K, Boschi-Pinto C, Lambrechts T, Mathai M. Improving the Quality of Health Care Services for Adolescents, Globally: A Standards-Driven Approach. J Adolesc Health. 2015 Sep;57(3):288–98. https://doi.org/10.1016/j.jadohealth.2015.05.011
- Leung S, Walgrave M, Mennito S. Improving Transitions of Care for Healthy Adolescents and Young Adults. South Med J. 2019 Oct;112(10):501–11. https://doi.org/10.14423/SMJ.0000000000001021
- Eaton CK, Davis MF, Gutierrez-Colina AM, LaMotte J, Blount RL, Suveg C. Different Demands, Same Goal: Promoting Transition Readiness in Adolescents and Young Adults With and Without Medical Conditions. J Adolesc Health. 2017 Jun;60(6):727–33. https://doi.org/10.1016/j.jadohealth.2017.01.002
- Lebrun-Harris LA, McManus MA, Ilango SM, Cyr M, McLellan SB, Mann MY, et al. Transition Planning Among US Youth With and Without Special Health Care Needs. Pediatrics. 2018 Oct;142(4):e20180194. https://doi.org/10.1542/peds.2018-0194
- Schuiteman S, Chua KP, Plegue MA, Ilyas O, Chang T. Self-Management of Health Care Among Youth: Implications for Policies on Transitions of Care. J Adolesc Health. 2020 May;66(5):616–22. https://doi.org/10.1016/j.jadohealth.2020.01.009
- Wisk LE, Finkelstein JA, Sawicki GS, Lakoma M, Toomey SL, Schuster MA, et al. Predictors of timing of transfer from pediatric- to adult-focused primary care. JAMA Pediatr. 2015 Jun;169(6):e150951. https://doi.org/10.1001/jamapediatrics.2015.0951
- Baggio S, Iglesias K, Fernex A. Healthcare renunciation among young adults in French higher education: A population-based study. Prev Med. 2017 Jun;99:37–42. https://doi.org/10.1016/j.ypmed.2017.02.002
- Ziv A, Boulet JR, Slap GB. Emergency department utilization by adolescents in the United States. Pediatrics. 1998 Jun;101(6):987–94. https://doi.org/10.1542/peds.101.6.987
- Lotstein DS, McPherson M, Strickland B, Newacheck PW. Transition planning for youth with special health care needs: results from the National Survey of Children with Special Health Care Needs. Pediatrics. 2005 Jun;115(6):1562–8. https://doi.org/10.1542/peds.2004-1262
- Hibell B, Andersson B, Bjarnason T, Ahlström S, Balakireva O, Kokkevi A, et al. The ESPAD report 2003: Alcohol and Other Drugs Use Among Students in 35 European Countries. The Swedish Council for Information on Alcohol and Other Drugs; 2003.
- Allgaier AK, Pietsch K, Frühe B, Prast E, Sigl-Glöckner J, Schulte-Körne G. Depression in pediatric care: is the WHO-Five Well-Being Index a valid screening instrument for children and adolescents? Gen Hosp Psychiatry. 2012 May-Jun;34(3):234–41. https://doi.org/10.1016/j.genhosppsych.2012.01.007
- Berg-Kelly K, Erdes L. Self-assessment of sexual maturity by mid-adolescents based on a global question. Acta Paediatr. 1997 Jan;86(1):10–7. https://doi.org/10.1111/j.1651-2227.1997.tb08822.x
- Bertakis KD, Azari R, Helms LJ, Callahan EJ, Robbins JA. Gender differences in the utilization of health care services. J Fam Pract. 2000 Feb;49(2):147–52.
- Rutishauser C, Sawyer SM, Ambresin AE. Transition of young people with chronic conditions: a cross-sectional study of patient perceptions before and after transfer from pediatric to adult health care. Eur J Pediatr. 2014 Aug;173(8):1067–74. https://doi.org/10.1007/s00431-014-2291-9
- Wong LH, Chan FW, Wong FY, Wong EL, Huen KF, Yeoh EK, et al. Transition care for adolescents and families with chronic illnesses. J Adolesc Health. 2010 Dec;47(6):540–6. https://doi.org/10.1016/j.jadohealth.2010.04.002
- Toulany A, Stukel TA, Kurdyak P, Fu L, Guttmann A. Association of Primary Care Continuity With Outcomes Following Transition to Adult Care for Adolescents With Severe Mental Illness. JAMA Netw Open. 2019 Aug;2(8):e198415. https://doi.org/10.1001/jamanetworkopen.2019.8415
- Delisi K, Gold MA. The initial adolescent preventive care visit. Clin Obstet Gynecol. 2008 Jun;51(2):190–204. https://doi.org/10.1097/GRF.0b013e31816d1fd6
- Knishkowy B, Palti H. GAPS (AMA Guidelines for Adolescent Preventive Services). Where are the gaps? Arch Pediatr Adolesc Med. 1997 Feb;151(2):123–8. https://doi.org/10.1001/archpedi.1997.02170390013002
- Pérez-Cárceles MD, Pereñiguez JE, Osuna E, Luna A. Balancing confidentiality and the information provided to families of patients in primary care. J Med Ethics. 2005 Sep;31(9):531–5. https://doi.org/10.1136/jme.2004.010157
- Ackard DM, Neumark-Sztainer D. Health care information sources for adolescents: age and gender differences on use, concerns, and needs. J Adolesc Health. 2001 Sep;29(3):170–6. https://doi.org/10.1016/S1054-139X(01)00253-1
- Knowlton AR, Weir B, Fields J, Cochran G, McWilliams J, Wissow L, et al. Pediatric Use of Emergency Medical Services: The Role of Chronic Illnesses and Behavioral Health Problems. Prehosp Emerg Care. 2016 May-Jun;20(3):362–8. https://doi.org/10.3109/10903127.2015.1115928
- Hanson MD, Chen E. Socioeconomic status and health behaviors in adolescence: a review of the literature. J Behav Med. 2007 Jun;30(3):263–85. https://doi.org/10.1007/s10865-007-9098-3
- Corscadden L, Levesque JF, Lewis V, Strumpf E, Breton M, Russell G. Factors associated with multiple barriers to access to primary care: an international analysis. Int J Equity Health. 2018 Feb;17(1):28. https://doi.org/10.1186/s12939-018-0740-1
- Ishizaki Y, Maru M, Higashino H, Katsumoto S, Egawa K, Yanagimoto Y, et al. The transition of adult patients with childhood-onset chronic diseases from pediatric to adult healthcare systems: a survey of the perceptions of Japanese pediatricians and child health nurses. Biopsychosoc Med. 2012 Mar;6(1):8. https://doi.org/10.1186/1751-0759-6-8
- Brener ND, Billy JO, Grady WR. Assessment of factors affecting the validity of self-reported health-risk behavior among adolescents: evidence from the scientific literature. J Adolesc Health. 2003 Dec;33(6):436–57. https://doi.org/10.1016/S1054-139X(03)00052-1