TY - JOUR
T1 - Perspectives on care for young adults with type 1 diabetes transitioning from pediatric to adult health systems
T2 - A national survey of pediatric endocrinologists
AU - Agarwal, Shivani
AU - Garvey, Katharine C.
AU - Raymond, Jennifer K.
AU - Schutta, Mark H.
N1 - Publisher Copyright:
© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
PY - 2017/11
Y1 - 2017/11
N2 - Background: Healthcare transition from pediatric to adult care for young adults (YA) with type 1 diabetes (T1D) is associated with risk of adverse outcomes. Consensus recommendations exist from US professional societies on transition care for YA with T1D, but it is not known whether they have been widely adopted. We describe experiences, barriers, and provider characteristics associated with transition care in a national sample of pediatric endocrinologists. Methods: US pediatric endocrinologists identified through the American Medical Association Physician Masterfile were sent an electronic survey. Results: Response rate was 16% (164/1020) representing 32 states. The majority of pediatric endocrinologists (age 44 ± 10; years in practice 12 ± 11) were female (67%) and worked in academic centers (75%). Main reasons for transfer were age (49%) and glycemic control (18%). Barriers to transition included ending long-therapeutic relationships with patients (74%), lack of transition protocols (46%), and perceived deficiencies in adult care (42%). The majority of pediatric endocrinologists reported lack of transition training (68%); those who received training were less likely to have difficulty ending patient relationships [odds ratio (OR) = 0.39, P =.03], more likely to perform patient record transfer to adult systems (OR=1.27, P =.006), and less likely to report patient returns to pediatric care after transfer (OR=0.49, P =.01), independent of endocrinologist gender, years in practice, or practice type. Conclusions: There is wide variation in transition care for YA with T1D among US pediatric endocrinologists despite consensus recommendations. Dissemination of educational programming on transition care and provision of actionable solutions to overcome local health system and perceived barriers is needed.
AB - Background: Healthcare transition from pediatric to adult care for young adults (YA) with type 1 diabetes (T1D) is associated with risk of adverse outcomes. Consensus recommendations exist from US professional societies on transition care for YA with T1D, but it is not known whether they have been widely adopted. We describe experiences, barriers, and provider characteristics associated with transition care in a national sample of pediatric endocrinologists. Methods: US pediatric endocrinologists identified through the American Medical Association Physician Masterfile were sent an electronic survey. Results: Response rate was 16% (164/1020) representing 32 states. The majority of pediatric endocrinologists (age 44 ± 10; years in practice 12 ± 11) were female (67%) and worked in academic centers (75%). Main reasons for transfer were age (49%) and glycemic control (18%). Barriers to transition included ending long-therapeutic relationships with patients (74%), lack of transition protocols (46%), and perceived deficiencies in adult care (42%). The majority of pediatric endocrinologists reported lack of transition training (68%); those who received training were less likely to have difficulty ending patient relationships [odds ratio (OR) = 0.39, P =.03], more likely to perform patient record transfer to adult systems (OR=1.27, P =.006), and less likely to report patient returns to pediatric care after transfer (OR=0.49, P =.01), independent of endocrinologist gender, years in practice, or practice type. Conclusions: There is wide variation in transition care for YA with T1D among US pediatric endocrinologists despite consensus recommendations. Dissemination of educational programming on transition care and provision of actionable solutions to overcome local health system and perceived barriers is needed.
KW - pediatric endocrinologists
KW - pediatric to adult transition
KW - physician survey
KW - type 1 diabetes
KW - young adults
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U2 - 10.1111/pedi.12436
DO - 10.1111/pedi.12436
M3 - Article
C2 - 27578432
AN - SCOPUS:84992214297
SN - 1399-543X
VL - 18
SP - 524
EP - 531
JO - Pediatric Diabetes
JF - Pediatric Diabetes
IS - 7
ER -