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Enhanced information needed in transition from pediatric to adult diabetes care
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Improvements are necessary in the transition of patients with type 1 diabetes from pediatric health care providers to adult care, including more efficient transfer of information between providers and better access to mental health resources for young adults, according to data published in Diabetes Care.
Researchers created a structured survey addressing the clinical experiences, resources and obstacles to care encountered by adult endocrinologists treating young adults with type 1 diabetes. The 60-item questionnaire took approximately 10 minutes to complete and was divided into the following categories: practice characteristics, physician demographics, aspects of health care provider transition and their perceived importance, and barriers/suggestions for improvement.
The survey was sent to 4,214 eligible endocrinologists identified in the AMA Masterfile between July and September 2012; 418 surveys were included in the analysis.
Respondents most commonly reported endorsing having the patient’s parent at the first adult visit (47%), followed by having the opportunity to review pediatric records (36%).
Twelve percent or less of respondents reported receiving patient summaries, direct communication with pediatric providers, joint pediatric–adult provider visits or patient participation in a transition program. Despite the infrequency of these transitional components, 73% rated patient summaries as important/very important, 72% rated pediatric record review as important/very important and 56% rated the presence of parents at first adult practitioner visit as important/very important.
Most respondents reported having access to diabetes educators (94%), followed by dietitians (95%), interpreter services (61%) and access to mental health resources (42%). An analysis adjusting for practice setting and experiences found that endocrinologists without ready access to mental health professionals were more likely to encounter obstacles to diabetes management in young adults with depression (OR = 5.3; 95% CI, 3.4-8.2), substance abuse (OR = 3.5; 95% CI, 2.2-5.6) and eating disorders (OR = 2.5; 95% CI, 1.6-3.8).
“Our results provide important information about the experiences of adult endocrinologists caring for young adults with type 1 diabetes in the U.S.,” the researchers wrote. “Our findings support the high importance of enhanced information transfer and direct communication between pediatric and adult diabetes providers, along with efforts to increase mental health provider training and access and to implement educational opportunities for adult endocrinologists on behavioral health topics specific to young adults with type 1 diabetes.” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.
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