Survey: Few nephrology programs have established pediatric-to-adult transition clinics
Key takeaways:
- Overall, 20% of surveyed nephrology programs reported having a transition clinic.
- Meanwhile, 32% of programs reported having neither a transition clinic nor protocol.
Few nephrology programs have pediatric-to-adult transition clinics for young adult patients with kidney disease despite recommendations of established guidelines, according to a survey.
“Young adults living with chronic illness face unique challenges,” Andrew Vissing, MD, a nephrologist at the Northwestern University Feinberg School of Medicine Division of Nephrology and Hypertension in Chicago, wrote with colleagues. “Emerging adulthood, between 18 and 25 years old, is characterized by increased independence from parents and guardians, heightened social pressures, engagement in risky behaviors and greater financial responsibilities, all of which complicate the management of chronic illness.”
It is common during this time for young adults with chronic illness to “undergo a health care transition from pediatric to adult medical care,” the researchers wrote. Although, “while their disease follows a continuous course, their care is often fragmented.”
Researchers at the university targeted 488 general and transplant nephrology programs at pediatric and adult medical centers and received 188 survey responses (39% overall response rate). Within the analysis, four unique surveys were customized for the following study subgroups: adult general nephrology, adult transplant nephrology, pediatric general nephrology and pediatric transplant nephrology. Programs without transition clinics were asked to point out specific barriers that prevented the creation of such clinics..
Overall, 20% of programs had a transition clinic and 32% reported having neither a transition clinic nor transition protocol, according to the researchers. Adult programs were more likely to lack these resources, the researchers found, with 42% reporting no transition clinic or protocol. Regarding pediatric programs, 20% lacked transition outlets.
Among respondents, 17% of adult programs were more likely to report no perceived need or obstacles in creation of such clinics compared with 4% of pediatric programs.
For joint pediatric-adult programs, 51% reported disconnect in transition procedures.
In addition, Vissing and colleagues found that among 150 programs without a transition clinic, resource and financial strains were main obstacles, accounting for 50% of survey comments.
“Further studies are needed to improve the quality of [health care transition] for nephrology and kidney transplant patients,” the researchers wrote. “Future research should focus on strategies to overcome barriers related to establishing transition practices to ensure adherence to guidelines. ... One strategy to focus on would be fostering collaboration between adult and pediatric nephrologists through combined conferences to discuss complex cases, share best practices and develop unified approaches to [health care transition].”
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