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Transfer from pediatric to adult care occurring later than recommended
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The transfer from pediatric- to adult-focused primary care is occurring later than recommended — with gaps in care of more than 1 year, according to study results.
“While youths with chronic conditions have shorter gaps, they may need even shorter transfer intervals to ensure continuous access to care,” Lauren E. Wisk, PhD, of the Center for Child Health Care Studies, department of population medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute in Boston, and colleagues wrote.
Although the current guidelines recommend primary care transfers from pediatric to adult care occur between the ages of 18 and 21 years, the timing of transfer is unknown.
For this reason, Wisk and colleagues assessed the timing of transfer from pediatric- to adult-focused primary care providers (PCP), the time between last pediatric-focused and first adult-focused PCP visits and the predictors for transfer timing among 60,233 patients insured by Harvard Pilgrim Health Care between January 2000 and December 2012.
The adjusted median age at transfer of care occurred at 21.8 years for office visits and 23.1 years for preventive visits. The adjusted median gap length was 20.5 months for office visits and 41.6 months for preventive visits.
Compared with those with no chronic conditions at time of transfer, girls (HR = 1.32; 95% CI, 1.29-1.36) with complex chronic conditions (HR = 1.06; 95% CI, 1.01-1.11) and noncomplex chronic conditions (HR = 1.08; 95% CI, 1.05-1.12) were more likely to be aged younger at time of transfer.
Moreover, youths residing in lower-income neighborhoods were more likely to be aged older at time of transfer vs. those residing in higher-income neighborhoods (HR = 0.89; 95% CI, 0.83-0.95). There was a shorter gap between last pediatric-focused to first adult-focused primary care visit for girls vs. boys (HR = 1.57; 95% CI, 1.53-1.61). This was also true for children with complex chronic conditions (HR = 1.35; 95% CI, 1.28-1.41) and noncomplex chronic conditions (HR = 1.24; 95% CI, 1.2-1.28). Researchers observed longer gaps for those residing in lower-income neighborhoods vs. those in higher-income neighborhoods (HR = 0.8; 95% CI, 0.75-0.85).
“More work is needed to determine whether youths are experiencing clinically important lapses in care or other negative health effects due to the delayed timing of transfer,” the researchers wrote.
Disclosure: The researchers report no relevant financial disclosures.
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