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PCPs essential during transition to adult care in adolescents with severe mental illness
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For adolescents with severe mental illness, consistent access to a single primary care physician during the transition from pediatric to adult care could ensure improved long-term outcomes, according to a study published in JAMA Network Open.
“Most adolescents with severe mental disorders require a transition from pediatric to adult care practitioners because of the chronicity and functional impact of these disorders,” Alene Toulany, MD, MSc, of division of adolescent medicine at the Hospital for Sick Children in Toronto, and colleagues wrote.
“The first systematic attempt to study the policy, process, outcome and experience of transition for youth with mental illness demonstrated that almost half of youth ‘fell through the care gap’ between child and adult systems, and those who successfully transitioned received care that was poorly planned, executed and experienced,” they continued.
Researchers conducted a population-based cohort study using data from all adolescents aged 12 to 16 years with severe mental illness who were hospitalized for schizophrenia, eating disorders or mood disorders for longer than 72 hours in Ontario, Canada. Adolescents included in the study were hospitalized between April 1, 2002, to April 1, 2014. They were then followed throughout their transition to adult care (age 17-18 years) until March 31, 2017, or they were aged 27 years.
Those included in the study were divided into three groups based on the care they received during their transition into adult care. Adolescents who saw the same PCP prior to and during the transition had continuous primary care, those who saw different PCPs during the transition were in the discontinuous primary care group, and those who did not see a PCP during the transition period were in the no primary care group.
After exclusions, 8,409 adolescents with severe mental illness were included in the study. During their transition to adult care services, 5,478 (65.1%) received continuous primary care, 2,391 (28.4%) had discontinuous primary care, and 540 (6.4%) had no primary care.
Those who did not receive primary care during the transition period were more likely to be male (57.2%), be at a lower socioeconomic status (31.5%), and to not have received primary care at baseline (25.6%).
Researchers found increased rates of mental health–related hospitalizations during young adulthood among those with discontinuous (adjusted RR = 1.2; 95% CI, 1.1-1.3) and no primary care (adjusted RR = 1.3; 95% CI, 1.08-1.56), compared with those with continuous primary care.
Toulany and colleagues noted that although current guidelines for adolescents with severe mental illness transitioning to adult care are written for specialist-to-specialist care, primary care is an essential part of the transition.
“Our study suggests that primary care involvement in transitional care may be important for moderating or improving long-term health outcomes for youth with mental illness,” they wrote. – by Erin Michael
Disclosures: Toulany reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.