A pilot project: Improving the transition care process for neurosurgical adolescent patients with indwelling shunts to adult care

2021 ◽  
Vol 60 ◽  
pp. 164-167
Author(s):  
Amanda Johnson ◽  
Jill Marks ◽  
Jeanne Little
Keyword(s):  
Pilot Project ◽  
Care Process ◽  
Adult Care ◽  
Transition Care ◽  
Adolescent Patients

scholarly journals Does inflammatory bowel disease have different characteristics according to stage of adolescence?

2021 ◽  
Vol 14 ◽  
pp. 175628482098667
Author(s):  
Kata Judit Szántó ◽  
Tamás Balázs ◽  
Dóra Mihonné Schrempf ◽  
Klaudia Farkas ◽  
Tamás Molnár
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Severe Disease ◽  
Transition To Adult Care ◽  
Insurance Fund ◽  
Late Adolescent ◽  
Adult Care ◽  
Adolescent Group ◽  
Adolescent Patients ◽  
Inflammatory Bowel

Background: There is a lack of data about demographic and treatment characteristics of adolescent patients with inflammatory bowel disease (IBD). The aim of this retrospective, epidemiological study was to evaluate characteristics and therapeutic features of Hungarian adolescents with IBD. Methods: We analysed the social security databases of the National Health Insurance Fund. Adolescent patients with IBD for whom data from 2009 to 2016 were observable in the database were enrolled. Patients aged 14 to 17 years and 18 to 21 years were defined as middle and late adolescent patients. Results: The incidences of IBD were 20.12 per 100,000 middle adolescent patients and 29.72 per 100,000 late adolescent patients. Admission to gastroenterology department was higher in both groups compared with admissions to surgery department. Mesalazine was used by a high proportion of Crohn’s disease and ulcerative colitis patients. Rates of corticosteroid use were similar in both groups, with a tendency to decrease over time. The need for biologic agents was higher in the middle adolescent patients. The proportion of patients in the middle adolescent group who received anti-TNF therapy showed an increasing tendency. Conclusion: Our data suggest differences in the treatment strategies of gastroenterologists for these age groups. The greater need of anti-TNF therapy among the middle adolescent group indicates that adolescent patients before the transition to adult care may have a more severe disease phenotype. We expect that a strategy of early, effective treatment will significantly ameliorate the subsequent disease course, which is manifested in adult care.

scholarly journals Transition from paediatric to adult care of adolescent patients with congenital heart disease: a pathway to optimal care

2016 ◽  
Vol 24 (11) ◽  
pp. 682-690 ◽  
Author(s):  
A. M. M. Strijbosch ◽  
R. Zwart ◽  
N. A. Blom ◽  
B. J. Bouma ◽  
M. Groenink ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Adult Care ◽  
Optimal Care ◽  
Adolescent Patients

Resident Training in Transitioning Youth With Epilepsy Into Adult Care

2020 ◽  
Vol 36 (1) ◽  
pp. 60-64
Author(s):  
Francis G. Tirol ◽  
Anagha Kumar
Keyword(s):  
Health Care ◽  
Educational Intervention ◽  
Resident Training ◽  
University Hospital ◽  
Adult Care ◽  
Online Questionnaire ◽  
Transition Care ◽  
Transitioning Youth ◽  
Patients With Epilepsy ◽  
Pediatric Providers

Objective: To appraise the current training of Neurology (N), Pediatric (P), and Med-Peds (MP) residents at MedStar Georgetown University Hospital (MGUH) in providing care to patients with epilepsy who are transitioning from pediatric to adult care. Methods: Through an online questionnaire, we surveyed Neurology, Pediatric, and Med-Peds residents to assess their knowledge, confidence, and experience at transitioning youth with epilepsy to adult-oriented health care. Results: N, P, and MP residents generally rated their knowledge and confidence at providing transition care to youth with epilepsy to be poor; however, P and MP residents rated higher in limited measures of knowledge and experience. Conclusion: Our appraisal of resident training in transitions care for youth with epilepsy has highlighted training elements in our institution that require attention for both adult and pediatric providers, leading to the formulation of an educational intervention that will promote experiential and multimodal approaches in this area.

scholarly journals P35 Vasculitis by any other name would present just the same

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Sajida Rasul ◽  
Morven Dockery ◽  
Rachel Tattersall ◽  
Dan Hawley ◽  
Sarah Maltby ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Inflammatory Markers ◽  
Large Vessel Vasculitis ◽  
Large Vessel ◽  
Adult Care ◽  
Secondary Failure ◽  
Adolescent Patients ◽  
Night Sweats ◽  
Inflammatory Bowel

Abstract Background Vasculitis can present in many ways and large vessel vascultis is reported rarely to co-present with inflammatory bowel disease. We would like to present two adolescent patients who presented in very similar ways via the gastroenterology team with a seemingly clear diagnosis of inflammatory bowel disease but who were found to have large vessel vasculitis later in their disease journey. The presentation is to raise awareness of this rare co-presentation and to discuss treatment challenges in particular those apparent in adolescent patients crossing the transition bridge. Methods Patient A is a 17 year old boy who has had a long and rocky road to control of his inflammatory bowel disease which presented when he was 2 years old. Histologically it fitted a Crohn’s classification. His journey included moderate response to oral steroids and little to no response to a range of DMARDs, biologics (including infliximab and adalimumab which both had secondary failure) and elemental nutrition, over a period of 12 years. Vedolizumab was introduced this year with almost immediate improvement of gut symptoms, but with ongoing raised inflammatory markers (CRP 79, ESR 86). Incidental investigations of neck pain following the start of vedolizumab revealed significant abnormality in the external carotids, with 70% stenosis. MR angiography confirmed a typical pattern of stenotic large vessel vasculitis. The second patient, B is also 17 and was diagnosed with histological ulcerative colitis aged 14. He has an older brother with IBD but has recently been found to have small bowel disease and is likely therefore to have Crohn’s disease. He is on infliximab 10mg/kg 4 weekly but presented with a 3-month history of high inflammatory markers, malaise towards the end of the 4 week infliximab cycle and drenching night sweats. CT Chest confirmed vasculitis in the thoracic aorta, subclavians and carotids. On PET CT there is mural thickening and no stenosis. Results Patient A presented in paediatric care and B in adult care but because of the seamless rheumatology service and combined MDT with gastroenterology both patients’ care has been widely discussed amongst relevant adult and paediatric teams. Conclusion Large vessel vasculitis might be driving the inflammatory bowel disease in both patients as such the life threatening element of the disease ought to be managed immediately, while ensuring safe transition to between paediatric and adult care. Disclosures S. Rasul None. M. Dockery None. R. Tattersall None. D. Hawley None. S. Maltby None. A. McMahon None.

Evaluation of a Telehealth Clinic as a Means to Facilitate Dermatologic Consultation: Pilot Project to Assess the Efficiency and Experience of Teledermatology Used in a Primary Care Network

2010 ◽  
Vol 14 (1) ◽  
pp. 7-12 ◽  
Author(s):  
David A. Ludwick ◽  
Charles Lortie ◽  
John Doucette ◽  
Jaggi Rao ◽  
Christine Samoil-Schelstraete
Keyword(s):  
Primary Care ◽  
Pilot Project ◽  
Care Process ◽  
Wait Times ◽  
Referral Process ◽  
Consultation Process ◽  
Face To Face ◽  
Specialist Referral ◽  
Field Notes ◽  
Patients Experience

Background: Primary care offices spend considerable time coordinating the specialist referral process. Patients experience long wait times for consultation and intervention. Objective: To determine if telehealth combined with interdisciplinary team–based care can reduce wait times for dermatologic consultation while making the consultation process easier for physicians. Methods: Retrospective chart reviews as well as patient, referring physician, nonreferring physician, clinic physician, nurse, and teledermatologist interviews were used to evaluate the clinic. A comparative immersion approach generated themes from field notes. Wait times, appointment times, and encounter durations were measured. Results: Twenty-eight patients were seen (23 had previous specialist referral experience) within 1 week of referral compared to a wait period of 104 days for conventional referral. Patients requiring intervention were treated within 1 week of their initial appointment. Referring practitioners were concerned that they would lose control of patients' care. An easier referral process and faster intakes met physician expectations. Conclusions: Teledermatology improves the timeliness of appointments. Patients forgo face-to-face appointments if alternatives are available sooner. Physicians are concerned about their own liability if dermatologists do not assess the patient in person but will refer through teledermatology when patients are seen faster and they remain in control of the care process.

scholarly journals Transition for patients with congenital heart disease in the UK: need for a universal model with adequate training and support

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Krishnathasan ◽  
A Constantine ◽  
S Fitzsimmons ◽  
D Taliotis ◽  
R Bedair ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Administrative Support ◽  
Adult Care ◽  
Loss To Follow Up ◽  
Transition Service ◽  
Transition Care ◽  
The Uk

Abstract Background Adolescence is a vulnerable period for patients with congenital heart disease (CHD). Transition is a process that guides these patients through adolescence and ensures a smooth transfer to adult services, in order improve adherence to medical care and reduce loss to follow-up. While the importance of a formal Transition process is widely recognised and a requirement for specialist services in the UK, the optimal structure and delivery of Transition remains a matter of debate. Aims To examine the different models of Transition currently in place in specialist CHD centres around the UK. Methods A survey of Adult CHD centres in the UK was performed. A focus was placed on the structure of the Transition service, relevant training and areas of perceived improvement. Results There were 10 responses to our survey covering 10 specialist CHD centres. All respondents were consultant adult CHD specialists, looking after patients from the age of 16 [14–17] years. All centres have a specialised Transition service, which runs from the age 13 [11–15] to 18 [16–25] years (duration of transition 5 [2–13] years). The majority of centres (80%) report providing transition care “well before” transfer to adult care, whereas 20% provide transition care at or immediately before transfer (i.e. first adult CHD appointment). Transition is delivered by physicians and clinical specialist nurses in approximately equal numbers in 9 (90%) centres and exclusively by clinical nurse specialists in 1 (10%) centre. A median of 2 [1–5] visits are planned for each patient, with 7 (70%) centres seeing patients at least twice during transition. The majority, but not all centres (70%) provide a health passport during transition. A significant number of centres felt they werer not receiving sufficient support in the following domains: financial (50%), training (30%), clinical space (30%), referrals from paediatrics (50%). All respondents felt that their Transition service had room for improvement. Other areas of improvement highlighted included reduction in loss to follow-up, difficulties in providing a Transition service to patients followed in peripheral hospitals, the need for more support from paediatric services in referring all appropriate patients, and dedicated administrative support. The vast majority of respondents (9, 90%) felt equipped with the appropriate skills to care for transition patients. However, few (2, 20%) had completed formal training in more than one area related to adolescent health and transition. Conclusions While all CHD centres have a Transition service, Transition models and delivery differs significantly. There is urgent need for research in this area to develop a unified model, greater financial support and relevant training to optimise care. Figure 1. Participating UK centres Funding Acknowledgement Type of funding source: None

A Focus Group Interview with Health Professionals: Establishing Efficient Transition Care Plan for Older Adult Patients in Korea

2021 ◽  
Author(s):  
Chan Mi Park ◽  
Seung Jun Han ◽  
Jae Hyun Lee ◽  
Jin Lim ◽  
Sung do Moon ◽  
...  
Keyword(s):  
Older Adults ◽  
Focus Group ◽  
Focus Group Interview ◽  
Transition Period ◽  
Group Interview ◽  
Smooth Transition ◽  
Care Plan ◽  
Care Process ◽  
Rehabilitation Service ◽  
Transition Care

Abstract BackgroundEven though transition care can affect functional status and quality of life after acute hospitalization for older adults, less is known on problems associated with discharge planning in Korean acute hospitals. We aimed to investigate barriers and possible solutions on transfer planning of complex older patients in this study.MethodsWe used focus group interview with application of framework analysis. Twelve physicians providing inpatient care from 6 different institutions in Korea participated for the interview. Facilitating questions were extracted from 2 roundtable meetings prior to the main interview. From transcribed verbatim, themes were constructed from corresponding remarks by participants. ResultsWe revealed two main domains of the barrier which included multiple subdomains for each of them. First domain was a patient factor barrier, a composite of misperception of medical provider’s intentions, incomprehension of the healthcare system, and communication failure between the caregivers or decision makers. Second domain, institutional factors included different fee structures across the different levels of care, high barrier to accessing health service in tertiary hospitals or to be referred to, hardship of communication between institutions, and insufficient subacute rehabilitation service across the country. ConclusionsThrough the interview, physicians in the field recognized barriers of smooth transition care process from tertiary level hospitals to community care especially for older adults. Participants emphasized both the patients and hospital sides of adjustment on behaviors, communication, and greater attention for what really matters for the individuals during the transition period.

scholarly journals Group education for adolescents with type 1 diabetes during transition from paediatric to adult care: study protocol for a multisite, randomised controlled, superiority trial (GET-IT-T1D)

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e033806
Author(s):  
Elise Mok ◽  
Melanie Henderson ◽  
Kaberi Dasgupta ◽  
Elham Rahme ◽  
Mohammad Hajizadeh ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Cost Effectiveness ◽  
Emerging Adults ◽  
Adult Care ◽  
Group Education ◽  
Transition Care ◽  
Superiority Trial ◽  
Adult Diabetes ◽  
Secondary Outcomes

IntroductionTransition from paediatric to adult care is challenging for adolescents and emerging adults (ages 18 to 30 years) with type 1 diabetes (T1D). This transition is characterised by a deterioration in glycaemic control (haemoglobin A1c (HbA1c)), decreased clinical attendance, poor self-management and increased acute T1D-related complications. However, evidence to guide delivery of transition care is lacking. Given the effectiveness of group education in adult diabetes glycaemic control and improvements in qualitative measures in paediatric diabetes, group education is a potentially feasible and cost-effective alternative for the delivery of transition care. In emerging adults with T1D, we aim to assess the effectiveness of group education visits compared with usual care on HbA1c, T1D-related complications, psychosocial measures and cost-effectiveness after the transfer to adult care.Methods and analysisIn a multisite, assessor-blinded, randomised, two-arm, parallel-group, superiority trial, 212 adolescents with T1D (ages 17 years) are randomised to 12 months group education versus usual T1D care before transfer to adult care. Visits in the active arm consist of group education sessions followed by usual T1D care visits every 3 months. Primary outcome is change in HbA1c measured at 24 months. Secondary outcomes are delays in establishing adult diabetes care, T1D-related hospitalisations and emergency department visits, severe hypoglycaemia, stigma, self-efficacy, diabetes knowledge, transition readiness, diabetes distress, quality of life and cost-effectiveness at 12 and 24 months follow-up. Analysis will be by intention-to-treat. Change in HbA1c will be calculated and compared between arms using differences (95% CI), along with cost-effectiveness analysis. A similar approach will be conducted to examine between-arm differences in secondary outcomes.Ethics and disseminationThe study was approved by McGill University Health Centre Research Ethics Board (GET-IT/MP-37-2019-4434, version ‘Final 1.0 from November 2018). Study results will be disseminated through peer-reviewed publications.Trial registration numberNCT03703440.

Challenges in the Transition of Care Process for Patients with Dravet and Lennox–Gastaut Syndromes

2020 ◽  
Vol 09 (04) ◽  
pp. 135-142
Author(s):  
Cemal Karakas ◽  
Rebecca J. Schultz ◽  
Jay R. Gavvala
Keyword(s):  
Transition Planning ◽  
Medication Management ◽  
Disease Process ◽  
Parental Knowledge ◽  
Transition Process ◽  
Dravet Syndrome ◽  
Care Process ◽  
Transition Of Care ◽  
Adult Care ◽  
Transition Readiness

AbstractEpileptic encephalopathies such as Dravet syndrome (DS) and Lennox–Gastaut syndrome (LGS) present unique challenges in the transition of care not only for the providers but also for the patients and families. Some of these challenges include the complexity of disease process, differences in medication management between children and adults, high incidence of comorbidities such as psychosocial issues, a lack of structured transition process from pediatric to adult care, and the lack of parental knowledge and reluctance to transition to an adult provider. Improving transition readiness and transfer of care are essential to long-term management and continuity of care. Studies show that patients/families who possess transition readiness skills have better health outcomes. Furthermore, participation in a structured transition intervention has been shown to improve transition readiness and utilization of ambulatory care in the adult setting. Reported benefits of implementation of transition planning include increased self-esteem, improved health literacy, fewer emergency room visits, decreased hospitalizations and comorbidities, and fewer school absences. Nevertheless, there is a lack of evidenced-based, family/patient-centered transition model of care. This review's primary goal is to provide an overview of challenges in the transition of care and recommendations for an ideal transition for patients with DS and LGS.

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