Journal Article

Improving the transition between paediatric and adult healthcare: a systematic review

McKee, M, Crowley, R, Wolfe, I, Lock, K

2011

Overview

Introduction The transition between paediatric and adult care for young people with chronic illness or disability is often poorly managed, with adverse consequences for health. Although many agree that adolescent services need to be improved, there is little empirical data on which policies can be based. Objectives To systematically review the evidence of effectiveness of transitional care programmes in young people aged 11–25 with chronic illness (physical or mental) or disability, and identify their successful components. Design A systematic literature review in July 2010 of studies which consistently evaluated health outcomes following transition programmes, either by comparison with a control group or by measurement pre-intervention and post-intervention. Results 10 studies met the inclusion criteria, six of which showed statistically significant improvements in outcomes. Descriptive analysis identified three broad categories of intervention, directed at: the patient (educational programmes, skills training); staffing (named transition co-ordinators, joint clinics run by paediatric and adult physicians); and service delivery (separate young adult clinics, out of hours phone support, enhanced follow-up). The conditions involved varied (eg, cystic fibrosis, diabetes mellitus), and outcome measures varied accordingly. All six interventions that resulted in significant improvements were in studies of patients with diabetes mellitus, with glycosylated haemoglobin level, acute and chronic complications, and rates of follow-up and screening used as outcome measures. Conclusions The most commonly used strategies in successful programmes were patient education and specific transition clinics (either jointly staffed by paediatric and adult physicians or dedicated young adult clinics within adult services). It is not clear how generalisable these successful studies in diabetes mellitus will be to other conditions.

• Publisher: BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health,BMJ Publishing Group,BMJ Publishing Group Ltd,BMJ Publishing Group LTD
• Subject: Adolescent / Adolescent Health Services - organization & administration / Adolescent Health Services - standards / Adolescents / Adult / Biological and medical sciences / Care and treatment / Child / Child care services / Child development / Child Health / Children & youth / Chronic Disease - therapy / chronic illness / Chronic illnesses / Company business management / Congenital Impairments / Continuity of Patient Care - organization & administration / Continuity of Patient Care - standards / Control Groups / Critically ill children / Cystic fibrosis / Delivery of Health Care - organization & administration / Diabetes / Disability / Folkhälsovetenskap / General aspects / Health Needs / Health services / Health Services Research - methods / Holistic Approach / Humans / Information Seeking / Intervention / Literature reviews / Management / Medical sciences / Mental disorders / Meta Analysis / Miscellaneous / Outcome Assessment, Health Care - methods / Outcome Measures / paediatric care / Patient Education / Patient Education as Topic / Patients / Pediatric clinics / Pediatricians / Pediatrics / Practice / Prevention and actions / Public Health Science / Public health. Hygiene / Public health. Hygiene-occupational medicine / Qualitative research / Search Strategies / Social Development / transition clinics / transitional care programmes / Transplants & implants / Young Adult / Young adults