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Perceptions of the family physician from adolescents and their caregivers preparing to transition to adult care.

ABSTRACT: BACKGROUND:Adolescents with chronic health conditions and/or disabilities (CHC/D's) often face challenges when transitioning to adult care, which leads to a higher risk of morbidity and mortality. Although it is recommended that establishing the medical home and family physician (FP) attachment prior to transfer will improve health outcomes, there is little evidence or policy surrounding the role of the FP during this transition. This study explores the described use of health services by adolescents with CHC/D's, as well as the adolescent's and caregiver's perceptions of their FP. METHODS:Participants were recruited from the British Columbia Children's Hospital, Canada and a multi-method phased approach was used. In Phase 1, 84 adolescent and caregiver pairs completed questionnaires asking what medical services they accessed for specific health needs. In Phase 2, another cohort of 21 adolescent and caregiver pairs completed the same questionnaires and were interviewed regarding their perception of their FP. RESULTS:96% (n =?81) of adolescents with CHC/D's in phase 1 had a FP. Thirty four percent (n =?34) of adolescents had not seen their FP in the last 6 months. While adolescents with CHC/D mostly accessed their FP for primary health issues, they frequently also accessed specialists for prescription refills (50%, n =?51), mental health (29%, n =?30) and sexual health (16%, n =?16). While most adolescent/caregiver participants reported positive communication and trust in their FP, some had a poor understanding of the FP's role in coordinating care. CONCLUSION:As many adolescents with CHC/D may see their FP infrequently and may not clearly understand their role, opportunities exist for strengthening primary care home attachment as well as adolescent and caregiver literacy around the potential contribution of the FP during and after transfer to adult services. Responsibility for improving care coordination for this population should be ideally shared between FPs and pediatric specialists.

SUBMITTER: Han AX

PROVIDER: S-EPMC6106717 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Perceptions of the family physician from adolescents and their caregivers preparing to transition to adult care.

Han Angela Xiao AX Whitehouse Sandy Rosalie SR Tsai Steve S Hwang Sandy S Thorne Sally S

BMC family practice 20180823 1

<h4>Background</h4>Adolescents with chronic health conditions and/or disabilities (CHC/D's) often face challenges when transitioning to adult care, which leads to a higher risk of morbidity and mortality. Although it is recommended that establishing the medical home and family physician (FP) attachment prior to transfer will improve health outcomes, there is little evidence or policy surrounding the role of the FP during this transition. This study explores the described use of health services b ...[more]

PMID: 30134842

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Project description:ImportanceAdolescents with severe mental illness often age out of pediatric care without a clear transfer of care to adult services. The extent to which primary care provides stability during this vulnerable transition period is not known.ObjectiveTo analyze the association between primary care continuity during the transition from pediatric to adult care and need for acute mental health services in young adulthood.Design, setting, and participantsThis population-based cohort study used linked health and demographic administrative data for all adolescents aged 12 to 16 years with severe mental illness ascertained by hospitalization for schizophrenia, eating disorder, or mood disorder between April 1, 2002, and April 1, 2014, in Ontario, Canada. Participants were followed up through March 31, 2017. Data were analyzed from July 2018 to January 2019.ExposuresContinuous primary care (same physician as baseline [age 12-16 years] always or sometimes), discontinuous primary care (visits to a primary care physician during the transition period who was not the patient's usual physician), and no primary care during the transition period (age 17-18 years).Main outcomes and measuresMental health-related hospitalizations and emergency department visits in young adulthood (age 19-26 years) adjusted for sex, rurality, neighborhood income, mental illness type, and health service use before transition.ResultsAmong 8409 adolescents with severe mental illness (5720 [68.0%] female; mean [SD] age, 14.8 [1.2] years), 5478 (65.1%) had continuous primary care, 2391 (28.4%) had discontinuous primary care, and 540 (6.4%) had no primary care during the transition period. Youths with no primary care during transition were more likely to be male (57.2%), have lower socioeconomic status (31.5%), and have no usual primary care practitioner at baseline (25.6%). Compared with continuous care, patients with discontinuous and no primary care had an increased rate of mental health-related hospitalization in young adulthood (adjusted relative rate, 1.20; 95% CI, 1.10-1.30; and adjusted relative rate, 1.30; 95% CI, 1.08-1.56, respectively).Conclusions and relevanceIn the context of decreasing outpatient specialist mental health visit rates following transition to adult care, ensuring adequate access to primary care during this vulnerable period may improve mental health outcomes in young adulthood.

Dataset Information

Perceptions of the family physician from adolescents and their caregivers preparing to transition to adult care.

Publications

Perceptions of the family physician from adolescents and their caregivers preparing to transition to adult care.

Similar Datasets

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