Kipps S, Bahu T, Ong K, Ackland F M, Brown R S, Fox C T, Griffin N K, Knight A H, Mann N P, Neil H A W, Simpson H, Edge J A, Dunger D B
Department of Paediatrics, Addenbrookes Hospital, Hills Road, Cambridge CB2 2QQ, UK.
Diabet Med. 2002 Aug;19(8):649-54. doi: 10.1046/j.1464-5491.2002.00757.x.
To determine the efficacy and patient perception of various transfer procedures from paediatric to adult diabetes services.
Comparison between four districts in the Oxford Region employing different transfer methods, by retrospective study of case records and interviews of patients recently transferred from paediatric diabetes clinics. The main outcome measures were age at transfer, clinic attendance rates, HbA1c measurements and questionnaire responses.
Two hundred and twenty-nine subjects (57% males) > 18 years old in 1998 and diagnosed with Type 1 diabetes < 16 years of age between 1985 and 1995, identified from the regional diabetes register. The notes audit was completed for 222 (97%) and 164 (72%) were interviewed by a single research nurse. Mean age at transfer was 17.9 years (range 13.3-22.4 years). Few young people were lost to follow-up at the point of transfer. There was a high rate of clinic attendance (at least 6 monthly) 2 years pretransfer (94%), but this declined to 57% 2 years post-transfer (P < 0.0005). There was large interdistrict variation in clinic attendance 2 years post-transfer (29% to 71%); higher rates were seen in districts where young people had the opportunity to meet the adult diabetes consultant prior to transfer. The importance of this opportunity was confirmed by questionnaire responses on interview.
Adolescence is a vulnerable period for patients with diabetes. This regional survey demonstrated a marked decline in clinic attendance around the time of transition from paediatric to adult services. The reasons are complex, but mode of transfer may be an important factor.
确定从儿科糖尿病服务向成人糖尿病服务转移的各种程序的疗效及患者感受。
通过对病例记录的回顾性研究以及对近期从儿科糖尿病诊所转诊的患者进行访谈，比较牛津地区采用不同转诊方法的四个区。主要观察指标为转诊年龄、门诊就诊率、糖化血红蛋白测量值及问卷调查结果。
从地区糖尿病登记册中识别出1998年年龄大于18岁且在1985年至1995年间16岁之前被诊断为1型糖尿病的229名受试者（57%为男性）。对222名（97%）进行了病历审核，由一名研究护士对164名（72%）进行了访谈。平均转诊年龄为17.9岁（范围13.3 - 22.4岁）。在转诊时很少有年轻人失访。转诊前2年门诊就诊率较高（至少每6个月一次，为94%），但转诊后2年降至57%（P < 0.0005）。转诊后2年门诊就诊率在各区之间存在很大差异（29%至71%）；在年轻人在转诊前有机会见到成人糖尿病顾问的区，就诊率较高。访谈中的问卷调查结果证实了这种机会的重要性。
青春期是糖尿病患者的脆弱时期。这项地区性调查表明，从儿科服务向成人服务过渡期间门诊就诊率显著下降。原因很复杂，但转诊方式可能是一个重要因素。
