Division of Endocrinology, Boston Children's Hospital.
Endocr Pract. 2013 Nov-Dec;19(6):946-52. doi: 10.4158/EP13109.OR.
To examine barriers to health care transition reported by young adults with type 1 diabetes and associations between barriers and prolonged gaps between pediatric and adult diabetes care.
We surveyed young adults aged 22 to 30 years with type 1 diabetes about their transition experiences, including barriers to timely establishment of adult diabetes care. We evaluated relationships between barriers and gaps in care using multivariate logistic regression.
The response rate was 53% (258 of 484 eligible subjects). Respondents (62% female) were 26.7 ± 2.4 years old and transitioned to adult diabetes care at 19.5 ± 2.9 years. Reported barriers included lack of specific adult provider referral name (47%) or contact information (27%), competing life priorities (43%), difficulty getting an appointment (41%), feeling upset about leaving pediatrics (24%), and insurance problems (10%). In multivariate analysis, barriers most strongly associated with gaps in care >6 months were lack of adult provider name (odds ratio [OR], 6.1; 95% confidence interval [CI], 3.0-12.7) or contact information (OR, 5.3; 95% CI, 2.0-13.9), competing life priorities (OR, 5.2; 95% CI, 2.7-10.3), and insurance problems (OR, 3.5; 95% CI, 1.2-10.3). Overall, respondents reporting ≥1 moderate/major barrier (48%) had 4.7-fold greater adjusted odds of a gap in care >6 months (95% CI, 2.8-8.7).
Significant barriers to transition, such as a lack of specific adult provider referrals, may be addressed with more robust preparation by pediatric providers and care coordination. Further study is needed to evaluate strategies to improve young adult self-care in the setting of competing life priorities.
探讨青少年 1 型糖尿病患者在接受医疗保健过渡过程中报告的障碍，并分析这些障碍与儿科和成人糖尿病护理之间的时间差距之间的关联。
我们对年龄在 22 至 30 岁之间的青少年 1 型糖尿病患者进行了调查，内容包括他们的过渡经历，以及及时建立成人糖尿病护理方面存在的障碍。我们使用多变量逻辑回归评估了障碍与护理时间差距之间的关系。
回复率为 53%（484 名符合条件的受访者中有 258 名）。受访者（62%为女性）的年龄为 26.7 ± 2.4 岁，在 19.5 ± 2.9 岁时开始接受成人糖尿病护理。报告的障碍包括缺乏特定的成人提供者转介姓名（47%）或联系方式（27%）、生活优先事项冲突（43%）、预约困难（41%）、对离开儿科感到难过（24%）和保险问题（10%）。多变量分析显示，与护理时间差距 >6 个月关系最密切的障碍是缺乏成人提供者的姓名（比值比[OR]，6.1；95%置信区间[CI]，3.0-12.7）或联系方式（OR，5.3；95% CI，2.0-13.9）、生活优先事项冲突（OR，5.2；95% CI，2.7-10.3）和保险问题（OR，3.5；95% CI，1.2-10.3）。总体而言，报告存在≥1 项中度/主要障碍（48%）的患者，其护理时间差距 >6 个月的调整后比值比（95% CI，2.8-8.7）增加了 4.7 倍。
过渡过程中存在明显的障碍，例如缺乏特定的成人提供者推荐，这可能需要儿科医生提供更有力的准备和护理协调来解决。需要进一步研究以评估改善青少年在生活优先事项冲突背景下自我护理的策略。
