Plevinsky J M, Gumidyala A P, Fishman L N
Psychology Department, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA.
Boston Children's Hospital, Boston, MA, USA.
Child Care Health Dev. 2015 Sep;41(5):755-61. doi: 10.1111/cch.12213. Epub 2014 Nov 6.
Outcomes following transition can be poor; many young adults are ill prepared to take responsibility for their health care, older adolescents report incomplete understanding of medications, and parents remain largely responsible for their care. Good patient-provider relationships are associated with better adherence; however, the role of the relationship between post-transition patients and their providers has not been explored. The current study aimed to understand transition of young adults with inflammatory bowel diseases (IBD), the impact of the paediatric patient-provider relationship and what determines the adult patient-provider relationship.
This study examined the experience of young adults with Crohn's disease or ulcerative colitis (aged 18-30) after transition. Twenty-nine patients completed a 31-item online survey of their transition experience from paediatric to adult care. Responses were coded quantitatively and qualitatively, and qualitative responses were analysed by two independent raters.
Positive themes regarding adult providers included independence, autonomy and trust, while negative themes included initial discomfort and confusing logistics. Five of six patients who reported 'terrifying' first visit experiences with their adult providers reported overall positive relationships. The earlier the diagnosis age, the less involved in medical decisions they were as an adult (r = 0.41, P = .03). Those who had a more positive experience with their paediatric providers were more likely to bring up confusion with their adult providers (r = .45, P = .04), and those who had a more positive experience with their adult providers were more likely to endorse collaborative medical decision-making (r = .57, P < .001).
Patients diagnosed with IBD at a young age may need extra education and self-management strategies, as they were less likely to exhibit behaviours indicative of a successful transition to adult care. Additionally, transition programme development may benefit from the post-transition perspective across chronic illness populations.
过渡后的结果可能较差；许多年轻人对承担自己的医疗保健责任准备不足，年龄较大的青少年表示对药物的理解不完整，而父母在很大程度上仍对他们的护理负责。良好的医患关系与更好的依从性相关；然而，过渡后患者与其医疗服务提供者之间关系的作用尚未得到探讨。当前的研究旨在了解炎症性肠病（IBD）青年患者的过渡情况、儿科医患关系的影响以及决定成年医患关系的因素。
本研究调查了克罗恩病或溃疡性结肠炎青年患者（18 - 30岁）过渡后的经历。29名患者完成了一项关于他们从儿科护理过渡到成人护理经历的31项在线调查。对回答进行了定量和定性编码，定性回答由两名独立评分者进行分析。
关于成年医疗服务提供者的积极主题包括独立性、自主性和信任，而消极主题包括最初的不适和令人困惑的流程。在报告首次与成年医疗服务提供者就诊经历“可怕”的6名患者中，有5名报告总体关系积极。诊断年龄越早，成年后参与医疗决策的程度越低（r = 0.41，P = 0.03）。那些与儿科医疗服务提供者有更积极经历的人更有可能向成年医疗服务提供者提出困惑（r = 0.45，P = 0.04），而那些与成年医疗服务提供者有更积极经历的人更有可能认可协作性医疗决策（r = 0.57，P < 0.001）。
年轻时被诊断为IBD的患者可能需要额外的教育和自我管理策略，因为他们不太可能表现出向成人护理成功过渡的行为。此外，过渡项目的开发可能会从慢性病群体过渡后的角度中受益。
