Bhawra Jasmin, Toulany Alene, Cohen Eyal, Moore Hepburn Charlotte, Guttmann Astrid
Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.
BMJ Open. 2016 May 5;6(5):e011871. doi: 10.1136/bmjopen-2016-011871.
To determine effective interventions to improve primary care provider involvement in transitioning youth with chronic conditions from paediatric to adult care.
Systematic review. Multiple electronic databases were searched including Ovid MEDLINE, EMBASE and Web of Science (from 1 January 1947 to 5 August 2015). Evidence quality was assessed using a 36-point scoring system for disparate study designs.
Studies with paediatric-to-adult transition programmes and interventions involving primary care providers or in primary care settings.
Youth aged 16 years and over.
Relevant outcomes were grouped into 3 main domains based on the Triple Aim Framework: experience of care, population health, cost.
A total of 1888 unique citations were identified, yielding 3 studies for inclusion. Overall, primary care provider roles were not well defined. 2 studies used case managers to facilitate referrals to primary care, and the remaining study was the only 1 situated in a primary care setting. None of the studies examined transition in all 3 Triple Aim Framework domains. The most commonly reported outcomes were in the cost domain.
There is limited empiric evidence to guide primary care interventions to improve transition outcomes for youth with chronic conditions. Future research and policy should focus on developing and evaluating coordinated transition interventions to better integrate primary care for high need populations.
确定有效的干预措施,以提高初级保健提供者在慢性病青少年从儿科护理过渡到成人护理过程中的参与度。
系统评价。检索了多个电子数据库,包括Ovid MEDLINE、EMBASE和Web of Science(从1947年1月1日至2015年8月5日)。使用针对不同研究设计的36分评分系统评估证据质量。
涉及初级保健提供者或初级保健环境的儿科到成人过渡计划和干预措施的研究。
16岁及以上的青少年。
根据三重目标框架,相关结果分为3个主要领域:护理体验、人群健康、成本。
共识别出1888条独特的引文,纳入3项研究。总体而言,初级保健提供者的角色定义不明确。2项研究使用病例管理员来促进向初级保健的转诊,其余研究是唯一一项位于初级保健环境中的研究。没有一项研究在三重目标框架的所有3个领域中考察过渡情况。最常报告的结果在成本领域。
指导初级保健干预措施以改善慢性病青少年过渡结果的实证证据有限。未来的研究和政策应侧重于制定和评估协调的过渡干预措施,以更好地整合对高需求人群的初级保健。