González Florencia, Rodríguez Celin María de Las Mercedes, Roizen Mariana, Mato Roberto, García Arrigoni Patricia, Ugo Florencia, Staciuk Raquel, Fano Virginia
Servicio de Crecimiento y Desarrollo, Hospital Nacional de Pediatría "Prof. Dr. Juan P. Garrahan".
Servicio de Trasplante de Médula Ósea, Hospital Nacional de Pediatría "Prof. Dr. Juan P. Garrahan".
Arch Argent Pediatr. 2017 Dec 1;115(6):562-569. doi: 10.5546/aap.2017.eng.562.
The shift of adolescents from a pediatric to an adult health care facility is a complex process. The objective of this study was to assess the transition/transfer process for adolescents with chronic diseases at Hospital Garrahan.
Observational, cross-sectional, qualitative-quantitative study. Retrospective statistical data were obtained in relation to outpatient visits of patients aged 16-26; surveys and/or interviews were done with health care providers, adolescents, and family members from different follow-up programs.
The prevalence of care provided to individuals older than 16 years was 7.2%. Surveys were administered to 54 attending health care providers, 150 patients (16-26.7 years old) and 141 family members. In addition, 45 health care providers with management functions were interviewed. Health care providers: 39% had received training on transition. All identified barriers and facilitators among the different participants and facilities. They recognized the importance of encouraging autonomy among their patients, but only 30% of them interviewed their patients alone, and 56.6% delivered medical reports. Strategies: the median age of transfer was 18 years (13-20); 62% had a protocol; 84% had an informal agreement with another facility; joint or parallel care: 49%; only 20% implemented a transition plan. Patients and family members: 4.7% of adolescents attended visits alone, and health care providers had asked 45% about their autonomy and preparation to take care of their health. Adolescents and their parents had feelings (mostly negative) regarding the process and identified facilitation strategies, such as receiving a summary, knowing the new facility, and having trained health care providers.
The transition process for adolescents with chronic diseases is still deficient and approaching it involves health care teams and the families. A lack of formal inter-institutional agreements was identified, although there were more informal agreements among health care providers; besides, the need to encourage chronically-ill patients' autonomy was also determined. In relation to facilitation strategies, patients and parents mainly recognized the need to have a medical summary, health care guidelines, and trust in the new provider.
青少年从儿科医疗设施向成人医疗设施的转变是一个复杂的过程。本研究的目的是评估加拉汉医院慢性病青少年的转诊/转院过程。
观察性、横断面、定性定量研究。获取了16至26岁患者门诊就诊的回顾性统计数据；对来自不同随访项目的医疗服务提供者、青少年及其家庭成员进行了调查和/或访谈。
为16岁以上个体提供护理的患病率为7.2%。对54名主治医疗服务提供者、150名患者（16至26.7岁）和141名家庭成员进行了调查。此外，对45名具有管理职能的医疗服务提供者进行了访谈。医疗服务提供者：39%接受过转诊培训。所有人员都确定了不同参与者和机构之间的障碍及促进因素。他们认识到鼓励患者自主的重要性，但只有30%的人单独询问过患者情况，56.6%的人提供了医疗报告。策略：转诊的中位年龄为18岁（13至20岁）；62%有方案；84%与另一机构有非正式协议；联合或并行护理：49%；只有20%实施了转诊计划。患者和家庭成员：4.7%的青少年独自就诊，医疗服务提供者询问过45%的青少年关于他们的自主能力及照顾自身健康的准备情况。青少年及其父母对该过程有感受（大多为负面），并确定了促进策略，如收到总结、了解新机构以及有经过培训的医疗服务提供者。
慢性病青少年的转诊过程仍然存在不足，这需要医疗团队和家庭的参与。尽管医疗服务提供者之间有更多非正式协议，但仍发现缺乏正式的机构间协议；此外，还确定了鼓励慢性病患者自主的必要性。关于促进策略，患者和家长主要认识到需要有医疗总结、医疗指南以及对新提供者的信任。
