Mitchell Alice G, Belton Suzanne, Johnston Vanessa, Ralph Anna P
Menzies School of Health Research, PO Box 41096, Darwin, NT 0811, Australia.
Aust J Prim Health. 2018 Mar;24(1):9-13. doi: 10.1071/PY17069.
Aboriginal children in northern Australia have high rates of rheumatic fever and rheumatic heart disease, which are chronic conditions because of the need for long-term treatment and monitoring. This article critically reviews the literature on transition to adult care for children with chronic conditions and considers applicability to the care of these children. The review was merged with findings from a focussed ethnography conducted in four remote Aboriginal communities with young people who have these conditions. Transition care aims to support adolescents on a healthcare trajectory to facilitate best long-term health and personal outcomes. Characteristics of the two medical conditions, the children and their local health services in northern Australia were generalised and merged with principles from the transition care literature, including policies governing transition clinics in urban locations. In this setting, the challenge is to transition Aboriginal children safely through to adulthood without rheumatic heart damage rather than to a separate health service on reaching adulthood. Recommended tailoring of transition care involves engaging and valuing local navigators who can address language and cultural barriers to provide a sustainable alternative to transition coordinators in mainstream programs. This has potential to improve care without further burdening overstretched clinical resources.
澳大利亚北部的原住民儿童患风湿热和风湿性心脏病的比例很高，由于需要长期治疗和监测，这两种病都属于慢性病。本文批判性地回顾了有关慢性病患儿向成人护理过渡的文献，并考虑其对这些患儿护理的适用性。该综述与在四个偏远原住民社区对患有这些疾病的年轻人进行的重点人种志研究结果相结合。过渡护理旨在支持青少年的医疗保健进程，以促进最佳的长期健康和个人成果。对这两种疾病的特征、这些儿童及其在澳大利亚北部当地的医疗服务进行了归纳，并与过渡护理文献中的原则相结合，包括城市地区过渡诊所的相关政策。在这种情况下，挑战在于让原住民儿童安全过渡到成年而不出现风湿性心脏损伤，而不是成年后转到另一种医疗服务。建议对过渡护理进行调整，让当地导航员参与其中并重视他们，这些导航员能够克服语言和文化障碍，为主流项目中的过渡协调员提供可持续的替代方案。这有可能改善护理，而不会给本就捉襟见肘的临床资源增加更多负担。
