Hart Laura C, Deusen Reed Van, Gonzaga Alda Maria
Departments of Internal Medicine and Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
J Commun Healthc. 2017;10(2):149-155. doi: 10.1080/17538068.2017.1313479. Epub 2017 Apr 15.
Most youth with chronic illness will survive into adulthood. The complexity of the medical history and care in these patients necessitates a well-planned and coordinated transition over several years as they move from pediatric to adult-oriented health care.
We assessed pediatric residents' practice patterns and attitudes regarding transition communication by administering a survey about transition to pediatric, combined internal medicine-pediatrics, pediatric neurology, and combined psychiatry-child psychiatry-pediatric residents.
Among 110 residents who were contacted, 66 completed the survey, for a response rate of 61%. Surveyed residents report discussing transition with their patients when their patients are age 18 or older, when guidelines suggest a discussion should begin around age 12. Most residents felt that transition should be initially addressed one year prior to transfer. Residents also reported barriers such as lack of experience with transition and lack of role modeling by supervisors as barriers to providing transitional care.
The practice patterns and attitudes of pediatric residents in this study do not reflect the recommendations that have been published regarding transitional care services to prepare patients and families for transfer from pediatric to adult-oriented care. In particular, most residents report that they start transition discussions when a patient is near the age of 18, rather than the age of 12 as guidelines suggest and as families would prefer. Pediatric residents need further education regarding transition, with particular emphasis on the need for early and frequent discussions with patients and families regarding transition.
大多数患有慢性病的青少年将存活至成年期。这些患者病史和护理的复杂性使得在他们从儿科医疗转向成人导向医疗的过程中，需要在数年时间里进行精心规划和协调的过渡。
我们通过对儿科、内科 - 儿科联合、儿科神经科以及精神科 - 儿童精神科 - 儿科联合住院医师进行关于过渡沟通的调查，来评估儿科住院医师在过渡沟通方面的实践模式和态度。
在联系的110名住院医师中，66名完成了调查，回复率为61%。接受调查的住院医师报告称，当患者年满18岁时才与他们讨论过渡问题，而指南建议应在12岁左右开始讨论。大多数住院医师认为应在转诊前一年开始首次讨论过渡问题。住院医师还报告了一些障碍，如缺乏过渡经验以及上级缺乏榜样示范作用，这些都是提供过渡性护理的障碍。
本研究中儿科住院医师的实践模式和态度并未反映出已发表的关于过渡性护理服务的建议，这些建议旨在帮助患者和家庭为从儿科护理转向成人导向护理做好准备。特别是，大多数住院医师报告称，他们在患者接近18岁时才开始过渡讨论，而不是如指南建议以及家庭所希望的在12岁时。儿科住院医师需要接受关于过渡的进一步教育，尤其要强调需要尽早且频繁地与患者及家庭讨论过渡问题。
