General Adolescent Pediatrics Unit, Institute of Child Health, UCL, London, United Kingdom.
General Adolescent Pediatrics Unit, Institute of Child Health, UCL, London, United Kingdom.
J Adolesc Health. 2019 Jun;64(6):709-720. doi: 10.1016/j.jadohealth.2018.11.023. Epub 2019 Mar 2.
International guidance on health-care transition has existed for over a decade; however, many unanswered questions remain. This systematic review of reviews aimed to answer the question: is a later age of transfer from pediatric to adult health care associated with improved health and health service outcomes?
We included systematic reviews which considered at least one long-term condition and provided outcome data from adult services. Methodology of primary studies was not an exclusion criterion. We searched multiple databases and conducted an initial search in May 2015 which was repeated in May 2017. All reviews were assessed for quality using the Revised Assessment of Multiple Systematic Reviews (R-AMSTAR) tool. Reviews that scored less than 22 were excluded.
Initial searches identified 6,149 papers. Forty-three reviews met exclusion and inclusion criteria, and 15 reviews also met quality criteria. With one exception, primary studies from reviews which only considered quantitative evidence found that a delayed age of transfer resulted in improved outcomes. Qualitative and mixed-methods evidence supported the view that age 18 was an appropriate time of transfer.
We found moderate evidence that models of transition which transfer young people in late adolescence or early adulthood can improve transition outcomes and patient satisfaction.
国际医疗保健过渡期的指导已经存在了十多年，但仍有许多未解决的问题。本系统评价旨在回答以下问题：从儿科到成人医疗保健的转移年龄较晚是否与改善健康和医疗服务结果有关？
我们纳入了至少考虑一种慢性病并提供成人服务结果数据的系统评价。主要研究的方法不是排除标准。我们搜索了多个数据库，并于 2015 年 5 月进行了初步搜索，2017 年 5 月再次进行了搜索。所有的综述都使用修订后的多重系统评价评估工具（R-AMSTAR）进行了质量评估。评分低于 22 分的综述被排除在外。
最初的搜索确定了 6149 篇论文。43 篇综述符合排除和纳入标准，15 篇综述也符合质量标准。除了一个例外，仅考虑定量证据的综述中的主要研究发现，较晚的转移年龄会导致结果改善。定性和混合方法证据支持 18 岁是转移的适当时间的观点。
我们发现中度证据表明，将青少年晚期或成年早期的年轻人转移的过渡模式可以改善过渡结果和患者满意度。
