Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
J Gen Intern Med. 2019 Oct;34(10):2083-2090. doi: 10.1007/s11606-019-05226-w. Epub 2019 Aug 13.
The transition from pediatric to adult care is a critical period for young adults with childhood-onset conditions. General internists are tasked with participating in the care of this vulnerable population. Existing guidelines regarding transition do not fully address structural or organizational characteristics of practices that facilitate transition. Moreover, literature regarding transition has focused on pediatric subspecialty settings, leaving internists with little guidance after transfer.
To better understand post-transfer transitional care by describing care models that primary care providers have implemented, and examining common features of generalist physicians' experiences providing transitional care.
Qualitative methods, semi-structured interviews.
Nineteen generalist-trained physicians from across the USA, engaged in transition-focused and/or ongoing care of adolescents and young adults with childhood-onset conditions.
Content and grounded theory analyses.
Participants included nineteen physicians from seventeen institutions. Most (89%) were from academic medical centers. About 80% had completed a combined internal medicine-pediatrics residency. About 70% worked with clinic staff who were dedicated to transition. Practice structures fell into four main care models: (1) primary care in adult settings; (2) transition support and primary care in pediatric settings; (3) a blend of pediatric and adult care elements forming a bridge during transition; and (4) a transition consultative service. Most provided primary care for adults with childhood-onset conditions within larger adult-oriented primary care practices. Common features across interviews included taking extra time with patients both during and between visits and an interdisciplinary team-based approach. Shared practice strategies and philosophies emphasized care coordination, focus on the whole patient beyond immediate health concerns, and willingness to learn from practice and from families.
Participants used disparate care models. Common features and strategies among interviews highlight key functions and attributes of transitional care across settings, suggest important elements of care post-transfer, and clarify the role of generalists.
从儿科过渡到成人护理是儿童时期发病的年轻人的关键时期。普通内科医生的任务是参与照顾这一弱势群体。现有的过渡指南并没有充分解决促进过渡的实践的结构或组织特征。此外，关于过渡的文献主要集中在儿科专科领域，留给内科医生的指导很少。
通过描述初级保健提供者实施的护理模式，并研究普通内科医生提供过渡护理的常见经验特征，更好地了解转移后的过渡护理。
定性方法，半结构化访谈。
来自美国各地的 19 名接受过普通培训的医生，从事以过渡为重点的护理和/或正在为儿童时期发病的青少年和年轻人提供过渡护理。
内容和扎根理论分析。
参与者包括来自 17 个机构的 19 名医生。大多数（89%）来自学术医疗中心。约 80%的人完成了内科-儿科联合住院医师培训。约 70%的人与专门从事过渡的诊所工作人员合作。实践结构分为四种主要护理模式：（1）成人环境中的初级保健；（2）过渡支持和儿科环境中的初级保健；（3）儿科和成人护理要素的混合，在过渡期间形成桥梁；（4）过渡咨询服务。大多数人在更大的成人导向的初级保健实践中为儿童时期发病的成年人提供初级保健。访谈中的共同特征包括在就诊期间和就诊之间为患者额外花费时间，以及采用跨学科团队方法。共同的实践策略和理念强调护理协调，关注超越当前健康问题的整体患者，以及愿意从实践和家庭中学习。
参与者使用了不同的护理模式。访谈中的共同特征和策略突出了不同环境中过渡护理的关键功能和属性，提示了转移后的重要护理要素，并阐明了普通内科医生的角色。
