University of Technology Sydney, Faculty of Health, 15 Broadway, Ultimo, NSW 2007, Australia. Email:
University of Newcastle, Faculty of Health and Medicine, University Drive, Callaghan, NSW 2308, Australia. Email:
Aust Health Rev. 2020 Aug;44(4):601-608. doi: 10.1071/AH19117.
Objective The aim of this study was to determine, in the first 2 years after the last planned appointment with paediatric diabetes services for young people with Type 1 diabetes (T1D): (1) the number of planned and unplanned healthcare contacts and HbA1c measurements made; (2) factors linked to diabetes-related service use; and (3) factors predictive of the number of planned and unplanned service contacts, and of meeting the minimum number of planned service contacts. Methods Healthcare records of a major public healthcare provider in Australia were audited for preventive and acute service use by young people with T1D transferring from paediatric to adult public healthcare services. Statistical analyses included use of t-tests and logistic regression modelling. Results Of 172 young people with T1D, 21% had no planned specialist care and 49% accessed acute services for diabetes-related matters. Residents of metropolitan areas and users of continuous subcutaneous insulin infusion therapy were more likely to access specialist care and were less likely to use acute services for unplanned care. Those achieving a minimum of nine planned care contacts in 2 years had a shorter duration between the last paediatric and first adult healthcare contact. Conclusions Lack of specialist care in early adult years and non-metropolitan relative disadvantage compromise the present and future health of young people with diabetes. What is known about the topic? Well-managed transition is thought to offer the best chance of achieving cost-effective continuing engagement with specialist services for planned preventive care, effective T1D self-management and deferral or early attention to diabetes-related vascular complications. However, transition is commonly reported as problematic. What does this paper add? The findings of this study indicate a positive trend but continuing need to improve transition care for young people with T1D, especially those living in non-metropolitan areas and those not using continuous subcutaneous insulin infusion therapy. What are the implications for practitioners? Without service innovation, suboptimal and delayed access to planned care, high use of acute services for unplanned care and poor glycaemic control will continue to threaten the future health and well-being of young people with T1D.
本研究旨在确定在青少年 1 型糖尿病（T1D）患者最后一次预约儿科糖尿病服务后的头 2 年内：（1）计划和非计划医疗保健接触次数以及糖化血红蛋白测量次数；（2）与糖尿病相关服务使用相关的因素；以及（3）预测计划和非计划服务接触次数以及达到最低计划服务接触次数的因素。
对澳大利亚一家主要公共医疗保健提供商的医疗记录进行了审核，以了解 T1D 青少年从儿科转移到成人公共医疗保健服务时，预防和急性服务的使用情况。统计分析包括使用 t 检验和逻辑回归建模。
在 172 名 T1D 青少年中，21%没有计划的专科护理，49%因糖尿病相关问题而使用急性服务。居住在大都市区的人和使用持续皮下胰岛素输注疗法的人更有可能接受专科护理，而更不可能因非计划护理而使用急性服务。在 2 年内至少接受 9 次计划护理的人，其最后一次儿科和第一次成人医疗保健接触之间的时间间隔更短。
青少年期缺乏专科护理和非大都市区的相对劣势，损害了糖尿病青少年的现在和未来健康。
人们认为，良好的过渡管理最有机会实现具有成本效益的继续参与专科服务的计划预防保健，有效的 T1D 自我管理以及延迟或早期关注糖尿病相关血管并发症。但是，过渡通常被报道为存在问题。
本文增加了什么内容？这项研究的结果表明存在积极的趋势，但仍需继续改善 T1D 青少年的过渡护理，尤其是居住在非大都市区和不使用持续皮下胰岛素输注疗法的青少年。
对从业者有何影响？如果没有服务创新，计划护理的机会不理想和延迟，非计划护理急性服务的高使用率以及血糖控制不佳，将继续威胁 T1D 青少年的未来健康和福祉。
