Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles (UCLA) (RK Tsevat and LE Wisk).
Division of Adolescent/Young Adult Medicine, Boston Children's Hospital (ER Weitzman and LE Wisk), Boston, Mass; Department of Pediatrics, Harvard Medical School (ER Weitzman and LE Wisk), Boston, Mass; Computational Health Informatics Program, Boston Children's Hospital (ER Weitzman), Boston, Mass.
Acad Pediatr. 2023 May-Jun;23(4):737-746. doi: 10.1016/j.acap.2022.08.012. Epub 2022 Sep 5.
Adolescents with chronic diseases must navigate changing healthcare needs in college and beyond. This study examined the ability of college youth with type 1 diabetes (T1D) to achieve transition milestones and ascertained sociodemographic predictors of a successful healthcare transition (HCT).
College youth with T1D were recruited via social media and direct outreach to participate in a web-based study, during which they answered questions about the HCT process. Descriptive statistics and multivariable regression were used to evaluate HCT measures as a function of sociodemographic variables.
Nearly two-thirds of participants (N = 138) had discussions with their providers about changing healthcare needs (65.9%) and transferring care to adult physicians (64.5%); less than one-third (27.9%) discussed obtaining health insurance as an adult. Females were more likely than males to discuss transitioning to adult providers (70.3% vs 40.7%, P < .01). Those covered on a parent's insurance (vs other) plan were more likely to receive help with finding adult providers (79.3% vs 44.4%, P = .04) but less likely to discuss how to obtain health insurance (25.0% vs 61.1%, P < .01). These differences persisted after adjustment.
Improvement is needed with regard to college youth with T1D becoming autonomous managers of their own care. Gaps were found in their experiences of discussing changing healthcare needs, locating adult providers, and obtaining health insurance-especially among those who were younger, male, and not covered under parental insurance. Efforts to improve the HCT process should focus particularly on these subgroups to advance healthcare delivery in this population.
患有慢性病的青少年在大学及以后必须应对不断变化的医疗需求。本研究旨在调查患有 1 型糖尿病(T1D)的大学生实现过渡里程碑的能力,并确定成功过渡到医疗保健(HCT)的社会人口预测因素。
通过社交媒体和直接联系,招募患有 T1D 的大学生参加一项基于网络的研究,在此期间,他们回答了有关 HCT 过程的问题。使用描述性统计和多变量回归来评估 HCT 措施与社会人口统计学变量的关系。
近三分之二的参与者(N=138)与提供者讨论了改变医疗需求(65.9%)和将护理转移给成年医生(64.5%);不到三分之一(27.9%)讨论了作为成年人获得健康保险的问题。女性比男性更有可能讨论过渡到成年提供者(70.3%对 40.7%,P<0.01)。那些参加父母保险(而不是其他)计划的人更有可能获得寻找成年提供者的帮助(79.3%对 44.4%,P=0.04),但不太可能讨论如何获得健康保险(25.0%对 61.1%,P<0.01)。这些差异在调整后仍然存在。
需要改善患有 T1D 的大学生成为自身护理的自主管理者的能力。在讨论改变医疗需求、寻找成年提供者和获得健康保险方面,他们的经验存在差距,尤其是在年龄较小、男性和未参加父母保险的人群中。改善 HCT 过程的努力应特别针对这些亚组,以促进该人群的医疗保健服务。