Division of Health Sciences and Nursing, Department of Family Nursing, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
Department of Pediatrics, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan.
PLoS One. 2023 Aug 10;18(8):e0289927. doi: 10.1371/journal.pone.0289927. eCollection 2023.
The number of adult patients with childhood-onset chronic diseases is increasing. However, the process of transitioning these patients from child- to adult-centered medical services faces many difficulties. Despite the key role that doctors in the pediatric field are considered to play in transition, few fact-finding surveys about transition have been conducted among these doctors.
The aim of this study was to demonstrate the current status and challenges in the transition of patients with childhood-onset chronic diseases by a fact-finding survey of pediatricians and pediatric surgeons at a university hospital.
A cross-sectional survey was performed using an anonymous self-administered questionnaire. Seventy-six doctors of pediatrics and pediatric surgery (excluding junior residents) in a university hospital were asked to answer an anonymous self-report questionnaire. A multidisciplinary research team selected items related to the transitional process.
Sixty (79%) doctors participated, of whom 52 (87%) showed awareness of transition. No doctor answered that "Transition is conducted smoothly." Doctors with shorter pediatric department experience had lower awareness and poorer experience with transition. In contrast to pediatric surgeons, pediatricians explained "job-seeking activities" and "contraceptive methods" to the patient, and reported a higher patient age at which to initiate explanation of transition to the patient and his/her family. Among factors inhibiting transition, 39 (65%) respondents selected "The patient's family members do not desire transition" and 34 (57%) selected "Although a relevant adult healthcare department is available, it will not accept the patient." The medical providers most frequently considered to have responsibility for playing a central role in the transition process were "pediatrician/pediatric surgeon," "medical social worker," and "regional medical liaison office."
To promote transition, pediatric and adult healthcare departments should share concerns about and cooperate in the establishment of more effective methods of transition, and provide multidisciplinary collaboration to support patients and their families.
患有儿童期起病的慢性病的成年患者人数正在增加。然而，将这些患者从以儿童为中心的医疗服务过渡到以成人为中心的医疗服务面临许多困难。尽管儿科医生被认为在过渡中起着关键作用，但很少有针对这些医生的过渡情况调查。
本研究通过对一家大学医院的儿科医生和小儿外科医生进行调查，展示儿童期起病的慢性病患者过渡的现状和挑战。
采用横断面调查，使用匿名自填式问卷。我们邀请了一家大学医院的 76 名儿科和小儿外科医生（不包括初级住院医师）回答匿名自报式问卷。一个多学科研究团队选择了与过渡过程相关的项目。
共有 60 名（79%）医生参与了调查，其中 52 名（87%）医生表示了解过渡。没有医生回答“过渡进行得很顺利”。儿科部门工作经验较短的医生对过渡的认识和经验较差。与小儿外科医生相比，儿科医生向患者解释“求职活动”和“避孕方法”，并报告了开始向患者及其家属解释过渡的更高患者年龄。在阻碍过渡的因素中，39 名（65%）受访者选择了“患者家属不希望过渡”，34 名（57%）受访者选择了“尽管有相关的成人保健部门，但它不会接收患者”。在被认为在过渡过程中具有核心作用的医疗服务提供者中，排名最靠前的是“儿科医生/小儿外科医生”、“医务社工”和“区域医疗联络办公室”。
为了促进过渡，儿科和成人保健部门应共同关注并合作建立更有效的过渡方法，并提供多学科合作，以支持患者及其家属。
