Chan Melvin, Young Sarah, Hanna Melisha
Pediatric Nephrology, Children's Hospital Colorado, Aurora, USA.
Nephrology, University of Colorado Anschutz Medical Campus, Aurora, USA.
Cureus. 2024 Jun 28;16(6):e63367. doi: 10.7759/cureus.63367. eCollection 2024 Jun.
Introduction Transition is the process of preparing an adolescent or young adult for the adult model of care. Poor transitions have been linked to increased medical utilization and poorer kidney outcomes. There are limited studies evaluating predictors of transition readiness or interventions in pediatric patients with chronic kidney disease (CKD). Methods We enrolled 42 non-dialysis, non-transplant patients with CKD stage 2 or higher and 14 years and older receiving care in our pediatric nephrology clinic. Data collected included demographics, clinical information, and transition readiness as measured by the Transition Readiness Assessment Questionnaire (TRAQ). Patients were provided with a structured, remote curriculum with resources that addressed areas of need. Patients were followed every three to six months. Repeat TRAQ questionnaires were administered six months after enrollment. Results Our study found that younger age and male gender were risk factors for poor transition. Age was consistently a positive predictor of higher TRAQ scores in the medication, appointment, and total score domains (p < 0.05). Male gender was a risk factor for lower TRAQ scores in the appointment and communication domains (p < 0.05). Additionally, our curriculum was effective at improving scores across all TRAQ domains, with an average increase of about 25% in six months. There was no difference in patients who had a three-month follow-up as compared to a six-month follow-up (p > 0.05). Conclusion Our study finds that younger age and male gender are risk factors for poor transition. Additionally, a structured, remote curriculum is effective at improving transition readiness.
引言
过渡是指帮助青少年或青年成年人做好准备，以适应成人护理模式的过程。过渡不佳与医疗利用率增加和肾脏预后较差有关。评估慢性肾脏病（CKD）儿科患者过渡准备情况的预测因素或干预措施的研究有限。
方法
我们纳入了42例2期或更高分期的非透析、非移植CKD患者，年龄在14岁及以上，在我们的儿科肾脏病诊所接受治疗。收集的数据包括人口统计学、临床信息以及通过过渡准备评估问卷（TRAQ）测量的过渡准备情况。为患者提供了一个结构化的远程课程，其中包含满足需求领域的资源。每三到六个月对患者进行随访。在入组六个月后再次发放TRAQ问卷。
结果
我们的研究发现，年龄较小和男性是过渡不佳的危险因素。在药物、预约和总分领域，年龄始终是TRAQ得分较高的积极预测因素（p < 0.05）。男性是预约和沟通领域TRAQ得分较低的危险因素（p < 0.05））。此外，我们的课程在提高所有TRAQ领域的得分方面是有效的，六个月内平均提高约25%。三个月随访患者与六个月随访患者之间没有差异（p > 0.05）。
结论
我们的研究发现，年龄较小和男性是过渡不佳的危险因素。此外，结构化的远程课程在提高过渡准备情况方面是有效的。
