University of Toronto, Toronto, Canada.
Centre for Addiction and Mental Health, Toronto, Canada.
BMC Health Serv Res. 2024 Sep 27;24(1):1114. doi: 10.1186/s12913-024-11533-8.
Poorly supported transitions from pediatric to adult healthcare can lead to negative health outcomes for youth and their families. To better understand the current landscape of healthcare transition care across Canada, the Canadian Health Hub in Transition (the "Transition Hub", established in 2019) identified a need to: (1) describe programs and services supporting the transition from pediatric to adult healthcare across Canada; and (2) identify strengths, barriers, and gaps affecting the provision of transition services.
Our project included two iterative steps: a national survey followed by a qualitative descriptive study. Service providers were recruited from the Transition Hub and invited to complete the survey and participate in the qualitative study. The survey was used to collect program information (e.g., setting, clinical population, program components), and semi-structured interviews were used to explore providers' perspectives on strengths, barriers, and gaps in transition services. Qualitative data were analyzed using the Framework Method.
Fifty-one surveys were completed, describing 48 programs (22 pediatric, 19 bridging, and 7 adult) across 9 provinces. Almost half of the surveyed programs were in Ontario (44%) and most programs were based in hospital (65%) and outpatient settings (73%). There was wide variation in the ages served, with most programs focused on specific diagnostic groups. Qualitative findings from 23 interviews with service providers were organized into five topics: (1) measuring transition success; (2) program strengths; (3) barriers and gaps; (4) strategies for improvement; and (5) drivers for change.
While national transition guidelines exist in Canada, there is wide variation in the way young people and their families are supported. A national strategy, backed by local leadership, is essential for instigating system change toward sustainable and universally accessible support for healthcare transition in Canada.
儿科到成人医疗保健的过渡支持不足，可能会导致年轻人及其家庭的健康状况恶化。为了更好地了解加拿大各地医疗保健过渡护理的现状，加拿大过渡健康中心（“过渡中心”，成立于 2019 年）确定需要：（1）描述在加拿大支持儿科到成人医疗保健过渡的项目和服务；（2）确定影响过渡服务提供的优势、障碍和差距。
我们的项目包括两个迭代步骤：全国调查，随后是定性描述性研究。服务提供者是从过渡中心招募的，并被邀请完成调查并参与定性研究。调查用于收集项目信息（例如，设置、临床人群、项目组成部分），半结构化访谈用于探讨提供者对过渡服务的优势、障碍和差距的看法。使用框架方法对定性数据进行分析。
完成了 51 份调查，描述了 9 个省的 48 个项目（22 个儿科、19 个过渡和 7 个成人）。调查的项目中近一半（44%）在安大略省，大多数项目基于医院（65%）和门诊（73%）。服务对象的年龄差异很大，大多数项目专注于特定的诊断群体。对 23 名服务提供者的访谈进行了定性分析，结果组织成五个主题：（1）衡量过渡成功；（2）项目优势；（3）障碍和差距；（4）改进策略；（5）变革动力。
尽管加拿大有国家过渡指南，但年轻人及其家庭的支持方式存在很大差异。加拿大需要一个国家战略，由地方领导支持，以启动系统变革，为加拿大的医疗保健过渡提供可持续和普遍可获得的支持。
