Hooker Emily, Eckenrode Madeline, Hopson Betsy, Somerville Carlie Stein
University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, AL, USA.
Department of Medicine, University of Alabama at Birmingham, AL, USA.
Health Care Transit. 2023 Jun 21;1:100005. doi: 10.1016/j.hctj.2023.100005. eCollection 2023.
Approximately one million adolescents with medical complexity transition into adult healthcare each year. Pediatric and adult providers alike have identified several barriers to transition, including insufficient knowledge of community resources, a lack of reimbursement for providing transition services, and an overall shortage of medical providers. Because of these barriers, the healthcare needs and challenges of this population have been understudied. The purpose of this article is to describe findings regarding nutrition, mental health, transition readiness, and caregiver burnout in a patient population of medically complex young adults in the interdisciplinary STEP clinic in the state of Alabama. Through the establishment of streamlined transition programs such as STEP, providers can address the unique health care needs of this patient population, with particular emphasis on optimizing mental health and nutrition.
All patients seen at the STEP clinic from September 2020 to August 2021 (n = 169) were evaluated through pertinent validated assessments of transition readiness (TRAQ), and/or caregiver burden (ZBI), and/or mental health (PHQ9, GAD7). Additional variables collected from patient charts include age, race, diagnosis, primary insurance type, equipment dependence, and body mass index (BMI).
The average TRAQ score of patients included in this study is 3.57 ± 1.11. A TRAQ score of below 4.0 suggests that the patient is not yet ready to transition from pediatric to adult care. The average ZBI score of caregivers is 20.97 ± 12.59, which indicates mild to moderate caregiver burden. 33% of patients were found to have moderate to severe anxiety, and 28% were found to have moderate to severe depression. Only 3.6% of patients seen at the STEP clinic have a BMI within normal limits. 113 of our patients have ongoing use of medical technology, and 49% are wheelchair users.
The need for organized transition care for medically complex young adults is apparent and growing. This patient population faces unique challenges in navigating the adult healthcare system, and patients are often unprepared for the transition. It is crucial that multidisciplinary clinics in which mental health and nutrition are addressed become accessible to all patients within this high-risk population.
每年约有100万患有复杂疾病的青少年过渡到成人医疗保健阶段。儿科和成人医疗服务提供者都发现了过渡过程中的几个障碍，包括对社区资源了解不足、提供过渡服务缺乏报销以及医疗服务提供者总体短缺。由于这些障碍，这一人群的医疗保健需求和挑战尚未得到充分研究。本文的目的是描述阿拉巴马州跨学科STEP诊所中患有复杂疾病的年轻成人患者群体在营养、心理健康、过渡准备情况和照顾者倦怠方面的研究结果。通过建立如STEP这样的简化过渡项目，医疗服务提供者可以满足这一患者群体独特的医疗保健需求，特别强调优化心理健康和营养状况。
对2020年9月至2021年8月在STEP诊所就诊的所有患者（n = 169），通过相关的经过验证的过渡准备情况评估（TRAQ）、和/或照顾者负担评估（ZBI）、和/或心理健康评估（PHQ9、GAD7）进行评估。从患者病历中收集的其他变量包括年龄、种族、诊断、主要保险类型、设备依赖情况和体重指数（BMI）。
本研究中患者的平均TRAQ评分为3.57 ± 1.11。TRAQ评分低于4.0表明患者尚未准备好从儿科护理过渡到成人护理。照顾者的平均ZBI评分为20.97 ± 12.59，这表明照顾者负担为轻度至中度。发现33%的患者有中度至重度焦虑，28%的患者有中度至重度抑郁。在STEP诊所就诊的患者中，只有3.6%的患者BMI在正常范围内。我们的113名患者持续使用医疗技术，49%是轮椅使用者。
对患有复杂疾病的年轻成人进行有组织的过渡护理的需求显而易见且日益增长。这一患者群体在进入成人医疗保健系统时面临独特的挑战，而且患者往往对过渡没有做好准备。至关重要的是，应让这一高风险人群中的所有患者都能进入兼顾心理健康和营养问题的多学科诊所。
