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Barriers to Transition From Pediatric to Adult Care: A Systematic Review
Wendy N Gray1, Megan R Schaefer1, Alana Resmini-Rawlinson2
1Auburn University.
Insights
Barriers to transitioning from pediatric to adult care are common across chronic illnesses, with relationship issues, access, and beliefs being most frequent. Addressing these can improve patient care.
Area of Science:
- Health Services Research
- Pediatric to Adult Healthcare Transition
- Chronic Illness Management
Background:
- Transition research for chronic pediatric illnesses often occurs in isolated silos.
- A comprehensive understanding of transition barriers across diverse chronic conditions is crucial for effective information sharing and improved patient care.
- Existing literature lacks a consolidated review of barriers encountered during the transition from pediatric to adult healthcare settings.
Purpose of the Study:
- To systematically review and identify barriers to healthcare transition from pediatric to adult care.
- To analyze these barriers across various pediatric chronic illness populations.
- To provide insights for facilitating smoother transitions and enhancing patient outcomes.
Main Methods:
- Systematic literature search across Medline, CINAHL, PsychINFO, Social Services Abstracts, Web of Science, and Cochrane Library.
- Inclusion criteria: peer-reviewed English articles, original data on transition barriers, specific pediatric chronic illness focus, and US-based studies.
- Barriers were extracted and categorized using the Socioecological Model of Adolescent/Young Adult Readiness to Transition.
Main Results:
- Fifty-seven articles were included in the review.
- The most prevalent barriers were categorized under 'Relationships' (e.g., attachment to pediatric providers), 'Access/Insurance' (e.g., finding qualified providers, insurance complexities), and 'Beliefs/Expectations' (e.g., negative perceptions of adult care).
- Barriers related to 'Knowledge' (e.g., limited patient/caregiver understanding of illness and transition) and 'Skills/Efficacy' (e.g., insufficient self-management skills) were also significant. Some barriers differed based on transfer status (pre- vs. post-transfer).
Conclusions:
- While specific challenges exist within each chronic illness group, several barriers to pediatric-to-adult care transition are common across populations.
- Addressing these common barriers is essential for improving the transition process for all young adults with chronic conditions.
- The study provides suggestions for overcoming identified barriers to enhance care continuity and patient outcomes.
Objective:
Transition research in each disease group is developing in its own "silo." A comprehensive review of barriers to transition within and across chronic illness groups is needed to facilitate information sharing and larger-scale efforts to overcome barriers and improve patient care. This study systematically reviews and identifies the barriers to transition from pediatric to adult care across pediatric illness populations.
Methods:
Medline, CINAHL, PsychINFO, Social Services Abstracts, Web of Science, and the Cochrane library databases were searched. Peer-reviewed English articles presenting original data on barriers to transition to adult care, focused on a specific pediatric chronic illness population, and conducted in the United States were included. Study design, population, and barriers were extracted. Barriers were categorized according to the Socioecological Model of Adolescent/Young Adult Readiness to Transition. Articles were evaluated for study quality.
Results:
Fifty-seven articles were included. The most common barriers to transition fell within the "Relationships" domain (e.g., difficulties letting go of long-standing relationships with pediatric providers) followed by "Access/Insurance" (e.g., difficulty accessing/finding qualified practitioners, insurance issues), and "Beliefs/Expectations" (e.g., negative beliefs about adult care). Barriers related to "Knowledge" (e.g., limited patient/caregiver knowledge about medication/illness and the transition process) and "Skills/Efficacy" (e.g., lack of self-management skills) were also common. While relationship barriers were commonly reported by all, some barriers varied by transfer status (pre- vs. posttransfer).
Conclusions:
Each chronic illness group experiences illness-specific challenges but certain barriers transcend chronic illness populations. Suggestions to overcome these barriers are provided.
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