Transition of Care in Paediatric Surgery: Current practices and perspectives of paediatric surgeons in Malaysia
Shung K Tan1, Anand Sanmugam1, Mahmoud Danaee2
1Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Insights
Transition of care (TOC) in Malaysia is underdeveloped. Most paediatric surgeons lack organized TOC models and desire continued involvement in adult patient care, highlighting the need for guidelines and multi-stakeholder input.
Area of Science:
- Healthcare Management
- Paediatric Surgery
- Transition of Care
Background:
- Transition of care (TOC) from pediatric to adult healthcare services is critical but underdeveloped in Malaysia.
- Paediatric surgeons often continue to manage complex cases into adulthood due to a lack of structured TOC processes.
Purpose of the Study:
- To explore current practices and perspectives on transition of care among paediatric surgeons in Malaysia.
- To identify barriers and facilitators for establishing effective TOC models.
Main Methods:
- A questionnaire-based survey was distributed to 48 paediatric surgeons in Malaysia.
- Data were collected between June and December 2017, with a response rate of 79.2% (38 participants).
Main Results:
- Nearly all surveyed surgeons (97.4%) reported no organized TOC model.
- The majority (86.8%) believe care should transition to credentialed adult surgeons, yet prefer ongoing involvement (84.2%).
- Adult comorbidities were the primary trigger for TOC (81.6%), while a lack of guidelines was the main perceived barrier (84.2%).
Conclusions:
- Paediatric surgeons in Malaysia recognize the need for TOC but face significant systemic barriers, primarily the absence of formal guidelines.
- Further research involving patients and adult healthcare providers is essential to develop a successful TOC framework in Malaysia.
Objectives:
Transition of care (TOC) from paediatric to adult care is still at an early stage in Malaysia. This study aimed to explore current practices and perspectives regarding TOC among paediatric surgeons in Malaysia.
Methods:
This study was carried out between June and December 2017. All 48 paediatric surgeons currently working in Malaysia were invited to participate in a questionnaire-based survey to assess demographic characteristics and practices and perspectives regarding TOC.
Results:
A total of 38 paediatric surgeons participated in the survey (response rate: 79.2%). Overall, 97.4% did not have an organised TOC model in their institution, with most (65.8%) caring for paediatric patients with complex surgical conditions until adulthood. Although the majority (86.8%) felt that care should be transitioned to adult surgeons with appropriate credentials, most surgeons (84.2%) nevertheless preferred to be involved in the management of adolescent patients after transition. However, there was no consensus regarding the most suitable age to begin the transition. Years of experience as a paediatric surgeon and place of practice did not affect overall TOC practice scores (P >0.050 each). The presence of adult comorbidities was considered the most common reason to initiate TOC (81.6%), while the lack of TOC guidelines was perceived to be the greatest barrier (84.2%).
Conclusion:
This study provides a better understanding of TOC from the point of view of paediatric surgeons in Malaysia. However, further studies involving other stakeholders (i.e. patients and adult surgeons) are needed to help formulate a suitable and successful TOC model in this setting.
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