JPP Student Journal Club Commentary: Advancing Transition Medicine for Adolescents and Young Adults with Chronic Conditions.
JPP Student Journal Club Commentary: Advancing Transition Medicine for Adolescents and Young Adults with Chronic Conditions.
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JPP 学生期刊俱乐部评论：推进患有慢性病的青少年和年轻人的过渡医学。
DOI：
10.1093/jpepsy/jsaa109
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发表时间：
2021
影响因子：
3.6
通讯作者：
Hilliard,MarisaE
中科院分区：
文献类型：
--
作者：
Eshtehardi,SaharS;Hilliard,MarisaE
在过去二十年中，在过渡医学方面取得了重大进展，以更好地支持患有慢性疾病的青少年和年轻人（AYAs）从儿科转向成人护理（White & Cooley, 2018）。然而，复杂性仍然存在，包括确保儿科助理医生有足够的疾病知识和自我管理技能的挑战，不愿意打破建立良好的儿科患者-提供者关系，以及难以找到成人提供者（Callahan等人，2001）。在这一转变之前和过程中，美国医疗保健系统继续努力有效地支持aya，导致医疗保健的长期差距和脱离，治疗依从性欠佳，生活质量下降，紧急医疗保健利用率增加，健康结果不佳（Eaton等人，2017;Hobart & Phan, 2019）。虽然儿科心理学家在将aya转变为成人医疗保健方面发挥了几个重要作用（Gray等人，2015），但很少有经验支持的行为干预措施可以跨越慢性疾病（Hart等人，2019），特别是对于患有炎症性肠病（IBD）的aya。Gray和他的同事（本期）开展了一项多地点、非随机的可行性研究，旨在通过对16-23岁患有IBD的AYAs患者进行一种新的过渡干预来扩展先前的文献。自我管理过渡强化方案（STEP）干预包括一次面对面小组会议和四次个人远程保健会议，涵盖多个过渡准备主题。其优势包括干预内容的全面性、面对面和远程医疗干预相结合以及纳入同伴关系。此外，Gray等人使用的严格干预发展策略与干预映射框架的各个方面保持一致，包括需求评估知情设计，使用基于理论的干预组件，针对过渡的行为决定因素，并将组件集成到有组织的计划中（Kok等人，2016）。干预满意度很高，可能是由于作者在发展过程中优先考虑家庭投入。前后结果表明，自我和父母报告的过渡准备，自我管理技能和疾病知识有所改善。在2019冠状病毒病（COVID-19）时代，当无法进行现场护理时，调整行为干预措施以适应远程分娩变得至关重要（Badawy & Radovic, 2020）。此外，通过减少干预参与的障碍和增加便利性，使用数字卫生技术在asa中提供针对健康行为的干预措施即使在非大流行情况下也可能是有用的（oostereven等人，2017）。STEP干预措施非常适合COVID-19大流行的情况，因为Gray及其同事使用远程医疗形式提供了大部分干预措施。也有机会扩大STEP干预的移动健康方面。例如，作者讨论了想要进一步利用技术来自动化干预的部分。这可能是一个值得追求的特征，因为自动化干预可能会增加覆盖范围并降低成本（Thompson等人）。
Significant strides in transition medicine have been made over the past two decades to better support adolescents and young adults (AYAs) with chronic medical conditions in navigating the shift from pediatric to adult care (White & Cooley, 2018). However, complexities remain, including challenges ensuring AYAs have adequate disease knowledge and selfmanagement skills, reluctance breaking wellestablished pediatric patient-provider relationships, and difficulty finding adult providers (Callahan et al., 2001). The US healthcare system continues to struggle with effectively supporting AYAs prior to and through this transition, resulting in prolonged gaps in and disengagement from medical care, suboptimal treatment adherence, reduced quality of life, increased emergency healthcare utilization, and poor health outcomes (Eaton et al., 2017; Hobart & Phan, 2019). While pediatric psychologists play several important roles in transitioning AYAs to adult healthcare (Gray et al., 2015), there are few empirically supported behavioral interventions for transition across chronic conditions (Hart et al., 2019), especially for AYAs with inflammatory bowel disease (IBD). Gray and colleagues’(this issue) multi-site, nonrandomized feasibility study aimed to expand upon prior literature by piloting a novel transition intervention for AYAs, aged 16–23 years, with IBD. The Self-Management Transition Enhancement Program (STEP) intervention consisted of one in-person group session and four individual telehealth sessions covering multiple transition preparation topics. Strengths include the comprehensiveness of the intervention content, combination of in-person and telehealth intervention, and incorporation of peer connections. Moreover, the rigorous intervention development strategy Gray et al. used aligns with aspects of the Intervention Mapping framework, including needs assessment-informed design, using theory-based intervention components targeting behavioral determinants of transition, and integrating components into an organized program (Kok et al., 2016). Intervention satisfaction was high, likely due to the authors prioritizing family input during development. Pre-post results suggested improvements in self-and parent-reported transition readiness, self-management skills, and disease knowledge.In the era of COVID-19, adapting behavioral interventions for remote delivery has become essential when in-person care is not feasible (Badawy & Radovic, 2020). Furthermore, delivering interventions targeting health behaviors in AYAs using digital health technologies may be useful even in non-pandemic circumstances by reducing barriers to intervention participation and increasing convenience (Oosterveen et al., 2017). The STEP intervention is ideally suited for the circumstances surrounding the COVID-19 pandemic, as Gray and colleagues used a telehealth format to deliver a large portion of the intervention. There are also opportunities to expand the mHealth aspects of the STEP intervention. For example, the authors discussed wanting to further leverage technology to automate parts of the intervention. This may be a worthwhile feature to pursue, as automated interventions may increase reach and reduce costs (Thompson et al.,