Transitioning HIV-infected adolescents to adult care at 14 clinics across the United States: using adolescent and adult providers' insights to create multi-level solutions to address transition barriers.
Transitioning HIV-infected adolescents to adult care at 14 clinics across the United States: using adolescent and adult providers' insights to create multi-level solutions to address transition barriers.
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在美国的14个诊所中将艾滋病毒感染的青少年转变为成人护理：使用青少年和成人提供者的见解来创建多层解决方案来解决过渡障碍。
DOI：
10.1080/09540121.2017.1338655
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发表时间：
2017-10
期刊：
影响因子：
1.7
通讯作者：
The Adolescent Trials Network
中科院分区：
文献类型：
--
作者：
Philbin MM;Tanner AE;Chambers BD;Ma A;Ware S;Lee S;Fortenberry JD;The Adolescent Trials Network
感染艾滋病毒的青少年的照顾率和病毒抑制率低得不成比例。大约一半的人在过渡到成人诊所时脱离了护理，部分原因是护理系统支离破碎，缺乏简化的方案。从2015年8月至2016年6月，我们对14家青少年试验网络诊所(n=28)和20家接受过渡青少年的成人诊所(n=30)的社会服务和医疗保健提供者进行了58次定性访谈。我们使用不断比较的方法来检查成人护理过渡的过程、障碍和促进者。过渡障碍围绕着三个层面结合在一起。结构：保险资格、交通和艾滋病毒相关污名；临床：诊所间沟通、护理文化差异和资源/人员限制；以及个人：青少年过渡准备和发展能力。工作人员发起的解决办法(例如，赠款资助的交通运输)往往是不可持续的，适用于个人一级的结构性障碍解决办法。迫切需要全面的计划，这些计划制定协作策略和协议，支持提供商匹配解决方案和障碍级别(即，结构到结构)的能力。这些举措还应支持当地的系统规划，以促进诊所间的结构和沟通。这种方法将帮助感染艾滋病毒的青少年过渡到成人护理，并改善长期健康结果。
HIV-infected adolescents have disproportionately low rates of care retention and viral suppression. Approximately half disengage from care while transitioning to adult clinics, in part due to fragmented care systems and lack of streamlined protocols. We conducted 58 qualitative interviews with social service and health care providers across 14 Adolescent Trials Network clinics (n=28) and 20 adult clinics that receive transitioning adolescents (n=30) from August 2015 – June 2016. We used the constant comparative approach to examine processes, barriers, and facilitators of adult care transition. Transition barriers coalesced around three levels. Structural: insurance eligibility, transportation, and HIV-related stigma; Clinical: inter-clinic communication, differences in care cultures, and resource/personnel limitations; and Individual: adolescents’ transition readiness and developmental capacity. Staff-initiated solutions (e.g., grant-funded transportation) were often unsustainable and applied individual-level solutions to structural-level barriers. Comprehensive initiatives, which develop collaborative policies and protocols that support providers’ ability to match the solution and barrier level (i.e., structural-to-structural), are sorely needed. These initiatives should also support local systematic planning to facilitate inter-clinic structures and communication. Such approaches will help HIV-infected adolescents transition to adult care and improve long-term health outcomes.
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影响因子：
4.9
作者：
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通讯作者：
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