Impact of a transition program with navigator on loss to follow-up, medication adherence, and appointment attendance in hemoglobinopathies
Impact of a transition program with navigator on loss to follow-up, medication adherence, and appointment attendance in hemoglobinopathies
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DOI：
10.1002/pbc.27781
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发表时间：
2019-08-01
影响因子：
3.2
通讯作者：
Kuo, Kevin H. M.
中科院分区：
文献类型：
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作者：
Allemang, Brooke;Allan, Kate;Kuo, Kevin H. M.
背景：对于患有血红蛋白病的青少年和青壮年（AYA）来说，从儿科到成人护理的过渡是失去随访、发病率和死亡率的高风险时期。本研究的目的是确定与非结构化转移相比，过渡导航（TN）的过渡方案是否减少了随访和住院的损失，并提高了药物依从性和预约出勤率。一项回顾性观察性研究比较了所有在开始过渡计划一年前（n = 51）和一年后（n = 61）年满18岁的AYA血红蛋白病患者。从每位患者收集最后一次儿科预约前一年和首次成人预约后一年的数据。结果TN过渡方案将随访损失从29%降低到7% （P = 0.034）。在过渡队列中，更大比例的患者维持或改善了对羟基脲或铁螯合剂的依从性至>= 4天/周；接触该程序与这种改善独立相关（P = 0.047）。观察到有改善或维持>= 90%出勤率的趋势（P = 0.096）。两组患者住院次数差异无统计学意义（P = 0.985）。结论：TN过渡方案可显著减少随访损失，显著提高并维持公平至良好的药物依从性。对经济效益和患者满意度进行进一步分析。
Background Transition from pediatric to adult care is a period of high risk for loss to follow-up, morbidity, and mortality in adolescents and young adults (AYA) with hemoglobinopathies. The purpose of this study was to determine whether a transition program with transition navigator (TN) reduced loss to follow-up and hospitalizations and improved medication adherence and appointment attendance compared with an unstructured transfer. Procedure A retrospective observational study compared all AYA with hemoglobinopathies who turned 18 one year prior to (n = 51) and one year after (n = 61) the initiation of the transition program. Data from one year prior to last pediatric appointment and one year following first adult appointment were collected from each patient. Results The transition program with TN reduced loss to follow-up from 29% to 7% (P = 0.034). A greater proportion of patients in the transition cohort maintained or improved adherence to hydroxyurea or iron chelation to >= 4 days/week; exposure to the program was independently associated with such improvement (P = 0.047). A trend toward improvement or maintenance of >= 90% attendance to appointments was observed (P = 0.096). Frequency of hospitalization was not significantly different between the two cohorts (P = 0.985). Conclusions A transition program with TN significantly reduced loss to follow-up, and significantly improved and maintained fair to good medication adherence. Further analysis of economic benefit and patient satisfaction will be conducted.