Experiences of health care transition voiced by young adults with type 1 diabetes: a qualitative study.
Experiences of health care transition voiced by young adults with type 1 diabetes: a qualitative study.
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DOI：
10.2147/ahmt.s67943
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发表时间：
2014
期刊：
影响因子：
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通讯作者：
Ritholz MD
中科院分区：
文献类型：
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作者：
Garvey KC;Beste MG;Luff D;Atakov-Castillo A;Wolpert HA;Ritholz MD
这项定性研究旨在探讨从儿童到成人糖尿病护理过渡后新兴的1型糖尿病（T1 D）成人报告的经验，重点是准备实际转移的护理。26名在一家中心接受成人糖尿病治疗的T1 D新兴成人（平均年龄26.2±2.5岁）参加了按当前血糖控制水平分层的5个焦点组。一个多学科小组对记录誊本进行了编码，并进行了专题分析。从主题分析中，出现了四个关于向成人护理转移过程的关键主题：1）无目的的过渡（患者报告儿科提供者缺乏向成人糖尿病护理转移的过渡准备）; 2.大学时代的脆弱性（患者传达了随后的损失期-在大学期间，描述了儿童或成人提供者未充分解决的大学期间特有的健康风险和糖尿病管理挑战）; 3）儿科和成人卫生保健系统之间的意外差异（患者对成人糖尿病护理的不同感觉感到惊讶，特别是关于对糖尿病并发症的关注增加）;和4）患者改善过渡过程的愿望清单（患者建议加强儿科过渡咨询，实施成人诊所定向计划，以及对过渡患者的同伴支持）。我们的研究结果确定了T1 D过渡过程中可修改的缺陷，并强调了儿科诊所加强准备的计划过渡的重要性，以及在成人诊所环境中为患者量身定制的发展方向。
This qualitative study aimed to explore the experience of transition from pediatric to adult diabetes care reported by posttransition emerging adults with type 1 diabetes (T1D), with a focus on preparation for the actual transfer in care. Twenty-six T1D emerging adults (mean age 26.2±2.5 years) receiving adult diabetes care at a single center participated in five focus groups stratified by two levels of current glycemic control. A multidisciplinary team coded transcripts and conducted thematic analysis. Four key themes on the process of transfer to adult care emerged from a thematic analysis: 1) nonpurposeful transition (patients reported a lack of transition preparation by pediatric providers for the transfer to adult diabetes care); 2) vulnerability in the college years (patients conveyed periods of loss to follow-up during college and described health risks and diabetes management challenges specific to the college years that were inadequately addressed by pediatric or adult providers); 3) unexpected differences between pediatric and adult health care systems (patients were surprised by the different feel of adult diabetes care, especially with regards to an increased focus on diabetes complications); and 4) patients’ wish list for improving the transition process (patients recommended enhanced pediatric transition counseling, implementation of adult clinic orientation programs, and peer support for transitioning patients). Our findings identify modifiable deficiencies in the T1D transition process and underscore the importance of a planned transition with enhanced preparation by pediatric clinics as well as developmentally tailored patient orientation in the adult clinic setting.