A province wide review of transition practices for young adult patients
with type 1 diabetes
Abstract
Background: Most studies on the transition from pediatric to adult care
focus on practices at a single institution. We examine the transition
for young adults with type 1 diabetes across an entire Canadian province
with a small, mostly rural population: Newfoundland and Labrador (NL).
Our aim is to determine a comprehensive picture of how transition is
occurring in one jurisdiction and explore potential methods for
improvement. Methods: A provincial diabetes database and hospital
admission data were reviewed for a cohort of young adults who
transitioned into adult care to determine the number of transfers
occurring, patient characteristics, and the number of diabetes-related
hospitalizations. Semi-structured interviews with pediatric and adult
diabetes providers were conducted to determine the current process of
transition and identify ways for improvement, including the potential
role of family physicians. Results: Between 2008 and 2013, 93 patients
with type 1 diabetes transitioned into adult care. Fifteen interviews
were conducted across the province’s four regional health authorities.
Various models of transition care are being employed, reflecting staff
and resource availability. While no structured transition program was
identified, many providers were comfortable with their current
transition processes. Suggested improvements included more structured
processes, shared educational resources, and a dedicated transfer
clinic. Conclusions: In a province with a relatively small number of
patients who transition out of pediatric care annually, we found
different approaches for transitioning them into adult care, but this
variation may not negatively impact patient outcomes.