A longitudinal, observational study of the features of transitional healthcare associated with better outcomes for young people with long-term conditions

Colver, A., McConachie, H., Le Couteur, A., Dovey-Pearce, G., Mann, K. D., McDonagh, J. E., Pearce, M. S., Vale, L., Merrick, H., Parr, J. R. and Rapley, Tim (2018) A longitudinal, observational study of the features of transitional healthcare associated with better outcomes for young people with long-term conditions. BMC Medicine, 16 (1). p. 111. ISSN 1741-7015

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Abstract

Background: Most evidence about what works in transitional care comes from small studies in single clinical specialties. We tested the hypothesis that exposures to nine recommended features of transitional healthcare were associated with better outcomes for young people with long-term conditions during transition from child-centred to adult-oriented health services. Methods: This is a longitudinal, observational cohort study in UK secondary care including 374 young people, aged 14-18.9years at recruitment, with type 1 diabetes (n = 150), cerebral palsy (n = 106) or autism spectrum disorder with an associated mental health problem (n = 118). All were pre-transfer and without significant learning disability. We approached all young people attending five paediatric diabetes centres, all young people with autism spectrum disorder attending four mental health centres, and randomly selected young people from two population-based cerebral palsy registers. Participants received four home research visits, 1 year apart and 274 participants (73%) completed follow-up. Outcome measures were Warwick Edinburgh Mental Wellbeing Scale, Mind the Gap Scale (satisfaction with services), Rotterdam Transition Profile (Participation) and Autonomy in Appointments. Results: Exposure to recommended features was 61% for 'coordinated team', 53% for 'age-banded clinic', 48% for 'holistic life-skills training', 42% for 'promotion of health self-efficacy', 40% for 'meeting the adult team before transfer', 34% for 'appropriate parent involvement' and less than 30% for 'written transition plan', 'key worker' and 'transition manager for clinical team'. Three features were strongly associated with improved outcomes. (1) 'Appropriate parent involvement', example association with Wellbeing (b=4.5, 95% CI 2.0-7.0, p=0.001); (2) 'Promotion of health self-efficacy', example association with Satisfaction with Services (b=-0.5, 95% CI -0.9 to -0.2, p=0.006); (3) 'Meeting the adult team before transfer', example associations with Participation (arranging services and aids) (odds ratio 5.2, 95% CI 2.1-12.8, p<0.001) and with Autonomy in Appointments (average 1.7 points higher, 95% CI 0.8-2.6, p<0.001). There was slightly less recruitment of participants from areas with greater socioeconomic deprivation, though not with respect to family composition. Conclusions: Three features of transitional care were associated with improved outcomes. Results are likely to be generalisable because participants had three very different conditions, attending services at many UK sites. Results are relevant for clinicians as well as for commissioners and managers of health services. The challenge of introducing these three features across child and adult healthcare services, and the effects of doing so, should be assessed.

Item Type: Article
Additional Information: Funding Information: This article presents independent research funded by the National Institute for Health Research (NIHR) under the Programme Grants for Applied Research programme: RP-PG-0610-10112. The views expressed in this article are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The funder took no part in the collection, analysis or interpretation of the data, in the writing of the article nor in the decision to submit the article for publication.
Uncontrolled Keywords: Adolescence, Health service delivery, Transition
Subjects: A300 Clinical Medicine
A900 Others in Medicine and Dentistry
B800 Medical Technology
B900 Others in Subjects allied to Medicine
Department: Faculties > Health and Life Sciences > Social Work, Education and Community Wellbeing
Depositing User: Rachel Branson
Date Deposited: 18 May 2021 15:59
Last Modified: 31 May 2021 14:37
URI: http://nrl.northumbria.ac.uk/id/eprint/46209

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