Fiona Campbell|Katie Biggs|Susie Aldiss|P. O'Neill|Mark Clowes|Janet E. McDonagh|Alison While|Faith Gibson
Transition of care for adolescents from paediatric services to adult health services
University of Sheffield|University of Sheffield|London South Bank University|Sheffield Teaching Hospitals NHS Foundation Trust|Northern General Hospital|University of Sheffield|University of Manchester|King's College London|London South Bank University
evidence process transition paediatric child adult health services often associated deterioration health adolescents chronic conditionstransitional care term used describe services seek bridge care gap defined purposeful planned movement adolescents young adults chronic physical medical conditions childcentred adultoriented health care systems order develop appropriate services adolescents evidence works factors act barriers facilitators effective interventions neededto evaluate effectiveness interventions designed improve transition care adolescents paediatric adult health serviceswe searched cochrane central register controlled trials 2015 issue 1 including cochrane effective practice organisation care group specialised register medline embase psycinfo web knowledge 19 june 2015 also searched reference lists included studies relevant reviews contacted experts study authors additional studieswe considered randomised controlled trials rcts controlled afterstudies cbas interrupted timeseries studies itss evaluated effectiveness intervention care model clinical pathway aimed improve transition care adolescents paediatric adult health services considered adolescents chronic condition required ongoing clinical care leaving paediatric services going receive services adult healthcare units families participating providers included health professionals responsible care young peopletwo review authors independently extracted data included papers assessed risk bias study assessed certainty evidence main comparisons using grade discrepancies resolved discussion authors contacted missing data reported findings studies pre postintervention means calculated unadjusted absolute change baseline 95 confidence intervals ciwe included four rcts n 238 participants explored twoday workshopbased transition preparation training adolescents spina bifida nurseled oneonone teaching session additional support health passport adolescents heart disease web smsbased educational intervention adolescents range different conditions structured comprehensive transition programme transition coordinator adolescents type 1 diabetesone study evaluating oneonone nurseled intervention one evaluating technologybased intervention suggested interventions may lead slight improvements transitional readiness chronic disease selfmanagement measured six eightmonth followups low certainty evidence results traq selfmanagement tool md 020 95 ci 016 056 md 043 95 ci 009 095 traq selfadvocacy tool md 037 95 ci 006 080 pam tool md 10 95 ci 296 1704 contrast transitionpreparation training delivered via twoday workshop patients spina bifida may lead little difference measures selfcare practice general health behaviours measured using dscpi90two studies evaluated use health services one study evaluated technologybased intervention another comprehensive transition programme interventions may lead slightly young people taking positive steps initiate contact health professionals relative risk rr 487 95 ci 024 9812 rr 150 95 ci 032 694 respectively low certainty evidenceyoung peoples knowledge disease may slightly improve nurseled oneonone intervention prepare young people transition adult congenital heart programme md 14 95 ci 267 2533 one study low certainty evidencediseasespecific outcome measures reported two studies led little difference outcomes low certainty evidence one study found little difference intervention control groups second study found followup hba1c young people type 1 diabetes mellitus increased 12 percentage increase baseline hba1c independent treatment group 12 95 ci 04 19 p 001transition interventions may lead little difference wellbeing quality life measured pars iii pedsq two studies low certainty evidence technologybased intervention twoday workshop young people spina bifida found little difference intervention control groups md 129 95 ci 449 707 one study report datafour telephone support calls transition coordinator may lead little difference rates transfer paediatric adult diabetes services one study low certainty evidence 12month followup little difference groups young people receiving usual care telephone support rr 080 95 ci 059 108 may slightly reduce risk diseaserelated hospital admissions 12month followup rr 029 95 ci 003 240the available evidence four small studies n 238 covers limited range interventions developed facilitate transition limited number clinical conditions four 12 months followup followup periods may long enough changes become apparent transition lengthy process evidence improvement patients knowledge condition one study improvements selfefficacy confidence another since studies eligible review overall certainty body evidence low firm conclusions drawn effectiveness evaluated interventions research likely important impact confidence intervention effect likely could change conclusions considerable scope rigorous evaluation models transitional care reporting clinical outcomes longer term followup