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A province wide review of transition practices for young adult patients with type 1 diabetes
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  • Sarah Williams,
  • Rayzel Shulman,
  • Leigh Anne Allwood Newhook,
  • Heather Power,
  • Astrid Guttmann,
  • Sharon Smith,
  • John Knight,
  • Roger Chafe
Sarah Williams
Memorial University of Newfoundland
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Rayzel Shulman
Hospital for Sick Children
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Leigh Anne Allwood Newhook
Memorial University of Newfoundland Faculty of Medicine
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Heather Power
Eastern Health
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Astrid Guttmann
Hospital for Sick Children
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Sharon Smith
Memorial University of Newfoundland Faculty of Medicine
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John Knight
Memorial University of Newfoundland
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Roger Chafe
Memorial University of Newfoundland
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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.

Peer review status:ACCEPTED

02 Jan 2020Submitted to Journal of Evaluation in Clinical Practice
03 Jan 2020Submission Checks Completed
03 Jan 2020Assigned to Editor
07 Jan 2020Reviewer(s) Assigned
18 Feb 2020Review(s) Completed, Editorial Evaluation Pending
28 Feb 2020Editorial Decision: Revise Major
01 Mar 20201st Revision Received
02 Mar 2020Assigned to Editor
02 Mar 2020Submission Checks Completed
03 Mar 2020Reviewer(s) Assigned
10 Mar 2020Review(s) Completed, Editorial Evaluation Pending
10 Mar 2020Editorial Decision: Revise Minor
17 Mar 20202nd Revision Received
18 Mar 2020Assigned to Editor
18 Mar 2020Submission Checks Completed
22 Mar 2020Review(s) Completed, Editorial Evaluation Pending
22 Mar 2020Editorial Decision: Accept