57 Transition from paediatric to adult care: Current practices and barriers to care
Notice bibliographique
Résumé
Abstract Background Transition from paediatric to adult care is a challenging process. A recent Canadian Paediatric Society (CPS) call for action highlights difficulties in transition of care and calls on healthcare providers to advocate for improved transition practices. Results of this project will provide a guideline to develop transition standards in children’s hospitals across Canada. Objectives To assess transition from paediatric to adult care resources at a tertiary paediatric institution and compare current resources to transition standards across paediatric disciplines. Design/Methods A multidisciplinary survey was completed in a tertiary paediatric institution in Southwestern Ontario. An extensive literature review of 182 articles guided survey development, with a focus on transition of care standards, identifying common themes and complementing the CPS core components of successful transition. Mixed methods analysis was completed. Results There were 66 responses, 27% paediatric subspecialists, 64% allied health, and 9% other. Many providers noted significant barriers to transition care: 91% were not satisfied with the current way patients are transitioned from paediatric to adult care, 85% noted insufficient resources and personnel to adequately address transition care, 61% felt uncomfortable addressing transition patient general health needs, and 73% were in need of additional tools to facilitate transition. The top three barriers to adequate transition were lack of communication and guidelines between paediatric and adult systems, lack of allied health providers to support transition, and lack of adult specialists to provide transition care. Regarding transition standards of care, almost half of providers were following an informal transition policy. 72% had no designated transition clinic and 68% had no multidisciplinary transition team. 88% had no formal training in transition and almost half of providers noted no quality improvement or research initiatives in transition. Regarding recommended transition practices, the least performed practices were formally assessing transition readiness using a standardized tool, completing part of transition encounters with caregivers outside of the room, and discussing psychosocial factors related to transition. Regarding transition resources, 16% of providers had accessed the CPS statement on transition from paediatric to adult care. Conclusion Most providers were unsatisfied with transition practices and noted barriers relating to collaboration with adult specialists and lack of resources to support transition. Transition standards of care were poorly adhered to, with majority of participants noting no transition policy or team, no assessment of transition readiness, and poor use of transition resources. These results will inform hospital-wide and eventually nation-wide transition from paediatric to adult care guidelines.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,008 | 0,028 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,003 |
| Études des sciences et des technologies | 0,003 | 0,002 |
| Communication savante | 0,004 | 0,002 |
| Science ouverte | 0,001 | 0,003 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».