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Indicators of Healthcare Transition Progress Among College Youth With Type 1 Diabetes

  • Rebecca K. Tsevat
    Affiliations
    Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles (UCLA) (RK Tsevat and LE Wisk)
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  • Elissa R. Weitzman
    Affiliations
    Division of Adolescent/Young Adult Medicine, Boston Children's Hospital (ER Weitzman and LE Wisk), Boston, Mass

    Department of Pediatrics, Harvard Medical School (ER Weitzman and LE Wisk), Boston, Mass

    Computational Health Informatics Program, Boston Children's Hospital (ER Weitzman), Boston, Mass
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  • Author Footnotes
    1 The author's present address (Los Angeles) differs from where the work of this project was conducted (Boston).
    Lauren E. Wisk
    Correspondence
    Address correspondence to Lauren E. Wisk, PhD, 1100 Glendon Ave, Suite 850-809, Los Angeles, CA 90024.
    Footnotes
    1 The author's present address (Los Angeles) differs from where the work of this project was conducted (Boston).
    Affiliations
    Division of Adolescent/Young Adult Medicine, Boston Children's Hospital (ER Weitzman and LE Wisk), Boston, Mass

    Department of Pediatrics, Harvard Medical School (ER Weitzman and LE Wisk), Boston, Mass

    Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles (UCLA) (RK Tsevat and LE Wisk)

    Department of Health Policy and Management, Fielding School of Public Health at the University of California, Los Angeles (UCLA) (LE Wisk)
    Search for articles by this author
  • Author Footnotes
    1 The author's present address (Los Angeles) differs from where the work of this project was conducted (Boston).
Published:September 02, 2022DOI:https://doi.org/10.1016/j.acap.2022.08.012

      Abstract

      Objective

      Adolescents with chronic diseases must navigate changing healthcare needs in college and beyond. This study examined the ability of college youth with type 1 diabetes (T1D) to achieve transition milestones and ascertained sociodemographic predictors of a successful healthcare transition (HCT).

      Methods

      College youth with T1D were recruited via social media and direct outreach to participate in a web-based study, during which they answered questions about the HCT process. Descriptive statistics and multivariable regression were used to evaluate HCT measures as a function of sociodemographic variables.

      Results

      Nearly two-thirds of participants (N = 138) had discussions with their providers about changing healthcare needs (65.9%) and transferring care to adult physicians (64.5%); less than one-third (27.9%) discussed obtaining health insurance as an adult. Females were more likely than males to discuss transitioning to adult providers (70.3% vs 40.7%, P < .01). Those covered on a parent's insurance (vs other) plan were more likely to receive help with finding adult providers (79.3% vs 44.4%, P = .04) but less likely to discuss how to obtain health insurance (25.0% vs 61.1%, P < .01). These differences persisted after adjustment.

      Conclusions

      Improvement is needed with regard to college youth with T1D becoming autonomous managers of their own care. Gaps were found in their experiences of discussing changing healthcare needs, locating adult providers, and obtaining health insurance—especially among those who were younger, male, and not covered under parental insurance. Efforts to improve the HCT process should focus particularly on these subgroups to advance healthcare delivery in this population.

      Keywords

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      References

        • Blum RW
        • Garell D
        • Hodgman CH
        • et al.
        Transition from child-centered to adult health-care systems for adolescents with chronic conditions. A position paper of the Society for Adolescent Medicine.
        J Adolesc Health. 1993; 14: 570-576
        • Wisk LE
        • Magane KM
        • Levy S
        • et al.
        Alcohol use behaviors and reasons to abstain from or limit drinking among medically vulnerable youth.
        J Addict Med. 2020; 14: 311-318
        • Adams JS
        • Chien AT
        • Wisk LE.
        Mental illness among youth with chronic physical conditions.
        Pediatrics. 2019; 144e20181819
        • Wisk LE
        • Gray SH
        • Gooding HC
        I thought you said this was confidential?-Challenges to protecting privacy for teens and young adults.
        JAMA Pediatr. 2018; 172: 209-210
        • Wisk LE
        • Weitzman ER.
        Expectancy and achievement gaps in educational attainment and subsequent adverse health effects among adolescents with and without chronic medical conditions.
        J Adolesc Health. 2017; 61: 461-470
        • Wisk LE
        • Weitzman ER
        Substance use patterns through early adulthood: results for youth with and without chronic conditions.
        Am J Prev Med. 2016; 51: 33-45
        • Pacaud D
        • McConnell B
        • Huot C
        • et al.
        Transition from pediatric care to adult care for insulin-dependent diabetes patients.
        Can J Diabetes Care. 1996; 20: 14-20
        • Scott L
        • Vallia M
        • Charette M
        • et al.
        Transition of care: researching the needs of young adults with type 1 diabetes.
        Can J Diabetes. 2005; 29: 203-210
        • Nakhla M
        • Daneman D
        • To T
        • et al.
        Transition to adult care for youths with diabetes mellitus: findings from a Universal Health Care System.
        Pediatrics. 2009; 124: e1134-e1141
        • Coyne I
        • Sheehan A
        • Heery E
        • et al.
        Healthcare transition for adolescents and young adults with long-term conditions: qualitative study of patients, parents and healthcare professionals' experiences.
        J Clin Nurs. 2019; 28: 4062-4076
        • Campbell F
        • Biggs K
        • Aldiss SK
        • et al.
        Transition of care for adolescents from paediatric services to adult health services.
        Cochrane Database Syst Rev. 2016; 4CD009794
        • Busse FP
        • Hiermann P
        • Galler A
        • et al.
        Evaluation of patients’ opinion and metabolic control after transfer of young adults with type1 diabetes from a paediatric diabetes clinic to adult care.
        Hormone Res Paediatr. 2007; 67: 132-138
        • Lotstein DS
        • Seid M
        • Klingensmith G
        • et al.
        Transition from pediatric to adult care for youth diagnosed with type 1 diabetes in adolescence.
        Pediatrics. 2013; 131: e1062-e1070
        • White PH
        • Cooley WC
        • Transitions Clinical Report Authoring Group; American Academy of Pediatrics; American Academy of Family Physicians; American College of Physicians
        Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home.
        Pediatrics. 2018; 142e20182587
        • Bryden K
        • Dunger D
        • Mayou R
        • et al.
        Poor prognosis of young adults with type 1 diabetes: a longitudinal study.
        Diabetes Care. 2003; 26: 1052-1057
        • Monaghan M
        • Helgeson V
        • Wiebe D.
        Type 1 diabetes in young adulthood.
        Curr Diabetes Rev. 2015; 11: 239-250
        • Bowen ME
        • Henske JA
        • Potter A.
        Health care transition in adolescents and young adults with diabetes.
        Clinical Diabetes. 2010; 28: 99-106
        • Shulman R
        • Chafe R
        • Guttmann A.
        Transition to adult diabetes care: a description of practice in the ontario pediatric diabetes network.
        Can J Diabetes. 2019; 43: 283-289
        • Lyons SK
        • Libman IM
        • Sperling MA.
        Clinical review: diabetes in the adolescent: transitional issues.
        J Clin Endocrinol Metab. 2013; 98: 4639-4645
        • Kyngäs H
        • Hentinen M
        • Barlow JH.
        Adolescents’ perceptions of physicians, nurses, parents and friends: help or hindrance in compliance with diabetes self-care?.
        J Adv Nurs. 1998; 27: 760-769
        • Wisk LE
        • Finkelstein JA
        • Sawicki GS
        • et al.
        Predictors of timing of transfer from pediatric- to adult-focused primary care.
        JAMA Pediatr. 2015; 169e150951
        • Lotstein DS
        • Kuo AA
        • Strickland B
        • et al.
        The transition to adult health care for youth with special health care needs: do racial and ethnic disparities exist?.
        Pediatrics. 2010; 126: S129-S136
        • Sawicki GS
        • Whitworth R
        • Gunn L
        • et al.
        Receipt of health care transition counseling in the national survey of adult transition and health.
        Pediatrics. 2011; 128: e521-e529
        • White P
        • et al.
        Six Core Elements of Health Care Transition™ 3.0. 2020; (July)
        • Wisk LE
        • Magane KM
        • Nelson EB
        • et al.
        Comparison of peer versus provider messaging to reduce alcohol use for college students with type 1 diabetes: results from a pilot trial.
        J Med Internet Res. 2021; 23: e26418
        • Wisk LE
        • Nelson EB
        • Magane KM
        • et al.
        Clinical trial recruitment and retention of college students with type 1 diabetes via social media: an implementation case study.
        J Diabetes Sci Technol. 2019; 13: 445-456
      1. 2009-2010 National Survey of Children with Special Health Care Needs.
        Centers for Disease Control and Prevention, Atlanta, GA2011 (Updated December 14, 2011. Accessed July 29, 2021)
        • Chiang JL
        • Maahs DM
        • Garvey KC
        • et al.
        Type 1 diabetes in children and adolescents: a position statement by the American diabetes association.
        Diabetes Care. 2018; 41: 2026-2044
        • Beal SJ
        • Riddle IK
        • Kichler JC
        • et al.
        The associations of chronic condition type and individual characteristics with transition readiness.
        Acad Pediatr. 2016; 16: 660-667
        • Haarbauer-Krupa J
        • Alexander NM
        • Mee L
        • et al.
        Readiness for transition and health-care satisfaction in adolescents with complex medical conditions.
        Child Care Health Dev. 2019; 45: 463-471
        • Lotstein DS
        • Ghandour R
        • Cash A
        • et al.
        Planning for health care transitions: results from the 2005–2006 National Survey of Children With Special Health Care Needs.
        Pediatrics. 2009; 123
        • Sawicki GS
        • Lukens-Bull K
        • Yin X
        • et al.
        Measuring the transition readiness of youth with special healthcare needs: validation of the TRAQ–transition readiness assessment questionnaire.
        Pediatric Psychol. 2011; 36: 160-171
        • Ferris ME
        • Harward DH
        • Bickford K
        • et al.
        A clinical tool to measure the components of health-care transition from pediatric care to adult care: the UNC TRxANSITION scale.
        Ren Fail. 2012; 34: 744-753
        • Klassen AF
        • Grant C
        • Barr R
        • et al.
        Development and validation of a generic scale for use in transition programmes to measure self-management skills in adolescents with chronic health conditions: the TRANSITION-Q.
        Care Health Dev. 2014;
        • Moynihan M
        • Saewyc E
        • Whitehouse S
        • et al.
        Assessing readiness for transition from paediatric to adult health care: revision and psychometric evaluation of the AM I ON TRAC for adult care questionnaire.
        J Adv Nurs. 2015; 71: 1324-1335
        • Wisk LE
        • Finkelstein JA
        • Toomey SL
        • et al.
        Impact of an individual mandate and other health reforms on dependent coverage for adolescents and young adults.
        Health Serv Res. 2018; 53: 1581-1599
        • Wisk LE
        • Sharma N.
        Inequalities in young adult health insurance coverage post-federal health reform.
        J Gen Intern Med. 2019; 34: 65-74