Health Care Transitions最新文献

{"title":"Self-Management assistance for recommended treatment (SMART) IBD app randomized control trial in adolescents with IBD: Design and methodology","authors":"Caroline M. Roberts ,&nbsp;Jill M. Plevinsky ,&nbsp;Kaitlyn L. Gamwell ,&nbsp;Amy E. Noser ,&nbsp;Lee A. Denson ,&nbsp;Kevin A. Hommel","doi":"10.1016/j.hctj.2023.100031","DOIUrl":"https://doi.org/10.1016/j.hctj.2023.100031","url":null,"abstract":"<div><h3>Aims</h3><p>Adherence to medical regimens, including medications and appointments, is a significant concern for adolescent populations that warrants behavioral interventions. Negative health behaviors during adolescence can persist into adulthood and lead to long-term negative health outcomes. Due to the limited availability and resources for behavioral self-management intervention, many youth do not receive evidence-based behavioral care and continue to struggle with managing their illness. Therefore, there is a need for easily accessible mHealth interventions targeting self-management in order to reduce health care barriers and provide more timely and effective behavioral care particularly during this developmental stage.</p></div><div><h3>Methods</h3><p>We provide a description of the design and methodology of the Self-Management Assistance for Recommended Treatment (SMART) IBD App randomized controlled pilot trial in pediatric inflammatory bowel disease (IBD) that aims to test the preliminary efficacy of the SMART IBD app compared to a usual care (UC) arm. Thirty participants 13–17 years of age will be recruited and randomized in the trial. Those randomized to the intervention arm will use the app for four weeks, each with one weekly challenge that focuses on self-management. Participants in both arms will complete baseline assessments, daily diaries for four weeks, and post-treatment assessments.</p></div><div><h3>Conclusion</h3><p>We hypothesize that participants in the intervention arm will experience clinically significant improvements in their self-management compared to those in the UC arm at the post-treatment assessment. Findings from the current study could provide initial evidence to support self-management interventions in adolescents with health conditions via mobile health apps, thereby reducing health care barriers and strains on institutional and nursing resources. Mobile health apps may also be a preferred avenue to disseminate interventions to adolescents.</p></div>","PeriodicalId":100602,"journal":{"name":"Health Care Transitions","volume":"2 ","pages":"Article 100031"},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949923223000314/pdfft?md5=de3b1a3f7b00a856c0b1d8d95e90f5d1&pid=1-s2.0-S2949923223000314-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138472056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Providing LGBTQ+ affirming care to young adults with inflammatory bowel diseases","authors":"Cade Johnson ,&nbsp;Sneha Dave ,&nbsp;Sydney Reed ,&nbsp;Victor Chedid ,&nbsp;Lucy Laube ,&nbsp;Laura Targownik","doi":"10.1016/j.hctj.2023.100030","DOIUrl":"https://doi.org/10.1016/j.hctj.2023.100030","url":null,"abstract":"<div><p>Creating an affirming care environment for young adults with IBD in the LGBTQ+ community is an essential part of inflammatory bowel disease (IBD) care. This article summarizes the discussions held during the Roundtable on Young Adults with IBD, which focused on essential information for adult-care providers to successfully navigate the complexities and intricacies of sexuality and gender identity for young adult IBD patients. The Roundtable on Young Adults with IBD is held through the Crohn’s and Colitis Young Adults Network. Key focus areas include establishing effective communication between providers and patients, maintaining patient safety and privacy, emphasizing trauma-informed practices, and building trust-based provider-patient relationships. Addressing these issues will allow providers to more fully and effectively treat LGBTQ+ young adults with IBD, ensuring a better, safer path into successful adult lives.</p></div>","PeriodicalId":100602,"journal":{"name":"Health Care Transitions","volume":"2 ","pages":"Article 100030"},"PeriodicalIF":0.0,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949923223000302/pdfft?md5=4769e49e235ca97225e660c671e384f9&pid=1-s2.0-S2949923223000302-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138472057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing self-care and access – The Dutch stepped care model to strategically organize public sexual health for young people","authors":"Filippo Zimbile ,&nbsp;Silke David ,&nbsp;Elmari Briedenhann ,&nbsp;Lisette Schutte ,&nbsp;Rik Crutzen","doi":"10.1016/j.hctj.2023.100028","DOIUrl":"https://doi.org/10.1016/j.hctj.2023.100028","url":null,"abstract":"<div><p>Public Sexual and Reproductive Health (SRH) services are traditionally provided face-to-face by Dutch Sexual Healthcare Clinics. High demand for these services led to the exploration of digital health to increase access and support self-care. However, the implementation was fragmented and uncoordinated. Therefore, the Stepped Care Model (SCM) was introduced to (1) organize coordination and cooperation between regional and national providers of public SRH-services for young people; (2) link digital services to clinical services and identify opportunities for new digital services; (3) increase the accessibility of SRH-services; and (4) stimulate self-care. This article describes the Dutch SCM and how digital health is integrated The process started by identifying key stakeholders and promoting collaboration followed by development and implementation of an unified national online platform to access comprehensive SRH services. The different levels of care of the existing services were categorized and overlap between services were inventoried. Based on ‘ideal client journeys’ for different sexual health themes, relevant services on different care levels were linked to each other and new opportunities for digital or combined digital-professional supported services were identified. It is explained how young people can gain easy access to increasingly specific and specialist services at the higher steps of the model via the online central portal with general information as a first step. The lessons learned highlight the importance of partnerships, coordination and a shared strategy leading to reduced fragmentation and increased accessibility of services and more self-care. The constraints of the Dutch SCM are related to restricted evaluation possibilities due to anonymized client data, limited target group involvement, complexity of digital service development along with possible resistance from health professionals. The SCM shows how efficiency in health systems can be achieved following the principle of economies of scale: more coordination and less fragmentation, leading to lower costs for development and implementation of digital services, availability and bundling of specialized technical and regulatory expertise and financial resources, ultimately leading to reduced waiting times and more self-care for young people.</p></div>","PeriodicalId":100602,"journal":{"name":"Health Care Transitions","volume":"2 ","pages":"Article 100028"},"PeriodicalIF":0.0,"publicationDate":"2023-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949923223000284/pdfft?md5=41197e862e3c4dd49b044504b96d9fb7&pid=1-s2.0-S2949923223000284-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138345444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gynecological care needs for young women with spina bifida","authors":"Ellen Fremion ,&nbsp;Rachel Madey ,&nbsp;Elizabeth Harper ,&nbsp;Kristen A. Staggers ,&nbsp;K. Jordan Kemere ,&nbsp;John Berens ,&nbsp;Tara Harris","doi":"10.1016/j.hctj.2023.100002","DOIUrl":"https://doi.org/10.1016/j.hctj.2023.100002","url":null,"abstract":"","PeriodicalId":100602,"journal":{"name":"Health Care Transitions","volume":"1 ","pages":"Article 100002"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49744033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Freeman Center for intellectual and developmental disabilities: Patient-centered interdisciplinary care","authors":"Joshua Smith ,&nbsp;Brittany N. Hand ,&nbsp;Emily Johnson ,&nbsp;Corey Keeton ,&nbsp;Lauren Wang","doi":"10.1016/j.hctj.2023.100003","DOIUrl":"https://doi.org/10.1016/j.hctj.2023.100003","url":null,"abstract":"<div><h3>Objectives</h3><p>Adults with intellectual or developmental disabilities (IDD) face substantial barriers to accessing high-quality, patient-centered care. This paper describes the development and evolution of the Freeman Center, an integrated, interdisciplinary center developed using feedback from adults with IDD and their family members.</p></div><div><h3>Methods</h3><p>We evaluated the reach of the Freeman Center services and described the patient population.</p></div><div><h3>Results</h3><p>As of November, 2022, 1068 patients were seen at the Freeman Center. These patients represent about 5 % of all people with IDD in Hamilton County Ohio, where the Freeman Center is located. On average in 2022, the Freeman Center provided approximately 380 primary care visits, 47 psychiatry visits, and 85 combined primary care and psychiatry service visits per month.</p></div><div><h3>Conclusions</h3><p>Patient demographic characteristics are largely consistent with the general population of Hamilton County, indicating patients are representative of the county the clinic primarily serves. Further work is needed to evaluate patient outcomes at the Freeman Center.</p></div>","PeriodicalId":100602,"journal":{"name":"Health Care Transitions","volume":"1 ","pages":"Article 100003"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49744034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parentyouth interactions: Transitioning to toileting self-management in spina bifida patients","authors":"Tae Kawahara,&nbsp;Akemi Yamazaki","doi":"10.1016/j.hctj.2023.100009","DOIUrl":"https://doi.org/10.1016/j.hctj.2023.100009","url":null,"abstract":"<div><h3>Purpose</h3><p>Spina bifida (SB) involves neurogenic bladder and bowel deficits. While parents manage the bladder and bowel disorders of their youth in the early years, the youth themselves must eventually take responsibility for their own management. However, the experience of shifting responsibility for complex toilet management from the parents to the youth has not been thoroughly investigated. Therefore, as exploratory research, the present study aimed to reveal the interactions between parents and youths with SB during the time of increasing responsibility for bladder and bowel management (i.e., the transition phase).</p></div><div><h3>Methods</h3><p>Twelve parent–youth pairs (youths with SB aged 11–18 years) participated in dyadic interviews, and a parent–youth transition experience was categorized by the context of parent–youth interactions and analyzed using the grounded theory approach.</p></div><div><h3>Results</h3><p>The results indicated that parents provide professional, complete bladder and bowel management until their youth reach physical and mental maturity. During the transitional phase, they work together to master youth self-management in interactions described as “share, try, and decide through parent–youth interactions”. Finally, the youth are able to master control of their own bladder and bowel management without requiring assistance from their parents.</p></div><div><h3>Conclusions</h3><p>Although parent–youth interactions are not always present during the pre- and post-transition phases, the parent–youth relationship acts to facilitate the independence of the youth by taking advantage of the parent–youth subsystem during the transitional phase. Interventions during these challenging periods could help facilitate the transition to bladder and bowel self-management among the youth.</p></div>","PeriodicalId":100602,"journal":{"name":"Health Care Transitions","volume":"1 ","pages":"Article 100009"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49763827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Roundtable on Young Adults with IBD: A multi-stakeholder perspective and patient-driven analysis of the current transitional challenges and gaps in research","authors":"Sneha Dave ,&nbsp;Sydney Reed ,&nbsp;Kajal Patel ,&nbsp;Sandra C. Kim","doi":"10.1016/j.hctj.2023.100006","DOIUrl":"https://doi.org/10.1016/j.hctj.2023.100006","url":null,"abstract":"<div><p>The “Roundtable on Young Adults with IBD” is a year-long learning community consisting of monthly discussions between providers, patients, and healthcare partners. The group aims to enhance outcomes for the young adult IBD patient population. The first discussion centered on the difficulties that IBD patients face during the transition from pediatric to adult care and how care can be improved for young adult patients during this phase. The group discussed the need to identify developmental milestones for young adult patients, further screening for disordered eating, and the importance of collaboration between specialists and pediatric and adult providers for a successful transition. Additionally, the group highlighted areas of concern such as the spread of misinformation through social media, social determinants of health, and the potential lifelong psychosocial, mental, and economic burdens of IBD for the young adult patient population.</p></div>","PeriodicalId":100602,"journal":{"name":"Health Care Transitions","volume":"1 ","pages":"Article 100006"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49743484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a specialty transition clinic: Inaugural clinical and financial operations","authors":"Wendy N. Gray ,&nbsp;Erin Benekos ,&nbsp;Courtney Malave ,&nbsp;Lauren Partain ,&nbsp;Parasto Dorriz ,&nbsp;Michael Weiss","doi":"10.1016/j.hctj.2023.100024","DOIUrl":"https://doi.org/10.1016/j.hctj.2023.100024","url":null,"abstract":"<div><h3>Purpose</h3><p>Few examples of hospital-wide transition programs have been presented in the literature and to date, we have no data on the clinical and financial operations of such services.</p></div><div><h3>Design and methods</h3><p>A transition clinic, guided by Got Transition’s Six Core Elements, was created for youth with moderate-to-high medical and psychosocial complexity (per Bob’s Levels of Social Support scale). The clinic visit and transition readiness assessment (UNC TR_xANSITION Index) were billed fee-for-service or under a bundled payment managed care model. We present data on patient characteristics, clinic operations, finances, and patient/parent satisfaction (online survey) in the clinic’s first year of operation (March 2021-February 2022).</p></div><div><h3>Results</h3><p>In Year 1, the clinic completed 115 appointments (113 unique patients). Most patients were older adolescents/young adults (M = 19.7 ± 1.8 years) and nearly half were Latinx. Patients presented with several complex medical needs including coordination of care across multiple subspecialties, high health care utilization, decision-making determinations, behavioral and mental health concerns, and resource needs. Implementation of the Six Core elements was high (range 99.1%−100%). The average billed per patient was $498 (in 2021–2022 USD). Considering paid and unpaid office visits, we collected an average of 31.6 cents on the dollar. Almost 80% of office visit claims and 21.9–33.3% of transition readiness assessments were paid by insurers. Patient/parent satisfaction was high, with over 90% of families reporting that they learned something, knew one thing they could do to improve transition readiness, and were able to get their questions asked and answered.</p></div><div><h3>Conclusions</h3><p>Transition clinics may never be fully self-sustainable given low collection rates and inability to capture extra charge codes related to chronic care management and transitional care. However, our collection rate was on-par with the collection rate for our hospital’s subspecialty clinics and we show it is possible to receive some funding from insurers.</p></div>","PeriodicalId":100602,"journal":{"name":"Health Care Transitions","volume":"1 ","pages":"Article 100024"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49743765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perspectives on health care transition among U.S. parents of internationally adopted children living with HIV: A qualitative study","authors":"Faith Glover ,&nbsp;Rosemary Olivero ,&nbsp;Cynthia Fair","doi":"10.1016/j.hctj.2023.100010","DOIUrl":"https://doi.org/10.1016/j.hctj.2023.100010","url":null,"abstract":"<div><h3>Objective</h3><p>To analyze perspectives on health care transitions among parents who have internationally adopted children living with HIV (IACH)The transition of youth with living with HIV from pediatric to adult care is associated with adverse health outcomes, including poor medication adherence and appointment attendance. However, little is known about the experiences of IACH.</p></div><div><h3>Methods</h3><p>This qualitative project explores the perspectives of 17 parents of 24 IACH in the United States through hour-long semi-structured phone interviews focused on healthcare transition. The purposive sample was recruited from two pediatric infectious disease clinics and private social media sites. Drawing on analytic principles of constant comparison, transcripts were analyzed for emergent themes.</p></div><div><h3>Results</h3><p>Most parents identified as white (<em>n</em> = 16), female (<em>n</em> = 16). Median age of IACH was 16 years. Two had transitioned to adult care. Fourteen did not have a transition plan with their provider. Many parents expressed apprehension regarding the transition to adult care. Anxiety over the ability to communicate with their child’s health provider and lack of comprehensive planning were expressed. Parents also felt their child may feel out of place in the adult infectious disease clinic and emphasized the trusting, long standing relationship with pediatric providers. Participants acknowledged that transition to another provider could be challenging for their child as adult providers may be less aware of adoption-related trauma.</p></div><div><h3>Conclusion</h3><p>It is vital that physicians consider trauma-informed care throughout the transition process with IACH. Providers should support health management-related independence of both IACH and their parents prior to transition. Coordination with adult care providers is key to a successful health care transition.</p></div>","PeriodicalId":100602,"journal":{"name":"Health Care Transitions","volume":"1 ","pages":"Article 100010"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49763825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peer support interventions for young adults with inflammatory bowel diseases","authors":"Sneha Dave ,&nbsp;Amy Bugwadia ,&nbsp;Sara Ahola Kohut ,&nbsp;Sydney Reed ,&nbsp;Mara Shapiro ,&nbsp;Hilary K. Michel","doi":"10.1016/j.hctj.2023.100018","DOIUrl":"https://doi.org/10.1016/j.hctj.2023.100018","url":null,"abstract":"<div><p>The “Roundtable on Young Adults with Inflammatory Bowel Diseases (IBD)” is a year-long learning community organized by the Crohn’s and Colitis Young Adults Network with monthly discussions between healthcare professionals, patients, and community-based partners. The group aims to improve outcomes for the young adult IBD patient population. The roundtable discussion highlighted in this article centered on the critical importance of peer support for adolescents and young adults (AYA) with IBD. The discussion underscored the need for increased research in peer support, the need to further consider peer support as an intervention, and the value of multi-stakeholder, peer-led collaboration in reducing isolation for young adults with IBD. Additionally, the group identified areas of opportunity, such as developing more appropriate metrics and scales to prove the inherent value of peer support for young adults with IBD.</p></div>","PeriodicalId":100602,"journal":{"name":"Health Care Transitions","volume":"1 ","pages":"Article 100018"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49743771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}