Service use of young people with Type 1 diabetes after transition from paediatric to adult-based diabetes health care
Lin Perry A B , Janet Dunbabin C , Xiaoyue Xu A C , Julia Lowe C , Shamasunder Acharya D , Steven James
E H and Katharine S. Steinbeck F G
A University of Technology Sydney, Faculty of Health, 15 Broadway, Ultimo, NSW 2007, Australia. Email: lin.perry@uts.edu.au; xiaoyue.xu@uts.edu.au
B South Eastern Sydney Local Health District, Prince of Wales Hospital, 320–346 Barker Street, Randwick, NSW 2031, Australia.
C University of Newcastle, Faculty of Health and Medicine, University Drive, Callaghan, NSW 2308, Australia. Email: janet.dunbabin@newcastle.edu.au; julia.lowe@newcastle.edu.au
D Hunter New England Local Health District, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305, Australia. Email: shamasunder.acharya@hnehealth.nsw.gov.au
E University of the Sunshine Coast, School of Nursing, Midwifery and Paramedicine, 80–106 Tallon Street, Caboolture, Qld 4510, Australia.
F University of Sydney, Discipline of Paediatrics and Child Health, Camperdown, NSW 2006, Australia. Email: kate.steinbeck@health.nsw.gov.au
G The Children’s Hospital at Westmead, Department of Adolescent Medicine, corner Hawkesbury Road and Hainsworth Street, Westmead, NSW 2145, Australia.
H Corresponding author. Email: sjames1@usc.edu.au
Australian Health Review 44(4) 601-608 https://doi.org/10.1071/AH19117
Submitted: 23 May 2019 Accepted: 15 December 2019 Published: 30 June 2020
Abstract
Objective The aim of this study was to determine, in the first 2 years after the last planned appointment with paediatric diabetes services for young people with Type 1 diabetes (T1D): (1) the number of planned and unplanned healthcare contacts and HbA1c measurements made; (2) factors linked to diabetes-related service use; and (3) factors predictive of the number of planned and unplanned service contacts, and of meeting the minimum number of planned service contacts.
Methods Healthcare records of a major public healthcare provider in Australia were audited for preventive and acute service use by young people with T1D transferring from paediatric to adult public healthcare services. Statistical analyses included use of t-tests and logistic regression modelling.
Results Of 172 young people with T1D, 21% had no planned specialist care and 49% accessed acute services for diabetes-related matters. Residents of metropolitan areas and users of continuous subcutaneous insulin infusion therapy were more likely to access specialist care and were less likely to use acute services for unplanned care. Those achieving a minimum of nine planned care contacts in 2 years had a shorter duration between the last paediatric and first adult healthcare contact.
Conclusions Lack of specialist care in early adult years and non-metropolitan relative disadvantage compromise the present and future health of young people with diabetes.
What is known about the topic? Well-managed transition is thought to offer the best chance of achieving cost-effective continuing engagement with specialist services for planned preventive care, effective T1D self-management and deferral or early attention to diabetes-related vascular complications. However, transition is commonly reported as problematic.
What does this paper add? The findings of this study indicate a positive trend but continuing need to improve transition care for young people with T1D, especially those living in non-metropolitan areas and those not using continuous subcutaneous insulin infusion therapy.
What are the implications for practitioners? Without service innovation, suboptimal and delayed access to planned care, high use of acute services for unplanned care and poor glycaemic control will continue to threaten the future health and well-being of young people with T1D.
Additional keywords: access, adolescents, appointments, young adults.
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