Article Text

Download PDFPDF

Health system strategies supporting transition to adult care
  1. Charlotte Moore Hepburn1,2,
  2. Eyal Cohen1,2,3,
  3. Jasmin Bhawra1,
  4. Natalie Weiser1,
  5. Robin Z Hayeems2,3,
  6. Astrid Guttmann1,2,3,4
  1. 1Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
  2. 2Department of Paediatrics, Child Health Policy Initiative, University of Toronto, Toronto, Ontario, Canada
  3. 3Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
  4. 4Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
  1. Correspondence to Dr Charlotte Moore Hepburn, Division of Paediatric Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8; charlotte.moorehepburn{at}sickkids.ca

Abstract

Background The transition from paediatric to adult care is associated with poor clinical outcomes, increased costs and low patient and family satisfaction. However, little is known about health system strategies to streamline and safeguard care for youth transitioning to adult services. Moreover, the needs of children and youth are often excluded from broader health system reform discussions, leaving this population especially vulnerable to system ‘disintegration’.

Objectives (1) To explore the international policy profile of paediatric-to-adult care transitions, and (2) to document policy objectives, initiatives and outcomes for jurisdictions publicly committed to addressing transition issues.

Methods An international policy scoping review of all publicly available government documents detailing transition-related strategies was completed using a web-based search. Our analysis included a comparable cohort of nine wealthy Organisation for Economic Co-operation and Development (OECD) jurisdictions with Beveridge-style healthcare systems (deemed those most likely to benefit from system-level transition strategies).

Results Few jurisdictions address transition of care issues in either health or broader social policy documents. While many jurisdictions refer to standardised practice guidelines, a few report the intention to use powerful policy levers (including physician remuneration and non-physician investments) to facilitate the uptake of best practice. Most jurisdictions do not address the policy infrastructure required to support successful transitions, and rigorous evaluations of transition strategies are rare.

Conclusions Despite the well-documented risks and costs associated with a poor transition from paediatric to adult care, little policy attention has been paid to this issue. We recommend that healthcare providers engage health system planners in the design and evaluation of system-level, policy-sensitive transition strategies.

  • Adolescent Health
  • General Paediatrics
  • Health services research
  • Paediatric Practice

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

View Full Text

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.