Keywords
cross-discipline
adolescents
young adults
Categories
How to Cite
Abstract
Purpose: Increasing prevalence and improved survival of children with a chronic disease necessitate effective transition programs for adolescents transferring to adult care services. Despite established benefits, real-world implementation of these programs varies across medical disciplines. This study aimed to elucidate the multifactorial nature of transition implementation and the underlying variations across disciplines from the perspectives of healthcare providers.
Methods: We conducted a qualitative Grounded Theory study using the Gioia method to explore real-world applicability factors of transition by in-depth interviews. Pediatricians and adult care physicians (N=18), representing diverse medical disciplines (i.e., cardiology, pneumology, gastro-enterology and hepatology, nephrology and rheumatology, oncology and hematology, neurology, endocrinology, and urology) were recruited using a theoretical sampling strategy.
Results: We identified a wide range of challenges of implementation, with variation across medical disciplines, resulting in four theoretical domains influencing the applicability of transition programs: healthcare service characteristics, personal factors, flexibility, and continuity. A cross-discipline key barrier for a comprehensive transition program was the absence of a coordinating treating physician for patients with complex health needs.
Conclusion: Current generic guidelines and programs for transition are not as applicable as they are presented. Variations in implementation are fundamentally rooted in basic healthcare principles and differ significantly across medical disciplines. The differences in characteristics of the patient population, medical departments, and the complexity of the care patients require are substantial barriers difficult to overcome. Feasibility and effectiveness-implementation hybrid design studies should be performed.
Implications: To improve transition, strategies should primarily focus on enhancing the domains of healthcare continuity.