medwireNews: An open-label randomized trial shows that an appointment manager reduces disengagement from health services among patients with type 1 diabetes after the first year following their transition from pediatric to adult care.
The appointment manager functioned as a point of contact between the transitioning patients and the adult diabetes clinics. They issued appointment reminders, coordinated rebooking of missed appointments, and used multiple forms of communication to attempt contact with patients who missed several appointments.
During the first year after transition, the appointments manager had no influence on the retention of patients; the 49 patients in the intervention group who had 12 months of data available attended an average of 2.3 appointments, as did the 55 patients in the usual care group, and 6% versus 11% disengaged from the service, attending no appointments during the preceding year.
However, a distinct difference emerged during the second year, report Mary White (The Royal Children's Hospital, Melbourne, Victoria, Australia) and colleagues in The Lancet Child & Adolescent Health.
A total of 32 patients from the intervention group and 37 from the control group had data for this period, during which they attended a respective average of 2.5 and 1.4 clinic appointments, with 6% and 49% disengaging. When the team accounted for patients not included due to missing data, the effect on the number of clinics attended lost statistical significance, but there was still a significant positive effect on disengagement rates.
“Rather than a time lag of the intervention itself, this result suggests that a support system that persists into the second year after transition might be protective,” say White and team.
They add that more studies of longer duration are needed “before appointment management can be widely recommended as standard practice.”
The researchers also note that regularity of attendance at pediatric clinics was predictive of attendance after transition, “which might help to identify individuals who will need more encouragement in engaging with adult care.”
In an accompanying commentary, Olga Kordonouri (Kinder und Jugendkrankenhaus Auf der Bult, Hannover, Germany) describes transition as “one of the great challenges facing the field of paediatrics—and indeed, health services overall.”
She writes: “Every paediatric diabetes clinic should have a specific transition policy; establishing appointment management support or joining an existing transition programme can help to ameliorate disengagement during transition, and lead to long-term clinical benefits for young adults with diabetes.”
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