Current Diabetes Reports

, Volume 13, Issue 6, pp 900–908 | Cite as

Transition Readiness in Adolescents and Emerging Adults with Diabetes: The Role of Patient-Provider Communication

  • Maureen Monaghan
  • Marisa Hilliard
  • Rachel Sweenie
  • Kristin Riekert
Psychosocial Aspects (KK Hood, Section Editor)

Abstract

Transition from pediatric to adult care represents a high risk period for adolescents and emerging adults with diabetes. Fundamental differences between pediatric and adult care delivery models may contribute to increased risk for poor health outcomes. This review provides a brief overview of models of care in pediatric and adult settings and focuses on patient-provider communication content and quality as potential points of intervention to improve transition-related outcomes. This review also highlights disparities in transition and communication for adolescents and emerging adults from racial/ethnic minority groups and discusses recent changes in health care legislation that have significant implications for the transition process. Intervention opportunities include programs to enhance developmentally-appropriate patient-provider interactions and increased attention to promoting transition readiness skills. Improving patient-provider communication may hasten the development of vital self-advocacy skills needed in adult health care systems and, thus, help establish a lasting pattern of positive diabetes self-care.

Keywords

Diabetes Transition Adolescents Young adults Glycemic control Health care delivery Patient-provider communication Racial/ethnic minority groups Health insurance 

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    •• Garvey KC, Markowitz JT, Laffell LMB. Transition to adult care for youth with type 1 diabetes. Curr Diab Rep. 2012;12:533–41. This review paper discusses the rationale for transition research by identifying unique challenges of emerging adulthood, providing recommendations for transition services, and specifying how transition is particularly challenging for emerging adults with type 1 diabetes. It reviews both observational and interventional studies evaluating transition to adult diabetes care and stresses the need for further research through randomized controlled trials.PubMedCrossRefGoogle Scholar
  2. 2.
    Peters A, Laffel L, American Diabetes Association Transitions Working Group. Diabetes care for emerging adults: recommendations for transition from pediatric to adult diabetes care systems. Diabetes Care. 2011;34:2477–85.PubMedCrossRefGoogle Scholar
  3. 3.
    Arnett J. Emerging adulthood: a theory of development from late teens through the twenties. Am Psychol. 2000;55:469–80.PubMedCrossRefGoogle Scholar
  4. 4.
    Luyckx K, Seiffge-Krenke I. Continuity and change in glycemic control trajectories from adolescence to emerging adulthood: relationships with family climate and self-concept in type 1 diabetes. Diabetes Care. 2009;32:797–801.PubMedCrossRefGoogle Scholar
  5. 5.
    Weissberg-Benchell J, Wolpert H, Anderson B. Transitioning from pediatric to adult care: a new approach to the post-adolescent young person with type 1 diabetes. Diabetes Care. 2007;30:2441–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Viner RM. Transition of care from paediatric to adult services: one part of improved health services for adolescents. Arch Dis Child. 2008;93:160–3.PubMedCrossRefGoogle Scholar
  7. 7.
    Pacaud D, Yale J, Stephure D, et al. Problems in transition from pediatric care to adult diabetes care for individuals with diabetes. Can J Diabetes. 2005;29:13–8.Google Scholar
  8. 8.
    Van Walleghem N, MacDonald CA, Dean HJ. Evaluation of a systems navigator model for transition from pediatric to adult care for young adults with type 1 diabetes. Diabetes Care. 2008;31:1529–30.PubMedCrossRefGoogle Scholar
  9. 9.
    Petitti DB, Klingensmith GJ, Bell RA, et al. Glycemic control in youth with diabetes: the SEARCH for diabetes in Youth Study. J Pediatr. 2009;155:668–72.PubMedCrossRefGoogle Scholar
  10. 10.
    •• Helgeson VS, Reynolds KA, Snyder PR, et al. Characterizing the transition from paediatric to adult care among emerging adults with type 1 diabetes. Diabet Med. 2013;30:610–5. This is an innovative prospective study of youth with type 1 diabetes in various stages of the transition from pediatric to adult care. Findings highlight that youth who remained in pediatric diabetes care demonstrated better self-care and did not experience a deterioration in glycemic control compared with youth who transitioned to adult diabetes care. Moreover, early transition was associated with worse self-care and glycemic control, and minority patients were more likely to transition early.PubMedCrossRefGoogle Scholar
  11. 11.
    Lotstein D, Kuo A, Strickland B, Tait F. The transition to adult health care for youth with speical health care needs: do racial and ethnic disparities exist? Pediatrics. 2010;126:S129–36.PubMedCrossRefGoogle Scholar
  12. 12.
    Dovey-Pearce G, Hurrell R, May C, et al. Young adults' (16–25 years) suggestions for providing developmentally appropriate diabetes services: a qualitative study. Health Soc Care Community. 2005;13:409–19.PubMedCrossRefGoogle Scholar
  13. 13.
    Eiser C, Flynn M, Green E, et al. Coming of age with diabetes: patients' views of a clinic for under 25-year-olds. Diabet Med. 1993;10:285–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Geddes J, McGeough E, Frier B. Young adults with type 1 diabetes in tertiary education: do students receive adequate specialist care? Diabet Med. 2005;23:1155–7.CrossRefGoogle Scholar
  15. 15.
    Visentin K, Koch T, Kralik D. Adolescents with type 1 diabetes: transition between diabetes services. J Clin Nurs. 2006;15:761–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Waitzfelder B, Pihoker C, Klingensmith G, et al. Adherence to guidelines for youth with diabetes mellitus. Pediatrics. 2011;128:531–8.PubMedGoogle Scholar
  17. 17.
    Busse F, Hiermann P, Galler A, et al. Evaluation of patients' opinion and metabolic control after tranfer of young adults with type 1 diabetes from a pediatric diabetes clinic to adult care. Horm Res. 2007;67:132–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Reiss J, Gibson R. Health care transition: destinations unknown. Pediatrics. 2002;110:1307–14.PubMedGoogle Scholar
  19. 19.
    Lotstein D, Seid M, Klingensmith G, et al. Transition from pediatric to adult care for youth diagnosed with type 1 diabetes in adolescence. Pediatrics. 2013;131:e1062–70.PubMedCrossRefGoogle Scholar
  20. 20.
    Nakhla M, Daneman D, To T, et al. Transition to adult care for youths with diabetes mellitus: findings from a universal health care system. Pediatrics. 2009;124:e1134–41.PubMedCrossRefGoogle Scholar
  21. 21.
    Garvey KC, Wolpert HA, Rhodes ET, et al. Health care transition in patients with type 1 diabetes: young adult experiences and relationship to glycemic control. Diabetes Care. 2012;35:1716–22.PubMedCrossRefGoogle Scholar
  22. 22.
    Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977–86.CrossRefGoogle Scholar
  23. 23.
    Pihoker C, Badaru A, Anderson A, et al. Insulin regimens and clinical outcomes in a type 1 diabetes cohort. Diabetes Care. 2013;36:27–33.PubMedCrossRefGoogle Scholar
  24. 24.
    Paris C, Imperatore G, Klingensmith G, et al. Predictors of insulin regimens and impact on outcomes in youth with type 1 diabetes: the SEARCH for Diabetes in Youth Study. J Pediatr. 2009;155:183–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Pai ALH, Ostendorf HM. Treatment adherence in adolescents and young adults affected by chronic illness during the health care transition from pediatric to adult health care: a literature review. Child Health Care. 2011;40:16–33.CrossRefGoogle Scholar
  26. 26.
    Willoughby L, Fukami S, Bunnapradist S, et al. Health insurance consideratins for adolescent transplant recipients as they transition to adulthood. Pediatr Transplant. 2007;11:127–31.PubMedCrossRefGoogle Scholar
  27. 27.
    Callahan S, Cooper W. Continuity of health insurance coverage among young adults with disabilities. Pediatrics. 2007;119:1175–80.PubMedCrossRefGoogle Scholar
  28. 28.
    Okumura M, Hersh A, Hilton J, Lotstein D. Change in health status and access to care in young adults with special health care needs: results from the 2007 National Survey of Adult Transition and Health. J Adolesc Health. 2013;52:413–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Cohen R, Martinez M. Health insurance coverage: early release of estimates from the National Health Interview Survey, 2011. Atlanta, GA: Centers for Disease Control and Prevention; 2012. p. 1–37.Google Scholar
  30. 30.
    Lau J, Adams S, Irwin C. Young adult health care utilization and expenditures before the implementation of the Affordable Care Act. In: Society for Adolescent Health and Medicine 2013 Annual Meeting. vol. 52. Atlanta, GA. J Adolesc Health. 2013:S21.Google Scholar
  31. 31.
    Kirzinger W, Cohen R, Gindi R. Health care access and utilization among young adults aged 19–25: early release of estimates from the national health interview survey, January-September 2011. Atlanta, GA: Centers for Disease Control and Prevention; 2012. p. 1–10.Google Scholar
  32. 32.
    • Collins S, Robertson R, Garber T, Doty M. Young, uninsured, and in debt: why young adults lack health insurance and how the Affordable Care Act is helping. In: Tracking Trends in Health System Performance. New York: The Commonwealth Fund; 2012. p. 1–23. This brief is the results of a survey of emerging adults (ages 19–25) between November 2010 and November 2011. The survey found that almost 40% of emerging adults did not have health insurance for all or part of 2011;and many emerging adults did not seek healthcare when needed due to cost as well as reported difficulty paying medical bills or medical debt. The Affordable Care Act helped many emerging adults by allowing them to stay on parents’ health plans, and these survey findings indicated the need for policymakers to enact the additional coverage expansions outlines in the Affordable Care Act. Google Scholar
  33. 33.
    Sommers B, Buchmueller T, Decker S, Carey C, Kronick R. The Affordable Care Act has led to significant gains in health insurance and access to care for young adults. Health Aff. 2013;32:165–74.CrossRefGoogle Scholar
  34. 34.
    Collins S, Garber T, Robertson R. Realizing health reform's potential: how the affordable care act is helping young adults stay covered. New York: The Commonwealth Fund; 2011. p. 1–26.Google Scholar
  35. 35.
    van Dam HA, van der Horst F, van den Borne B, et al. Provider-patient interaction in diabetes care: effects on patient self-care and outcomes. A systematic review. Patient Educ Couns. 2003;51:17–28.PubMedCrossRefGoogle Scholar
  36. 36.
    Street RLJ, Makoul G, Arora NK, Epstein RM. How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Educ Couns. 2009;74:295–301.PubMedCrossRefGoogle Scholar
  37. 37.
    Geenen SJ, Powers LE, Sells W. Understanding the role of health care providers during the transition of adolescents with disabilities and special health care needs. J Adolesc Health. 2003;32:225–33.PubMedCrossRefGoogle Scholar
  38. 38.
    DiMatteo MR. The role of effective communication with children and their families in fostering adherence to pediatric regimens. Patient Educ Couns. 2004;55:339–44.PubMedCrossRefGoogle Scholar
  39. 39.
    van Staa A, Jedeloo S, van der Stege H. On Your Own Feet Research Group: "What we want": chronically ill adolescents' preferences and priorities for improving health care. Patient Prefer Adherence. 2011;5:291–305.PubMedCrossRefGoogle Scholar
  40. 40.
    Armstrong K, Ravenell K, McMurphy S, Putt M. Racial/ethnic differences in physician distrust in the United States. Am J Public Health. 2007;97:1283–9.PubMedCrossRefGoogle Scholar
  41. 41.
    Sawicki GS, Whitworth R, Gunn L, et al. Receipt of health care transition counseling in the national survey of adult transition and health. Pediatrics. 2011;128:e521–9.PubMedGoogle Scholar
  42. 42.
    van Staa A, van der Stege H, Jedeloo S, et al. Readiness to transfer to adult care of adolescents with chronic conditions: exploration of associated factors. J Adolesc Health. 2011;48:295–302.PubMedCrossRefGoogle Scholar
  43. 43.
    Sonneveld HM, Strating MM, van Staa A, Nieboer AP. Gaps in transitional care: what are the perceptions of adolescents, parents and providers? Child Care Health Dev. 2013;39:69–80.PubMedCrossRefGoogle Scholar
  44. 44.
    Nobile C, Drotar D. Research on the quality of parent-provider communication in pediatric care: implications and recommendations. J Dev Behav Pediatr. 2003;24:279–90.PubMedCrossRefGoogle Scholar
  45. 45.
    Perry L, Lowe J, Steinbeck K, Dunbabin J. Services doing the best they can: service experiences of young adults with type 1 diabetes mellitus in rural Australia. J Clin Nurs. 2012;21:1955–63.PubMedCrossRefGoogle Scholar
  46. 46.
    van Staa A, Jedeloo S, van Meeteren J, Latour J. Crossing the transition chasm: experiences and recommendations for improving transitional care of young adults, parents, and providers. Child Care Health Dev. 2011;37:821–32.PubMedCrossRefGoogle Scholar
  47. 47.
    •• van Staa A. On Your Own Feet Research Group. Unraveling triadic communication in hospital consultations with adolescents with chronic conditions: the added value of mixed methods research. Patient Educ Couns. 2011;82:455–64. This study was conducted with adolescents with various chronic illnesses (ages 12–19), parents, and providers using mixed-methodology. It highlights discrepancies in communication and communication styles between adolescents, parents, and providers. Specifically, although adolescents had varying preferences regarding health communication, in general all wanted to be involved as partners in their own care. However, they often behaved more as spectators and were noncompliant and/or uninvolved. Parents took dominant roles in medical encounters and providers were often frustrated by perceived adolescent ambivalence. Authors suggest that providers should encourage adolescents to take a more active role in their own care.PubMedCrossRefGoogle Scholar
  48. 48.
    Martenson EK, Fagerskiold AM. Information exchange in paediatric settings: an observational study. Paediatr Nurs. 2007;19:40–3.PubMedCrossRefGoogle Scholar
  49. 49.
    Pyorala E. The participation roles of children and adolescents in the dietary counseling of diabetics. Patient Educ Couns. 2004;55:385–95.PubMedCrossRefGoogle Scholar
  50. 50.
    Tates K, Meeuwesen L. Doctor-parent–child communication. A (re)view of the literature. Soc Sci Med. 2001;52:839–51.PubMedCrossRefGoogle Scholar
  51. 51.
    Beresford BA, Sloper P. Chronically ill adolescents' experiences of communicating with doctors: a qualitative study. J Adolesc Health. 2003;33:172–9.PubMedCrossRefGoogle Scholar
  52. 52.
    Klein JD, Wilson KM. Delivering quality care: adolescents' discussion of health risks with their providers. J Adolesc Health. 2002;30:190–5.PubMedCrossRefGoogle Scholar
  53. 53.
    •• Zolnierek KB, DiMatteo MR. Physician communication and patient adherence: a meta-analysis. Med Care. 2009;47:826–34. This is a meta-analysis of 106 correlational and 21 experimental intervention studies linking patient adherence to patient-provider communication. Results demonstrate that physician communication is significantly positively correlated with adherence, and that training physicians in communication results in improved adherence. In addition, results showed that physician type (pediatric or adult) moderates the correlation between communication and adherence, such that the correlation is higher when the physician is a pediatrician.PubMedCrossRefGoogle Scholar
  54. 54.
    Piette J, Schillinger D, Potter M, Heisler M. Dimensions of patient-provider communication and diabetes self-care in an ethnically divese population. J Gen Intern Med. 2003;18:624–33.PubMedCrossRefGoogle Scholar
  55. 55.
    Heisler M, Bouknight RR, Hayward RA, et al. The relative importance of physician communication, participatory decision making, and patient understanding in diabetes self-management. J Gen Intern Med. 2002;17:243–52.PubMedCrossRefGoogle Scholar
  56. 56.
    Verlinde E, De Laender N, De Maesschalck S, Deveugele M, Willems S. The social gradient in doctor-patient communication. Int J Equlity Health. 2012;11:12.CrossRefGoogle Scholar
  57. 57.
    Street Jr RJ, Gordon HS, Ward MM, Krupat E, Kravitz RL. Patient participation in medical consultations: why some patients are more involved than others. Med Care. 2005;43:960–9.PubMedCrossRefGoogle Scholar
  58. 58.
    Kinnersley P, Edwards A, Hood K, et al. Interventions before consultations for helping patients address their information needs by encouraging question asking: systematic review. BMJ. 2008;337:a485.PubMedCrossRefGoogle Scholar
  59. 59.
    Harrington J, Noble LM, Newman SP. Improving patients' communication with doctors: a systematic review of intervention studies. Patient Educ Couns. 2004;52:7–16.PubMedCrossRefGoogle Scholar
  60. 60.
    Zoffmann V, Kirkevold M. Realizing empowerment in difficult diabetes care: a guided self-determination intervention. Qual Health Res. 2012;22:103–18.PubMedCrossRefGoogle Scholar
  61. 61.
    American Academy of Pediatrics. American Academy of Family Physicians, American College of Physicians Transitions Clinical Report Authoring Group. Clinical report - supporting the health care transition from adolescence to adulthood in the medical home. Pediatrics. 2011;128:182–200.CrossRefGoogle Scholar
  62. 62.
    Telfair J, Alexander L, Loosier P, et al. Providers' perspectives and beliefs regarding transition to adult care for adolescents with sickle cell disease. J Health Care Poor Underserved. 2004;15:443–61.PubMedCrossRefGoogle Scholar
  63. 63.
    Lotstein D, Ghandour R, Cash A, et al. Planning for health care transitions: results from the 2005–2006 National Survey of Children with Special Health Care Needs. Pediatrics. 2009;123:e145–52.PubMedCrossRefGoogle Scholar
  64. 64.
    Stivers T. Physician-child interaction: when children answer physicians' questions in routine medical encounters. Patient Educ Couns. 2012;87:3–9.PubMedCrossRefGoogle Scholar
  65. 65.
    Johnson RL, Roter D, Powe NR, Cooper LA. Patient race/ethnicity and quality of patient-physician communication during medical visits. Am J Public Health. 2004;94:2084–90.PubMedCrossRefGoogle Scholar
  66. 66.
    Stivers T, Majid A. Questioning children: interactional evidence of implicit bias in medical interviews. Soc Psychol Q. 2007;70:424–41.CrossRefGoogle Scholar
  67. 67.
    Schoenthaler A, Chaplin W, Allegrante J, et al. Provider communication effects medication adhenrece in hypertensive African Americans. Patient Educ Couns. 2009;75:185–91.PubMedCrossRefGoogle Scholar
  68. 68.
    Peek ME, Quinn MT, Gorawara-Bhat R, et al. How is shared decision-making defined among African Americans with diabetes? Patient Educ Couns. 2008;72:450–8.PubMedCrossRefGoogle Scholar
  69. 69.
    Teal C, Street R. Critical elements of culturally competent communication in the medical encounter: a review and model. Soc Sci Med. 2009;68:533–43.PubMedCrossRefGoogle Scholar
  70. 70.
    Miller K, Martell Z, Pazdirek L, et al. The role of interpreters in psychotherapy with refugees: an exploratory study. Am J Orthopsychiatry. 2005;75:27–39.PubMedCrossRefGoogle Scholar
  71. 71.
    Fernandez A, Schillinger D, Warton E, et al. Language barriers, physician-patient langauge concordance, and glycemic control among insured Latinos with diabetes: the Diabetes Study of Northern California (DISTANCE). J Gen Intern Med. 2011;26:170–6.PubMedCrossRefGoogle Scholar
  72. 72.
    de Beaufort C, Jarosz-Chobot P, Frank M, et al. Transition from pediatric to adult diabetes care: smooth or slippery? Pediatr Diabetes. 2009;11:24–7.PubMedCrossRefGoogle Scholar
  73. 73.
    Swedlund MP, Schumacher JB, Young HN, Cox ED. Effect of communication style and physician-family relationships on satisfaction with pediatric chronic disease care. Health Commun. 2012;27:498–505.PubMedCrossRefGoogle Scholar
  74. 74.
    Croom A, Wiebe DJ, Berg CA, et al. Adolescent and parent perceptions of patient-centered communication while managing type 1 diabetes. J Pediatr Psychol. 2011;36:206–15.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Maureen Monaghan
    • 1
  • Marisa Hilliard
    • 2
  • Rachel Sweenie
    • 1
  • Kristin Riekert
    • 2
  1. 1.Center for Translational Science, Children’s National Medical CenterWashingtonUSA
  2. 2.Johns Hopkins Adherence Research Center, Johns Hopkins Medical CenterBaltimoreUSA

Personalised recommendations