Outpatient volumes and medical staf fing resources as predictors for continuity of follow-up care during transfer of adolescents with congenital heart diseaseDepartment of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.
Heart and Vascular Theme, Congenital Heart Disease Group, Karolinska University Hospital, Solna, Swedenn.
Department of Paediatric Cardiology, Karolinska University Hospital, Stockholm, Sweden.
Department of Paediatric Cardiology, Skåne University Hospital, Barnhjärtcentrum avd 67, Lund, Sweden.
Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Department of Cardiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Örebro University, School of Medical Sciences. Department of Paediatric and Women's Health Care, Örebro University Hospital, Örebro, Sweden.
Department of Clinical and Experimental Medicine, Division of Paediatrics, Crown Princess Victoria Children's Hospital, Linköping University, Linköping, Sweden; Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Department of Paediatric Cardiology, Lund, Sweden.
Department of Paediatric Cardiology, Uppsala University, Uppsala, Sweden.
Department of Clinical Sciences, Unit of Paediatrics, Umeå University, Umeå University Hospital, Umeå, Sweden.
Division of Paediatric Cardiology, Department of Paediatric and Child Health, Red Cross War Memorial Children's Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
KU Leuven Department of Public Health and Primary Care, Leuven, Belgium; Research Foundation Flanders (FWO), Brussels, Belgium.
Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden; Department of Paediatric Cardiology, Queen Silvia's Children's Hospital, Gothenburg, Sweden.
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2020 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 310, p. 51-57Article in journal (Refereed) Published
Abstract [en]
Background: Providing continuous follow-up care to patients with congenital heart disease (CHD) remains a challenge in many settings. Previous studies highlight that patients with CHD experience discontinuation of followup care, but mainly describe a single-centre perspective, neglecting inter-institutional variations. Hospital-related factors above and beyond patient-related factors are believed to affect continuity of care. The present multicentre study therefore investigated (i) proportion of "no follow-up care"; (ii) transfer destinations after leaving paediatric cardiology; (iii) variation in proportions of no follow-up between centres; (iv) the association between no follow-up and outpatient volumes, and (v) its relationship with staffing resources at outpatient clinics.
Methods: An observational, multicentre study was conducted in seven university hospitals. In total, 654 adolescentswith CHD, born between 1991 and 1993, with paediatric outpatient visit at age 14-18 years were included. Transfer status was determined 5 years after the intended transfer to adult care (23y), based on medical files, self-reports and registries.
Results: Overall, 89.7% of patients were receiving adult follow-up care after transfer; 6.6% had no follow-up; and 3.7% were untraceable. Among patients in follow-up care, only one remained in paediatric care and the majority received specialist adult CHD care. Significant variability in proportions of no follow-up were identified across centres. Higher outpatient volumes at paediatric outpatient clinics were associated with better continued follow-up care after transfer (OR = 1.061; 95% CI = 1.001 - 1.124). Medical staffing resources were not found predictive.
Conclusion: Our findings support the theory of hospital-related factors influencing continuity of care, above and beyond patient-related characteristics. (c) 2020 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Place, publisher, year, edition, pages
Elsevier, 2020. Vol. 310, p. 51-57
Keywords [en]
Adolescent, Continuity of patient care, Heart defects, congenital, Patient transfer, Young adult, Transition to adult care
National Category
Cardiology and Cardiovascular Disease
Identifiers
URN: urn:nbn:se:oru:diva-85062DOI: 10.1016/j.ijcard.2020.01.016ISI: 000552054400012PubMedID: 31959410Scopus ID: 2-s2.0-85077930713OAI: oai:DiVA.org:oru-85062DiVA, id: diva2:1461324
Funder
Swedish Heart Lung FoundationForte, Swedish Research Council for Health, Working Life and Welfare, 2016-07259
Note
Funding Agencies:
Institute of Health and Care Sciences of the University of Gothenburg
South African Medical Research Council through FORTE
National Research Foundation - South Africa
2020-08-262020-08-262025-02-10Bibliographically approved