Transitions in care from pediatric to adult general surgery.


eMediNexus    04 November 2017

The goal of a new study published in the Journal of Pediatric Surgery was to understand the barriers to transition from pediatric to adult surgical providers for patients who have undergone childhood operations from a patient and family perspective. This was a cross sectional survey on patients with a history of anorectal malformation ARM or Hirschsprung Disease HD and their families. A total of 118 surveys were completed with an approximate 26.2 response. The average age of patients at time of survey was 12.3years while 64.5 were below 15 years of age. The findings revealed that the primary diagnosis was reported for 78.8 patients of which 29 were HD 61.3 were ARM and 9.7 were cloaca. The average distance traveled for ongoing care was 186.6miles with 40.9 of patients traveling 8805 30miles however the distance was statistically greater for patients with ARM. On inspection of ongoing symptoms 44.1 experienced constipation 40.9 had diarrhea and approximately 40.9 required chronic medication for management of bowel symptoms while only 3.2 respondents reported fecal incontinence. Furthermore a 52.7 patients reported of having visited a provider at least twice per year and they continued to be followed by a pediatric provider the majority of the cohort being less than 18 years of age. Moreover conversations with providers regarding transitioning to an adult physician had occurred in fewer than 13 of patients. The most commonly cited barrier to transition was the perception that adult providers would be ill equipped to manage the persistent bowel symptoms. From the findings it was concluded that patients undergoing childhood procedures for ARM or HD have a high prevalence of ongoing symptoms related to bowel function but very few have had conversations regarding transitions in care. It was stated that an early implementation of transitional care plans and engagement of adult providers are imperative to transitions and may render long term health benefits in this patient population.1 Reference 1. Cairo S Chiu P Dasgupta R et al. Transitions in care from pediatric to adult general surgery Evaluating an unmet need for patients with anorectal malformation and Hirschsprung disease. Journal of Pediatric Surgery. 2017. doi 10.1016 j.jpedsurg.2017.09.021.

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