142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

303795
Predictors of timing of transfer from pediatric to adult primary care

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Wednesday, November 19, 2014 : 11:10 AM - 11:30 AM

Lauren Wisk, PhD , Department of Population Medicine, Center for Child Health Care Studies, Harvard Medical School, Boston, MA
Jonathan Finkelstein, MD, MPH , Department of Population Medicine, Harvard Medical School, Boston, MA
Gregory Sawicki, MD, MPH , Cystic Fibrosis Center, Division of Pulmonary and Respiratory Diseases, Boston Children's Hospital, Boston, MA
Matthew Lakoma, MS , Department of Population Medicine, Harvard Medical School, Boston, MA
Sara Toomey, MD, MPhil, MPH, MSc , Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
Mark A. Schuster, MD, PhD , Department of Medicine, Children's Hospital Boston/Harvard Medical School, Boston, MA
Alison Galbraith, MD, MPH , Department of Population Medicine, Harvard Medical School, Boston, MA
Ensuring a smooth transfer from pediatric to adult health care is a crucial component of high quality care transition, especially for youth with chronic conditions.  However, little is known about the timing of such transfers and the factors that influence them. Our objective was to determine factors related to the time at transfer to adult primary care providers (PCPs) and to the time between last pediatric and first adult PCP visits for adolescents and young adults (AYA) while enrolled in a health plan.

We selected adolescents who were continuously enrolled in a large non-profit health plan from age 16 to at least age 18 between January 2000 and December 2012, and who had at least one pediatric PCP visit before age 18.  Multivariable Cox regression was used to model the time to first visit with an adult PCP or disenrollment. Multivariable linear regression was used to model the length of the gap between the last pediatric PCP visit and first adult PCP visit among those who transferred. Potential predictors included gender, chronic condition status, state of residence, neighborhood income, age at last pediatric PCP visit, dependent status, and year.

Of 57,565 AYA in our sample, 39.2% transferred from a pediatric PCP to an adult PCP during their enrollment, with a mean age at transfer of 20.5 years, and 88.5% of AYA had a gap of more than 12 months after their last pediatric PCP visit.  Transfer occurred at younger ages for female AYA (HR: 1.48, 95%CI: 1.44-1.52) and those with chronic conditions (HR: 1.17, 95%CI: 1.14-1.20), and at older ages for AYA in neighborhoods in the lowest income quartile (vs. highest) (HR 0.92, 95%CI: 0.89-0.96).  The gap between last pediatric and first adult PCP visit was shorter for female AYA than for males (2.8 months, 95%CI: 2.4 – 3.1 months) and those with chronic conditions than those without (1.5 months, 95%CI: 1.1 – 1.9 months), and longer for AYA in neighborhoods in the lowest income quartile than in the highest (0.8 months, 95%CI: 0.2-1.4 months).

Although it is reassuring that AYA with chronic conditions have shorter gaps than those without chronic conditions, this population may be more vulnerable to delays in primary care access and may need even shorter transfer intervals to ensure continuous care.  More work is needed to determine if AYA are experiencing clinically important lapses in care and promote optimal transfer from pediatric to adult primary care.

Learning Areas:

Clinical medicine applied in public health
Provision of health care to the public
Public health or related public policy
Social and behavioral sciences

Learning Objectives:
Describe the characteristics associated with earlier and later care transfers during the transition from adolescence to young adulthood. Assess the implications of disparities in quality for transitions from pediatric to adult primary care.

Keyword(s): Adolescents, Health Care Delivery

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I helped to design and conduct the analyses included in this abstract and have drafted the contents of the abstract.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.