Subject(s)
Diabetes Mellitus, Type 1/therapy , Diabetes Mellitus, Type 2/therapy , Transition to Adult Care/organization & administration , Adolescent , Humans , Manitoba , Medical Records Systems, Computerized , Patient Care Team , Transition to Adult Care/standards , United Kingdom , United States , Young AdultABSTRACT
OBJECTIVES: To determine whether a systems navigator service, The Maestro Project, could increase medical surveillance for young adults with type 1 diabetes who transfer from pediatric to adult care. RESEARCH DESIGN AND METHODS: There were two cohorts of participants: 1) a younger group (aged 18 years, n = 82) who had the assistance of the navigator as they graduated from pediatric care and 2) an older group (aged 19-25 years) who were transferred to adult care without this initial support but later enrolled in the program. RESULTS: Of the older group (who did not have initial access to the navigator), 40% dropped out of adult medical care, compared with a dropout rate of 11% for the younger group, who had access to the navigator at the time of transfer from pediatric care. CONCLUSIONS: The systems navigator helped improve medical surveillance for both groups, although there was no evidence of improved short-term medical outcomes.
Subject(s)
Delivery of Health Care , Diabetes Mellitus, Type 1/therapy , Patient Education as Topic , Adolescent , Adult , Child , Cohort Studies , Diabetes Mellitus, Type 1/rehabilitation , Humans , Patient Acceptance of Health CareABSTRACT
During the transition from pediatric to adult diabetes care there is often a high rate of medical dropout and increased rates of acute and chronic complications. Building Connections: The Maestro Project was initiated in September 2002 by the Diabetes Education Resource for Children and Adolescents and the City of Winnipeg Regional Health Authority in Manitoba, Canada to examine the feasibility and acceptability of an administrative support and systems navigation service for young adults with type 1 diabetes. The participation rate on February 28, 2005 was 78.9 percent (373/473). Of the 323 young adult participants 18 to 30 years of age, 127 requested 230 community contacts for access care and education. Specifically, 46 re-referrals were made for specialty care (adult endocrinologists or general internists), 34 contact numbers were given for family physician care, and there were 121 contacts to reconnect with diabetes education and counseling services and 29 contacts for an optometrist. The first 22 years of the project have demonstrated the feasibility and acceptability of this model of service for young adults with type 1 diabetes as they move from pediatric to adult care.
