Transition of care in pediatric surgery

Botelho, Amanda; Dias, Pedro Norton Gonçalves; Tsuji, Andre Hiroki Suyama; Leite, Mila Torii Corrêa

doi:10.31744/einstein_journal/2021AO6314

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Sumário

ORIGINAL ARTICLE • Einstein (São Paulo) 19 • 2021 • https://doi.org/10.31744/einstein_journal/2021AO6314 copy

Transition of care in pediatric surgery

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To identify among pediatric surgeons across Brazil how the transition of pediatric patients to adult clinics is carried out.

Methods

A questionnaire was emailed to pediatric surgeons registered with the Associação Brasileira de Cirurgia Pediátrica in 2018. The data assessed included training time, maximum age of care, subspecialty of practice, outpatient follow-up of adult patients, reason for continuing care of adult patients, referral to adult specialties, concern with transition of care, and what has been done to improve it.

Results

Most pediatric surgeons had more than 20 years of experience, and approximately 61% worked simultaneously at a public hospital, private hospital and private office. The maximum age of care at public, private hospitals and private offices proved to be quite varied. The follow-up of patients aged over 18 years at public hospitals, private hospitals and private clinics wase 32%, 23.58% and 20.75%, respectively. The main reason for patients aged over 18 years continued to be accompanied by pediatric surgeons was lack of knowledge about the disease by adult specialties. Most patients were referred to the adult specialty of the hospital, and roughly 37% of pediatric surgeons responded that they were in contact with the adult specialty. Most believed in autonomy of care of their patients and were concerned with transition of care.

Conclusion

Transition of care is a relevant issue that needs to be studied and debated to ensure an appropriate long-term follow-up.

Transitional care; Adolescent; Child; General surgery; Transition to adult care

Age	Public hospital	Private hospital	Private office
11 years and 11 months	4.71	2.83	1.88
12 years	10.37	9.43	6.60
12 years and 11 months	16.98	8.49	2.83
13 years	3.77	1.88	2.83
13 years and 11 months	3.77	9.43	5.66
14 years	4.71	9.43	6.60
14 years and 11 months	13.20	5.66	10.37
15 years	7.54	4.71	4.71
15 years and 11 months	4.71	2.83	1.88
16 years	1.88	5.66	4.71
16 years and 11 months	0.94	0.94
17 years			0.94
17 years and 11 months	11.32	13.20	13.20
18 years	3.77	5.66	6.60
18 years and 11 months	0.94
20 years	0.94		0.94
21 years	1.88	0.94	0.94
“No information”	6.59	10.37	17.92
“No age limit”	1.88	8.49	11.32

Reason	Responses
Does not apply since I refer all patients older than 18 years	48.11
Patient does not want to be referred to adult specialty	35.84
Long-standing physician-patient relationship, prevents referring to adult specialty	28.30
Adult specialties lack knowledge on this condition	22.64
Others	11.32

Forms of referral	Responses
Patient is referred to the adult specialty of the hospital where I work	64.15
Patient is referred to the private adult specialty I trust	51.88
Patient is referred to the health insurance adult specialty	39.62
Patient is referred to another hospital adult specialty	17.92
Does not apply because I never refer	4.71

How do you carry out patient transition?
I try to follow along with the adult’s surgeon
Direct contact with the adult’s specialist
Orientations to patients and family members
I offer my opinion on management
Transition consultation to provide the patient all information and written documents on their problem and plan for the future
Make themselves available for the patient and adult specialist shall they have any doubt
Inform that the record is available at the hospital
Contact with the service and carry out procedures for referral
Refer for adult specialists with experience in congenital malformations
Send the physician a report with the patient treatment history
Project “Travessia” from the City Health Department and Hospital Infantil Darcy Vargas, in São Paulo
Detailed report given to legal guardians
Create transition groups

Instituto Israelita de Ensino e Pesquisa Albert Einstein Avenida Albert Einstein, 627/701 , 05651-901 São Paulo - SP, Tel.: (55 11) 2151 0904 - São Paulo - SP - Brazil
E-mail: revista@einstein.br

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[1] Corresponding author: Mila Torii Corrêa Leite Rua Bagé, 230, apto. 113 – Vila Mariana Zip code: 04012-140 – São Paulo, SP, Brazil Phone: (55 11) 5581-1490 E-mail: milatorii@gmail.com