Content area
Abstract
Background
The American Academy of Pediatrics (AAP) has emphasized the importance of transitioning chronically ill adolescents from pediatric to adult care for over a quarter-century. Despite the development of generic guidelines and some age group cohorts in pediatric specialty care, adolescents continue to fall through care gaps, resulting in adverse clinical outcomes. Government bodies and international organizations have developed clinical practice guidelines (CPGs) for specific chronic physical illnesses. However, it is unclear how well these cover the transition from pediatric to adult care and how familiar medical care providers are with clinical practice guidelines concerning the healthcare transition of chronically ill adolescents to adult care. A large proportion of the Saudi Arabian population comprise of adolescents. Adolescent health care has recently started gaining momentum in Saudi Arabia; however, its general acceptance is still inadequate.
Objective
The objective of the present study was to assess the awareness of nephrologists in Saudi Arabia about healthcare transition policies for adolescents with chronic kidney disease.
Materials and Methods
A descriptive cross-sectional questionnaire-based research study was conducted. This research study surveyed actively practicing adult and pediatric nephrologists (registered with the Saudi Society of Nephrology) in multiple centers in Saudi Arabia dealing with adolescent patients with chronic kidney disease, end-stage renal disease, or kidney transplants. The research study was performed from February 01, 2022, to August 31, 2022. A survey questionnaire was developed using Google Forms, which comprised a total of 26 questions. The survey addressed barriers to transitions, destination of care, time of initiation of transfer of care, age of initiation of transition, mode of transition communication, awareness of transition process, transition policies, and awareness of local transition regulations. The Statistical Package for Social Sciences (SPSS) version 27.0 was used for statistical analyses. We considered the value of P ≤ 0.05 to be statistically significant.
Results
This research study recruited 98 physicians. The majority of the study participants were males (n=55, 56%) and constituted Saudi nationality (n=71, 72.4%). Five major barriers to formal health care transition are difficulty coordinating with multiple specialists to manage complex problems (n=49, 50%), lack of training in care coordination (n=47, 48%), lack of training in adolescent development and behavior (n=44, 44.9%), difficulty meeting psychosocial needs of young adults with care coordination (n=42, 42.9%), and lack of patients’/families’ familiarity with adult health care coordination (n=37, 37.8%). Over half (n=53, 54.1%) of the physicians believed that if patients reach adulthood, they should be transferred according to age, such as between 14 and 16 years of age (n=60, 61.2%). Overall, 74.5% of the physicians indicated that their institutions had an age bracket of 14 to 16 years old for transferring patients to adult care. Physicians were aware that the main body for transition age regulation was the MOH (n=66, 67.3%,) with 14 years of age being the cutoff for transition (n=76, 77.6%). The most important information during the transition process was about patients’ medical conditions and general health issues (n=92, 93.9%), and the most commonly preferred information to be given to the patients was to offer general information about routine adult care (n=74, 75.5%). The overall mean awareness score was 15.3±4.9, with poor, moderate, and good awareness concerning the transfer procedure/principles found among 27.6% (n=27), 38.8% (n=38), and 33.7% (n=33) of the physicians, respectively. Higher awareness scores were significantly associated with a background of pediatric residency training (P=0.022) and those currently employed at a governmental institution (P=0.045).
Conclusion
In summary, the overall level of awareness regarding transfer protocol is moderate to poor among physicians. Pediatric residency training background and employment at a governmental institution were associated with higher mean awareness scores. There is a need for a healthcare transition policy for adolescents with chronic kidney disease.
