Transitioning adolescents with diabetes mellitus from pediatric to adult clinical care at Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background: Advances in medical care have enabled children with chronic diseases to survive into adulthood. Transitioning is a process that involves preparing adolescents with chronic illnesses for follow up in adult care. Transfer is the physical movement from pediatric to adult care. Poor disease control has been reported in adolescents who do not go through transitioning. The extent to which this transitioning process is being followed at MTRH is unknown. Objectives: To determine the proportion of adolescents who met the elements of appropriate transitioning and to describe the process and possible determinants of transitioning adolescents with diabetes mellitus from pediatric to adult care at Moi Teaching and Referral Hospital. Methods: Design: A sequential explanatory mixed methods cross sectional study. Site: Pediatric and adult diabetic clinics at MTRH. Population: A census study of adolescents aged between 14 and 19 years on follow up at the adult and pediatric diabetic clinics at MTRH, guardians who accompanied the adolescents and health care providers in the clinics. Exclusion: Adolescents diagnosed after the age of 14 years. Data Collection: Semi-structured interviewer administered questionnaires collected both quantitative (age, gender, period of follow up) and qualitative data. Convenience sampling was used to select adolescents for the focus group discussions. Four separate FGD‟s comprising eight adolescents each, were conducted. Key informant interviews with health care providers were held. Data analysis: Descriptive statistics for continuous data. Qualitative analysis: Audio-recorded information obtained from the interviews was transcribed verbatim. Reduction was through coding. The data was categorized into themes. Data source triangulation was done. Results: The study participants included 65 adolescents (25 male, 40 female), 8 health care providers (2 pediatricians, 2 physicians, 2 nurses and 2 clinical officers) and 24 parents/guardians (18 female,6 male). Quantitative findings: All the adolescents met one element of appropriate transitioningdisclosed to their diagnosis of DM. The proportion was 100%. Qualitative findings: The movement from pediatric to adult care was abrupt without a preparation period informing the adolescents about the intended change. Facilitators of transitioning included adolescent clinics and sharing information on transitioning. Different categories of barriers were encountered: Health system factors: payment for services in the adult care clinic and lack of guidelines on transitioning. Individual factors: reluctance to move to a new environment and the feeling of abandonment by the pediatricians. Health care provider factors: unfriendly doctors in the adult care clinic. Conclusion: All the adolescents met one element of appropriate transitioning but did not go through the process of transitioning. The adolescents were moved from the pediatric to the adult diabetic clinics through an event of transfer rather than the process of transitioning. Facilitators that would make transitioning easier included establishment of adolescent-focused clinics and sharing information on transitioning with the parents and adolescents. The barriers to transitioning included payment for services and delays before seeing the doctors in the adult care clinic. Recommendation: The adolescents with DM should go through the process of transitioning and MTRH needs to have guidelines on transitioning adolescents with chronic illnesses to adult care. There is need to establish an adolescent friendly diabetic clinic in MTRH.