Jarvis, Stuart ORCID: https://orcid.org/0000-0001-8447-0306 (2022) Is transition from paediatric to adult healthcare with a life-limiting condition associated with more unplanned hospital care? PhD thesis, University of York.
Abstract
Life-limiting conditions, which shorten or threaten to shorten life, are becoming increasingly prevalent among young people in England, attributed partly to longer survival. There are concerns about the transition from paediatric to adult healthcare.. Specialist paediatricians oversee childhood healthcare, with needed allied services provided continuously. A General Practitioner (GP) often coordinates adult healthcare; GPs may lack knowledge of the young person or condition. There can be provision gaps in allied services. Sometimes no equivalent adult service. These issues may lead to an increase in unplanned hospital care. Previous research is limited to a few more prevalent conditions and has used small, potentially unrepresentative, samples or used age to assign transition status, risking misclassification. I aimed to determine whether there is an association between transition from paediatric to adult healthcare and increased unplanned hospital care for young people with life-limiting conditions, to understand the nature of the population, including changing medical complexity and to explore the role of primary care. I used secondary data analyses of routinely collected healthcare data in England and a systematic review. My research was the first to analyse healthcare use across the transition using national data with transition point estimated for each individual, using a newly- developed method. I found the population of young people with life-limiting conditions transitioning to adult healthcare is growing in size and medical complexity, with more comorbidities and consultants of more different specialities involved. Evidence from previous studies was mixed and conflicting on changes in healthcare use at transition and there was a lack of UK studies. My research found unplanned hospital care increases for young people with life-limiting conditions after the transition and regular contact with the same GP is associated with reduced use of unplanned hospital care. The role of the GP should be considered in reforms to improve transition.
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