Introduction
The transition from pediatric to adult care can be difficult for young adults with a chronic condition who require ongoing medical care, with many families not receiving appropriate services during this period.1 There are also clear impacts on patient outcomes related to their move into adult care. For young adults with type 1 diabetes, this transition period is associated with poorer glycemic control and less frequent clinic attendance.2,3,4,5 These young adults are also at higher risk for complications and hospitalization in the period after they move into adult care.5,6,7 Because of the greater recognition of these risks, there has been more focus, in both practice and research, on improving transition.
While there are exceptions,8,9 most studies on transition for individuals with type 1 diabetes have focused on practices at a single institution or program. This limited perspective may overlook the experiences of patients who are followed at centres without a dedicated pediatric diabetes or transition program. Taking this approach also likely under reports the experiences of patients who are cared for in rural or remote areas. In this article, we examine the transition for young adults with type 1 diabetes across an entire Canadian province: Newfoundland and Labrador (NL). Our aim is to determine how transition is occurring across this entire jurisdiction and to identify ways in which care delivery can be improved.
NL has one of the highest incidence rates of type 1 diabetes reported globally (49.9/100,000; 95% CI 42.2, 57.6).10,11Still the issue of transition to adult care for patients with diabetes has not been previously explored in the NL population. The NL population is also interesting from a transition perspective in that the region has a small and most rural population. Over half of the province’s population of 528,000 live in a rural area, with a population density of 1.4 persons per square kilometer.12 Health care in NL, including diabetes care, is delivered by four separate regional health authorities. There is only one tertiary care children’s hospital, located in the provincial capital. Much of the population faces challenges in terms of accessing speciality health care services locally, including diabetes care.13 Even though the province has a small population, there was little understanding of how transition care is being delivered in different regions. This lack of understanding of current practices is a barrier to identifying and implementing quality improvements, especially on a province-wide basis. The situation in NL related to diabetes transition is probably similar to that in other regions with mostly rural, widely dispersed populations. Understanding how transition occurs in NL can then provide insights into how the transition to adult care is managed in other jurisdictions and the type of interventions that can used to improve care.