Transition Intervention for Adolescents With Congenital Heart Disease
What is the impact of a nurse-led transition intervention on lapses between pediatric and adult care in adolescents with congenital heart disease (CHD)?
A cluster randomized clinical trial was performed at tertiary congenital heart centers in Canada. Patients with moderate or complex CHD at age 16 or 17 years were randomized to either a nurse-led transition intervention or standard care. The intervention consisted of two 1-hour long individualized sessions involving CHD education and self-management skills. The primary outcome was excess time to establishing with adult CHD care, defined as the interval between the final pediatric cardiology appointment and the first adult cardiology appointment, subtracting the recommended follow-up interval. Secondary outcomes included scores on the MyHeart CHD knowledge survey and the generic Transition Readiness Assessment Questionnaire.
One hundred and twenty-one participants were enrolled, of which 58 were randomized to the intervention and 63 received standard care. At the recommended time of the first visit with adult congenital cardiology, intervention participants were 1.8 times more likely to have their appointment within 1 month (95% confidence interval [CI], 1.1-2.9; p = 0.018). At an excess time of 6 months, intervention participants were 3.0 times more likely to have an appointment within 1 month (95% CI, 1.1-8.3). Both groups had similar baseline values on the knowledge survey and transition readiness assessment. Participants in the intervention group had higher scores on both instruments at 1, 6, 12, and 18 months.
The authors concluded that a nurse-led intervention reduced the likelihood of a delay in adult CHD care and improved CHD knowledge and self-management skills.
Optimizing the transition and transfer process of young adults with CHD remains a challenge. This study showed shorter lapses in follow-up after an individualized nurse-led educational intervention. In practice, it can be difficult for congenital heart centers to obtain the resources necessary to provide such services to their patients. Hopefully since this study shows improved follow-up after educational programs, it will assist. Ultimately, data suggesting improved health outcomes will be very important as well.
Keywords: Adolescent, Child, Heart Defects, Congenital, Intervention Studies, Outcome Assessment (Health Care), Pediatrics, Self Care, Transition to Adult Care, Young Adult
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