Poster Presentation ESA-SRB-APEG-NZSE 2022

Transition models of care for Type 1 Diabetes: a scoping review   (#465)

Ann Carrigan 1 , Yvonne Zurynski 1 2 , Isabelle Meulenbroeks 3 , Mitchell N Sarkies 1 , Genevieve Dammery 2 , Nicole Halim 2 , Rebecca Lake 1 , Liz Davis 4 , Tim Jones 4 , Jeffrey Braithwaite 1
  1. Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, NSW, Australia
  2. Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
  3. Australian Institute of Health Innovation, Centre for Health Systems and Safety Research, Macquarie University, Sydney, NSW, Australia
  4. Telethon Kids Institute, Perth Children’s Hospital, Perth, WA, Australia

Managing the care regimen for Type 1 Diabetes (T1D) is challenging for emerging adults, as they take on greater responsibility for self-management. A diverse range of models of care have been implemented to improve safety and quality of care during transition between paediatric and adult services. However, evidence about acceptability and effectiveness of these is limited.  

Our aim was to scope transition models and their components, examine the health and psychosocial outcomes, and to identify determinants associated with the implementation of person-centred models of transition care.  

We searched Medline, CINAHL, EMBASE and Scopus. Peer reviewed empirical studies that focused on T1D models of care published from 2010 to 2021 in English, reporting experimental, qualitative, mixed methods, and observational studies were included.  

Fourteen studies reported on health and psychosocial outcomes, and engagement with healthcare. Three key models of care emerged: structured transition education programs (6), multidisciplinary team (MDT) transition support (5) and telehealth/virtual care as an integral component of a broader model (3). Compared with usual practice, three of the six structured transition education programs led to improved maintenance of glycaemic control, improved psychological well-being, and improved engagement with health services. Four MDT transition care models reported improved health outcomes, and improved engagement with health services, however, three studies reported no benefit. Reduced diabetes related stress and increased patient satisfaction were reported by two studies, but three reported no benefit. Telehealth and virtual group appointments improved adherence to self-management and reduced diabetes distress but no change in health outcomes. No study reported on implementation determinants or applied an implementation framework to guide their research. 

Although some benefits are reported, the results were mixed. We identified a gap in evidence about model acceptability, adoption, and appropriateness as experienced by clinicians delivering care and this should be a priority for future research.