Preparing adolescents with chronic disease for transition to adult care: a technology program

Abstract

Background: Adolescents with chronic disease (ACD) must develop independent disease self-management and learn to communicate effectively with their health care team to transition from pediatric to adult-oriented health care systems. Disease-specific interventions have been implemented to aid specific ACD groups through transition. A generic approach might be effective and cost-saving.

Methods: Eighty-one ACD, aged 12 to 20 years, were recruited for a randomized clinical trial evaluating an 8-month transition intervention (MD2Me). MD2Me recipients received a 2-month intensive Web-based and text-delivered disease management and skill-based intervention followed by a 6-month review period. MD2Me recipients also had access to a texting algorithm for disease assessment and health care team contact. The intervention was applicable to adolescents with diverse chronic illnesses. Controls received mailed materials on general health topics. Disease management, health-related self-efficacy, and health assessments were performed at baseline and at 2 and 8 months. Frequency of patient-initiated communications was recorded over the study period. Outcomes were analyzed according to assigned treatment group over time.

Results: MD2Me recipients demonstrated significant improvements in performance of disease management tasks, health-related self-efficacy, and patient-initiated communications compared with controls.

Conclusions: Outcomes in ACD improved significantly among recipients of a generic, technology-based intervention. Technology can deliver transition interventions to adolescents with diverse chronic illnesses, and a generic approach offers a cost-effective means of positively influencing transition outcomes. Further research is needed to determine whether improved short-term outcomes translate into an improved transition for ACD.

Trial registration: ClinicalTrials.gov NCT01253733.

Keywords: adolescents; chronic disease management; self-management; transition to adulthood.

Copyright © 2014 by the American Academy of Pediatrics.

Figures

FIGURE 1

CONSORT (Consolidated Standards of Reporting Trials) diagram for the MD2Me randomized controlled clinical trial.

FIGURE 2

MD2Me SMS algorithm decision tree. Nonurgent, requiring intervention within 48 to 72 hours; Urgent, requiring intervention within 24 hours.