5 years after introduction of a transition protocol: An evaluation of transition care for patients with chronic bladder conditions.

Summary Introduction In recent years, more attention has been given to the transition of adolescents in urological care. In 2010, the current team investigated the needs of children with chronic bladder conditions, in preparation for transfer to adult care. A transition protocol was developed and implemented. The current study evaluated current transition care, in order to further improve the transition process. Objective To give insight into the current transition care of adolescents with chronic bladder conditions since the introduction of a transition protocol in 2011. Study design A total of 124 patients with chronic bladder conditions, born 1980–2003, received a questionnaire. The study population was divided in a pre-transfer (n = 97) and post-transfer group (n = 27). The questionnaire was based on that used for a national study and was supplemented with specific urological questions. The questions for the pre-transfer patients investigated their level of independence, what subjects were discussed with the healthcare professionals, and their expectations and wishes regarding transfer to adult urology care. The post-transfer group was asked for their opinions about their transfer process. Results A total of 61% (n = 76/124) responded (pre-transfer 61/97 patients and post-transfer 1527 patients). Their knowledge about their condition and related issues was generally good. The subjects ‘future’, ‘relationships’, ‘sexuality’ and ‘fertility’ were discussed more with the nurse practitioner than with the pediatric urologist in comparison with 2010. The last three subjects were only discussed with one third of the adolescents (Summary table). The bond with the pediatric urologist was the most common reason to continue care at the Pediatric Urology department. Adolescents aged >18 years were better prepared for transfer to adult urology than in 2010. The majority of the post-transfer patients were transferred because of being aged >17 years. Most patients in the post-transfer group were pleased with the current transition process. Discussion The results showed that changes occurred after implementation of the personal patient transition protocol. The mean age of the pre-transfer group was younger compared to 2010; this influenced some of the results. Therefore, they were divided into two age groups, for more reliable outcomes. More attention to subjects like relationships and sexuality could further improve the satisfaction of adolescents in transition. Conclusion The older adolescents seemed better prepared for their transfer from pediatric to adult urology than in 2010. The majority was satisfied with the current transition protocol. Tailor-made transition care seemed to be the best option. Summary table . Subjects discussed during consultation in 2015. Pre-transfer group Future Relationships Sexuality Fertility The subject is being discussed 64% 34% 28% 24% The pediatric urologist (alone) discusses the subject 51% 58% 38% 50% The nurse practitioner (alone) discusses the subject 16% 32% 31% 29% Both discuss the subject 32% 11% 25% 14%