Transitional care of adolescents and young adults with asthma and allergy—The healthcare professional perspective
Authors: Maria Ödling, Birgitta Lagercrantz, Emma Goksör, Hanna Sandelowsky, Christer Janson, Inger Kull
Journal: Allergy (2024)

Adolescence is a challenging time for both patients and healthcare professionals (HCPs).1, 2 In 2020, the European Academy of Allergy and Clinical Immunology (EAACI) presented clinical practice guidelines to provide evidence-based recommendations for HCPs to support the transitional care of adolescents and young adults (AYAs) with asthma and allergy.3 The same year, the Swedish Paediatric Society published national guidelines with similar contents as the EAACI's.4 To what extent these guidelines have been implemented in clinical practice in Sweden is currently unknown. In addition, related challenges faced by HCPs in the management of AYAs with asthma and allergy during the transition process should be addressed. The aim of the present study was therefore to investigate whether transitional care is performed in accordance with guidelines and identify any barriers to successful management from the HCP perspective. A web-based survey was conducted, and a convergent mixed-method design was applied.5 The survey included five key recommendations from the guidelines3, 4 (Table S1) and one open-ended question. The study population consisted of 213 HCPs, of whom 52.1% were nurses and 47.9% physicians (Table S2). Taking the five key guideline recommendations together, Figure 1 summarizes the overall percentage fulfilment of none or one, two, three and four to five recommendations among HCPs in paediatric and primary care, respectively (n = 173). In total, 56.4% (n = 93) followed none or one of the recommendations, 24.2% (n = 40) followed two, 15.8% (n = 26) followed three, and 3.6% (n = 6) followed four to five. In Table S3, the key recommendations are presented separately and also analysed in groups based on level of care. The qualitative analysis presented in Table S4 resulted in three categories: (1) A lack of resources, knowledge and time among HCPs. (2) Cultural differences between paediatric and adult healthcare settings, the patient's interest, and the consequences of a lack of interest. (3) Inadequate communication between paediatric and adult healthcare settings, unclear routines, and patients not being informed about the transfer to adult health care. Categories described and illustrated by quotations from the HCPs (Table S4). Figure 2 shows the integration of the quantitative and qualitative results. More than half of the HCPs did not follow any or just one of the key recommendations. This might reflect the qualitative findings, revealing that there was no routine for the transitional care of AYAs, and inadequate communication between HCPs. Further, the lack of resources, time and knowledge among HCPs could contribute to not following the key recommendations. Moreover, the small group of HCPs in paediatric and primary care who met with patients alone did not start with the transition early. This could reflect the qualitative findings that adolescent patients were not prepared for the adult healthcare settings, the differences in management and in their own involvement, or the potential consequences of their lacking interest in self-management of their disease. When the EAACI guidelines were evaluated, it was found to be important for AYAs and their parents that HCPs should have discussions with young people designed to strengthen their motivation to improving their self-management.6 Resources from healthcare settings have been developed to assist HCPs in managing health care and transition for AYAs.2 However, the evidence base on the effectiveness of these programmes in supporting positive self-management outcomes is weak. Important strengths of the present study include the nationwide study population including multiple professional groups at several different levels of care. Nonetheless, there are some limitations. Our results are based on HCPs in Sweden and the generalizability may be questioned, as healthcare systems vary between countries, for instance in regard to the use of specialist services vs. primary care. However, we believe that our results can be transferred to other countries and populations. In conclusion, there are deficiencies among HCPs in adherence to the guidelines to support the transitional care of AYAs with asthma and allergy. The HCP perspective of the barriers to successful transitional care seems to focus on the transfer more than on the transition; AYAs were not prepared for, for example, the cultural differences between paediatric and adult health care or for self-management. This study was supported by grants from the Swedish Asthma and Allergy research foundation, the Swedish Heart-Lung Foundation, the Konsul Th C Berghs foundation, Sällskapet Barnavård and the Asthma, Allergy and COPD Nursing Association. EG, HS and CJ made substantial contributions to the design of the work. MÖ, BL and IK analysed and interpreted the data. MÖ was a major contributor in writing the manuscript. IK substantively revised the work. All authors read and approved the final manuscript. We thank all the HCPs for their participation in this study and André Lauber for constructing the web survey. The authors declare that they have no relevant conflicts of interest. The datasets generated during the present study are available from the corresponding author on reasonable request. Data S1. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.