Continuity and transition of care for children with chronic conditions: a scoping review

Authors

DOI:

https://doi.org/10.33448/rsd-v10i10.19043

Keywords:

Transitional care; Child health; Chronic disease; Continuity of patient care; Health management.

Abstract

The growing availability of technological resources and the change in the population's nutritional profile have also increased the survival of children with chronic conditions. Care for children with chronic conditions requires a differentiated and specialized approach, considering their specific care and vulnerabilities. This article aims to understand the evidence found in the national and international scientific literature on continuity and/or transition in the care of children with chronic diseases. For this, a scope review was carried out in the BVS, Pubmed and Scopus databases in January 2019, with a search for data between 2009 and 2018, using the descriptors "Continuity of Patient Care" or "Transitional Care", "Child" and “Chronic Disease”. The inclusion criteria were articles published between 2009 and 2018, in Portuguese, English and Spanish. While the exclusion criteria were articles not available online in full format, theses and dissertations, duplicate publications and studies that did not address the theme. Nineteen articles were selected in the final sample, constructing the categories: Communication between Services in the Health Care Network; Transition of care from hospital to home; Rehospitalizations and their relationship with the continuity and transition of care; and, Longitudinal link and relational continuity. Among the findings, the evidence brings practical contributions to the health area, especially for professional nurses, as it presents strategies for the care of children with chronic health conditions, in addition to pointing out difficulties experienced in this context, highlighting aspects that need improvement.

References

Abreu, I. S., Nascimento, L. C., Lima, R. A. G. & Santos, C. B. (2015). Children and adolescents with chronic kidney disease in haemodialysis: perception of professionals. Revista Brasileira de Enfermagem, 68(6), 1020-1026.

Arksey, H. & Malley, L. O. (2005). Scoping studies towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19-32.

Baird, J., Rehm, R. S., Hinds, P. S., Baggott, C. & Davies, B. (2016). Do You Know My Child? Continuity of Nursing Care in the Pediatric Intensive Care Unit. Nursing Research, 65(2), 142-150.

Barker, I., Steventon, A. & Deeny, S. R. (2017). Association between continuity of care in general practice and hospital admissions for ambulatory care sensitive conditions: cross sectional study of routinely collected, person level data. British Medical Journal, 356, 1-9.

Bousquat, A., Giovanella, L., Campos, E. M. S., Almeida, P. F., Martins, C. L., Mota, P. H. S., Mendonça M. H. M., Medina, M. G., Viana, A. L. D., Fausto, M. C. R. & Paula D.F. (2017). Primary health care and the coordination of care in health regions: managers’ and users’ perspective. Ciência & Saúde Coletiva, 22(4), 1141-1154.

Brasil (2014). Implantação das Redes de Atenção à Saúde e Outras Estratégias da SAS. Brasília: Ministério da Saúde.

Carvalho, M. S. N., Menezes, L. A., Cruz Filho, A. D. & Maciel, C. M. P. (2019). Dehospitalization of children with complex chronic conditions: perspectives and challenges. Brasil, Rio de Janeiro: Eldorado.

Casanova, A. O., Cruz, M. M., Giovanella, L., Alves, G. R. & Cardoso, G. C. P. (2017). Health care networks implementation and regional governance challenges in the Legal Amazon Region: an analysis of the QualiSUS-Rede Project. Ciência & Saúde Coletiva, 22(4), 1209-1224.

Coleman, E. A., Parry, C., Chalmers, S. & Min, S. J. (2006). The Care Transitions Intervention: Results of a Randomized Trial. Archives of internal medicine, 166(17), 1822-1828.

Coleman, E. A., Parry, C., Chalmers, S. A., Chugh, A., & Mahoney, E. (2007). The Central Role of Performance Measurement in Improving the Quality of Transitional Care. Home Health Care Services Quarterly, 26(3), 93-104.

Coleman, E. A. & Boult, C. (2003). Improving the quality of transitional care for persons with complex care needs. Journal of the American Geriatrics Society, 52(5), 855-856.

Coller, R. J., Nelson, B. B., Sklansky, D. J., Saenz, A. A., Klitzner, T. S. & Lerner, C. F. (2014). Preventing Hospitalizations in Children With Medical Complexity: A Systematic Review. Pediatrics, 134(6), 1628-1647.

Coller, R. J., Nelson, B. B., Klitzner, T. S., Saenz, A. A., Shekelle, P. G., Lerner, C. F., & Chung, P. J. (2017). Strategies to Reduce Hospitalizations of Children with Medical Complexity through Complex Care: Expert Perspectives. Academic Pediatrics, 17(4), 381-388.

Conners, G. P., Kressly, S. J., Perrin, J. M., Richerson, J. E. & Sankrithi, U. M. (2017). Nonemergency Acute Care: When It’s Not the Medical Home. Pediatrics, 139(5), e20170629.

Daudt, H. M. L., Mossel, C. V. & Scott, S. J. (2013). Enhancing the scoping study methodology: a large, inter-professional team's experience with Arksey and O’Malley’s framework. BMC Medical Research Methodology, 13(48), 1-9.

Duarte, E. D., Silva, K. L., Tavares, T. S., Nishimoto, C. L. J., Silva, P. M., & Sena, R. R. D. (2015). Care of children with a chronic condition in primary care: challenges to the healthcare model. Texto & Contexto-Enfermagem, 24(4), 1009-1017.

Enlow, E., Passarella, M. & Lorch, S. A. (2017). Continuity of Care in Infancy and Early Childhood Health Outcomes. Pediatrics, 140(1), e20170339.

Foster, C. C., Jacob-Files, E., Arthur, K. C., Hillman, S. A., Edwards, T. C. & Mangione-Smith, R. (2017). Provider perspectives of high-quality pediatric hospital-to-home transitions for children and youth with chronic disease. Hospital pediatrics, 7(11), 649-659.

Goldstein, S. L., Jaber, B. L., Faubel, S. & Chawla, L. S. (2013). AKI transition of care: a potential opportunity to detect and prevent CKD. Clin J Am Soc Nephrol, 8(3), 476-483.

González, J. & Rousseau, M. (2016). Medication reconciliation at areas of transition in the patient care at a tertiary pediatric hospital. Medicina Infantil 2016, XXIII, 24–31.

Haggerty, J. L., Reid, R. J., Freeman, G. K., Starfield, B. H., Adair, C. E. & McKendry, R. (2003). Continuity of care: a multidisciplinary review. British Medical Journal, 327(7425), 1219-1221.

Haggerty, J. L., Roberge, D., Freeman, G. K. & Beaulieu, C. (2013). Experienced continuity of care when patients see multiple clinicians: a qualitative metasummary. The Annals of Family Medicine, 11(3), 262-271.

Hirschman, K. B., Shaid, E., McCauley, K., Pauly, M. V. & Naylor, M. D. (2015). Continuity of care: the transitional care model. Online journal of issues in nursing, 20(3), 1-14.

Jackson, J., MacKean, G., Cooke, T. & Lahtinen, M. (2017). Patient and provider experiences with relationship, information, and management continuity. Patient Experience Journal, 4(3), 38-47.

Jurgens, V., Spaeder, M. C., Pavuluri, P. & Waldman, Z. (2014). Hospital readmission in children with complex chronic conditions discharged from subacute care. Hospital pediatrics, 4(153), 8-11.

Kim, H. & Thyer, B. A. (2015). Does transitional care prevent older adults from rehospitalization? A review. Journal of Evidence-Informed Social Work, 12(3), 261-271.

Lerret, S. M., Weiss, M. E., Stendahl, G. L., Chapman, S., Menendez, J., Williams, L., Nadler, M. L., Neighbours, K., Amsden, K., Cao, C., Nugent, M., Alonso, E. M. & Simpson, P. (2015). Pediatric Solid Organ Transplant Recipients: Transition to Home and Chronic Illness Care. Pediatric Transplantation, 19(1), 118-129.

Leyenaar, J. K., Rizzo, P. A., O’Brien, E. R. & Lindenauer, P. K. (2018). Paediatric hospital admission processes and outcomes: a qualitative study of parents’ experiences and priorities. BMJ Quality and Safety, 0, 1-9.

Marcus, K. L., Henderson, C. M. & Boss, R. D. (2016). Chronic Critical Illness in Infants and Children: A Speculative Synthesis on Adapting ICU Care to Meet the Needs of Long-Stay Patients. Pediatric Critical Care Medicine, 17(8), 743-752.

Marinho, F., Passos, V. M. de A. & França, E. B. (2016). New century, new challenges: changes in the burden of disease profile in Brazil, 1990-2010. Epidemiologia e Serviços de Saúde, 25(4), 713-724.

Miller, A. R., Condin, C. J., McKellin, W. H., Shaw, N., Klassen, A. F. & Sheps, S. (2009). Continuity of care for children with complex chronic health conditions: parents' perspectives. BMC health services research, 9(1), 1-11.

Moreira, M. C. N., Albernaz, L. V., Sá, M. R. C. D., Correia, R. F., & Tanabe, R. F. (2017). Guidelines for a line of care for children and adolescents with complex chronic health conditions. Cadernos de Saúde Pública, 33(11), 1-13.

Moura, E. C. D., Moreira, M. C. N., Menezes, L. A., Ferreira, I. A. & Gomes, R. (2017). Complex chronic conditions in children and adolescents: hospitalizations in Brazil, 2013. Ciência & Saúde Coletiva, 22(8), 2727-2734.

Naert, J., Roose, R., Rapp, R. C. & Vanderplasschen, W. (2017). Continuity of care in youth services: A systematic review. Children and Youth Services Review, 75, 116-126.

Nóbrega, V. M. D., Reichert, A. P. D. S., Viera, C. S. & Collet, N. (2015). Longitudinality and continuity of care for children and adolescents with chronic diseases. Escola Anna Nery - Revista de Enfermagem, 19(4), 656-663.

Nóbrega, V. M. D., Silva, M. E. D. A., Fernandes, L. T. B., Viera, C. S., Reichert, A. P. D. S. & Collet, N. (2017). Chronic disease in childhood and adolescence: continuity of care in the Health Care Network. Revista da Escola de Enfermagem da USP, 51, e03226.

Peters, M. D. J, Godfrey, C., McInerney, P., Munn, Z., Tricco, A. C. & Khalil, H. (2020). Capítulo 11: Revisões do escopo (versão 2020). In: Aromataris E, Munn Z (Editores).JBI Manualfor Evidence Synthesis, JBI. Disponível em https://wiki.jbi.global/display/MANUAL.

Pontin, D. & Lewis, M. (2009). Maintaining the continuity of care in community children’s nursing caseloads in a service for children with life-limiting, life-threatening or chronic health conditions: a qualitative analysis. Journal of Clinical Nursing, 18, 1199-1206.

Reid, R., Haggerty, J. L. & Mckendry, R. (2002). Defusing the confusion: Concepts and measures of continuity of healthcare. Ottawa: Canadian Health Services Research Foundation.

Siden, H. & Urbanoski, K. (2011). Using network analysis to map the formal clinical reporting process in pediatric palliative care: a pilot study. BMC Health Services Research, 11(343), 1-11.

Silva, M. E. D. A., Reichert, A. P. D. S., Souza, S. A. F. D., Pimenta, E. A. G. & Collet, N. (2018). Chronic disease in childhood andadolescence: family bondsin the healthcare network. Texto & Contexto Enfermagem, 27(2), 1-11.

Smith, K. M., Lutenbacher, M. & Mcclure, N. (2015). Leveraging Resources to Improve Clinical Outcomes and Teach Transitional Care Through Development of Academic-Clinical Partnerships. Nurse Educator, 40(6), 303-307.

Sparud-Lundin, C., Berghammer, M., Moons, P. & Bratt, E. L. (2017). Health care provider's attitudes towards transfer and transition in young persons with long term illness- a web-based survey. BMC Health Serv Res, 17(1), 260.

Tarrant, C., Windridge, K., Baker, R., Freeman, G. & Boulton, M. (2015). “Falling through gaps”: Primary care patients’ accounts of breakdowns in experienced continuity of care. Family Practice, (32)1, 82-87.

Tom, J. O., Tseng, C. W., Davis, J., Solomon, C., Zhou, C. & Mangione-Smith, R. (2010). Missed well-child care visits, low continuity of care, and risk for ambulatory care sensitive hospitalizations in young children. Archives of Pediatrics and Adolescent Medicine, 164(11), 1052-1058.

Uijen, A. A., Schers, H. J., Schellevis, F. G. & van den Bosch, W. J. (2012) How unique is continuity of care? A review of continuity and related concepts. Family Practice, 29(3), 264-271.

Vargas, I., Mogollón-Pérez, A. S., De Paepe, P., Ferreira da Silva, M. R., Unger, J. P. & Vázquez, M. L. (2016). Barriers to healthcare coordination in market-based and decentralized public health systems: A qualitative study in healthcare networks of Colombia and Brazil. Health Policy and Planning, 31(6), 736-748.

Vieira, C. S., de Oliveira Lomba, G., Costa, M. A., Braga, P. P. & Gesteira, E. C. R. (2014). Learning and teaching experience in continuous care of children at risk: experience report. Revista de Enfermagem do Centroeste Mineiro, 3(4), 1393-1399.

Waibel, S., Vargas, I., Aller, M. B., Gusmão, R., Henao, D. & Vázquez, M. L. (2015). The performance of integrated health care networks in continuity of care: a qualitative multiple case study of COPD patients. International journal of integrated care, 15(3), e029.

Zanello, E., Calugi, S., Rucci, P., Pieri, G., Vandini, S., Faldella, G. & Fantini, M. P. (2015). Continuity of care in children with special healthcare needs: a qualitative study of family ’s perspectives. Italian Journal of Pediatrics, 41(7), 1-9.

Published

18/08/2021

How to Cite

PEITER, C. C.; LANZONI, G. M. de M. .; WACHHOLZ, L. F. .; GOMES, V. C. .; SCHMITT, M. D. .; SANTOS, J. L. G. dos . Continuity and transition of care for children with chronic conditions: a scoping review. Research, Society and Development, [S. l.], v. 10, n. 10, p. e559101019043, 2021. DOI: 10.33448/rsd-v10i10.19043. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/19043. Acesso em: 20 oct. 2021.

Issue

Section

Review Article