Eastern Health Region
Eastern Health is the largest health region in NL by population served and includes the provincial capital region. Its pediatric endocrinology program has approximately 300 patients with type 1 diabetes under its care. The pediatric diabetes clinic consists of a multidisciplinary team including three pediatric endocrinologists, two diabetes nurse educators, a dietician, a social worker, a school teacher, and a consultant clinical psychologist. Clinic appointments usually involve the patient seeing all members of their care team, making the clinic visit duration around an hour. Outside of scheduled appointments, patients have access to an on-call physician via a 24/7 emergency phone line.
Young adults are currently transferred into adult care between 18-19 years of age, however some patients have remained in pediatric care into their 20s. Participants described the current transition process as informal and unstructured (Table 2, Quote 1). The pediatrician usually send a referral letter and patient medical summary to the nearest adult diabetes clinic and direct their patients to follow-up with that program. This transfer involves a complete change of the patients’ diabetes care team and clinic location. Often the pediatric team is unaware of when their patients’ first adult appointment will be or if the patient attends their first appointment (Table 2, Quote 2). In preparation, pediatricians said that as part of their regular clinic visits they would discuss with patients issues like taking more responsibility for their self-care, discussing lifestyle issues, and seeing teenage patients without their parents for part of their appointments as the patient reached the teenage years. It was not clear if all patients received guidance on these topics.