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.