Transition chronisch neurologisch kranker Jugendlicher in die Erwachsenenmedizin

Zusammenfassung

Hintergrund: Als Transition im medizinischen Sinne bezeichnet man den Wechsel jugendlicher Patienten aus der Pädiatrie in die Erwachsenenmedizin. Welche Faktoren das Gelingen der Transition insbesondere bei chronisch neurologisch kranken Jugendlichen beeinflussen ist unzureichend erforscht.

Methoden: In einer Fragebogen-basierten Erhebung mit einer modifizierten Version des Patient Satisfaction Questionnaire Short-Form (PSQ-18) bei ehemaligen, mittlerweile volljährigen Patienten eines SPZ wurde überprüft, ob das Ausmaß der Zufriedenheit mit ihrer aktuellen Versorgung in der Erwachsenenmedizin von der Komplexität ihrer chronischen neurologischen Erkrankung abhängt. Entsprechend ihrer motorischen und/oder kognitiven Behinderung wurde die teilnehmenden Patienten in 2 Gruppen eingeteilt: komplex chronisch neurologisch Kranke (Gruppe 1; Intelligenzminderung oder Lernbehinderung plus ausgeprägte motorische Behinderung oder GdB≥80; n=11) vs. geringer Beeinträchtigte (Gruppe 2; n=39). Der Gruppenvergleich erfolgte deskriptiv und mit t-Statistik.

Ergebnisse: Patienten der Gruppe 1 weisen tendenziell eine geringere Zufriedenheit (M=3,25; 95% KI=[2,96–3,55]) mit der derzeitigen medizinischen Betreuung in der Erwachsenenmedizin auf als Patienten der Gruppe 2 (M=3,59; 95%.KI=[3,37–3,81], p=0,084). Die Zufriedenheit mit der Transition war in der Gruppe 1 signifikant niedriger (M=2,65; 95% KI=[2,29–3,01]) als in Gruppe 2 (M=3,11; 95% KI=[2,89–3,33], p=0,045). Die Mittelwertdifferenz von 0,46 spiegelt eine mittlere Effektstärke wider (Hedges‘ g=0,68).

Schlussfolgerung: Die niedrigere Zufriedenheit von Patienten mit komplexen chronischen neurologischen Erkrankungen mit ihrer erwachsenenmedizinischen Betreuung weist auf Bedarf an zusätzlichen Angeboten für die ambulante Betreuung von mehrfachbehinderten Erwachsenen hin.

Abstract

Background: Transition of care from pediatric to adult services is a complex process. Factors influencing the success of health care transition of adolescents with chronic neurological disorders are poorly understood.

Methods: Young adults with chronic neurological disorders who had been cared for in an Interdisciplinary Pediatric Center participated in this study. Using the Patient Satisfaction Questionnaire Short-form (PSQ-18) we investigated whether satisfaction of these patients with their medical care in adult services was depending on the severity and complexity of their condition. They were assigned to a group of severely disabled patients (group 1; intellectual disability or learning disability plus motor handicap or degree of disability≥80, n=11) or a group 2 of patients with milder impairment (N=39). We used descriptive and t-statistics to compare both groups.

Results: Patients of group 1 reported slightly lower satisfaction with their present medical care in adult services (M=3.25; 95%-KI=[2.96–3.55]) compared to patients of group 2 (M=3.59; 95%.KI=[3.37–3.81]; p=0.084). Satisfaction with transition was significantly lower in group 1 (M=2.65; 95% KI=[2.29–3.01]) than in group 2 (M=3.11; 95% KI=[2.89–3.33], p=0.045). The difference of mean values of 0.46 reflects a moderate effect size (Hedges‘ g=0.68).

Conclusion: Health care transition of adolescent patients with chronic neurological disorders is significantly more successful in patients with minor impairment compared to patients with severe complex neurological conditions.

Schlüsselwörter

Transition - Patientenzufriedenheit - Intelligenzminderung - Mehrfachbehinderung - Grad der Behinderung

Key words

health care transition - patient satisfaction - intellectual disability - severe chronic disorders - degree of disability

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