Transitioning adolescents with diabetes mellitus from pediatric to adult clinical care at Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Objectives: To determine the proportion of adolescents with diabetes mellitus who met the elements of appropriate transitioning and to describe the process and possible determinants of transitioning adolescents with diabetes mellitus from pediatric to adult care at MTRH.
Design: Mixed methods explanatory cross-sectional study design.
Setting: Pediatric and adult diabetic clinics at MTRH.
Subjects: Adolescents with diabetes mellitus aged between 14 and 19 years; Guardians who accompanied the adolescents; Health care providers (HCP).
Interventions: Semi-structured questionnaires for adolescents and guardians; focus group discussions with the adolescents; key informant interviews with the health care providers.
Main Outcome Measures: Proportion of adolescents who had appropriately transitioned; Process of transitioning; Barriers and facilitators of transitioning.
Results: None of the adolescents met all the elements of appropriate transitioning. Transitioning was described in four ways: Short discussion informing the adolescent that they had to move to the adult clinic; Moving to the adult clinic without any explanation; Requested whether they felt ready to move to the adult clinic; Compelled to move to the adult clinic despite raising objection.
Conclusion: None of the adolescents in the adult clinic met all the elements of appropriate transitioning. The adolescents were moved from the pediatric to the adult diabetic clinics through an event of transfer. Facilitators of transitioning - suggestion to introduce adolescent-focused clinics and sharing information on transitioning with the parents and adolescents. Barriers to transitioning - payment for services and delays before seeing the doctors on the adult care.