| Name: | Description: | Size: | Format: | |
|---|---|---|---|---|
| 1.11 MB | Adobe PDF |
Authors
Advisor(s)
Abstract(s)
Introdução. A transição de cuidados começou a ser discutida em 1989 no âmbito da United States Surgeon General Conference. Designa-se por transição o processo ativo, gradual e multidisciplinar que aborda as necessidades médicas, psicossociais e educativas do adolescente e cujo objetivo é promover a sua autonomia e adaptação à Medicina de Adultos.
A transferência dos pacientes pediátricos com Diabetes mellitus tipo 1 para as unidades de Medicina de Adultos pode ter efeitos nefastos para a saúde dos pacientes se a transição for conduzida de forma inadequada. Esta mudança ocorre durante a adolescência, período crítico no controlo metabólico pelos fatores psicológicos e fisiológicos que entram em jogo, condicionando um risco aumentado de complicações crónicas e de admissões hospitalares relacionadas com a Diabetes mellitus tipo 1. A mudança da equipa assistencial está também associada com maior perda de seguimento e com pior controlo metabólico destes pacientes.
O desenvolvimento de um programa de transição pode ultrapassar muitos dos problemas que surgem na transição entre dois tipos de sistemas de cuidados distintos.
Objetivos. A presente dissertação pretende realizar uma revisão das publicações sobre transição de cuidados pediátricos para Medicina de Adultos em adolescentes com Diabetes mellitus tipo 1. Numa primeira parte são reunidas as recomendações existentes; posteriormente serão analisados as publicações com avaliação dos resultados de programas de transição específicos. Por fim é proposto um modelo de transição de cuidados, elaborado mediante a investigação efetuada.
Métodos. Para a elaboração desta monografia foi realizada uma pesquisa na base de dados PubMed, complementada pela consulta de documentos de Sociedades Científicas Internacionais sobre transição de cuidados em adolescentes com Diabetes mellitus tipo 1.
Resultados. Constatou-se que, embora existam recomendações clínicas para o processo de transição em adolescentes com Diabetes mellitus tipo 1, são limitadas as práticas baseadas em evidência publicadas. Os programas de transição presentes na literatura representam iniciativas de cada unidade de cuidados e não protocolos estruturados das autoridades locais ou regionais de saúde. Poucos estudos avaliaram, de forma sistemática, a eficácia dos programas de transição implementados. Em Portugal não existem quaisquer orientações que rejam o cuidado transicional destes jovens.
Conclusões. Os programas de transição analisados, apesar das disparidades metodológicas, registaram melhorias no controlo metabólico e nas presenças em consultas na Medicina de Adultos bem como redução na taxa de complicações agudas. É proposto um modelo de transição de cuidados para adolescentes com Diabetes mellitus tipo 1.
Introduction. The transition in health care was first discussed in 1989 at the Unites States Surgeon General Conference. Transition is the active, gradual and multidisciplinary process that comprises the medical, psychosocial and educational needs of the adolescent, aiming to promote his autonomy and adjustment to the Adult Health Care Service. The transfer of paediatric patients with type 1 Diabetes mellitus to adult health care may have adverse health outcomes if transition is not done properly. This change takes place during adolescence which is a critical stage for metabolic control due to both psychological and physiological aspects, therefore increasing the risk of chronic complications and hospitalisations related do type 1 Diabetes mellitus. The change of the care team is also associated with greater loss to follow-up and poor metabolic control in these patients. The development of a transition programme can overcome many of the problems that arise from the transition between two different types of care system. Objectives. This dissertation intends to review the publications relating to the transition of adolescents with type 1 Diabetes mellitus from the paediatric to the adult health care service. After assembling the existing recommendations, the publications that assess specific transition programmes and their outcomes will be examined and a transition model will be proposed based on the findings. Methods. A search of the literature was performed with PubMed with additional research on Scientific Societies’ documents concerning the transition of care in adolescents with type 1 Diabetes mellitus. Results. Although clinical recommendations for the transition process of adolescents with type 1 Diabetes mellitus exist, published evidence-based practices are limited. The transition programmes found in the literature are initiatives of each care unit instead of structured protocols from local or regional health authorities. Few studies have evaluated, systematically, the effectiveness of the transition programmes carried out. In Portugal there aren’t any guidelines concerning the transitional care of these youths. Conclusions. In spite of different methodologies, the transition programmes examined showed improvements of the metabolic control and clinical attendance at the Adult Service and decrease of the acute complications rate. A transition model for adolescents with type 1 Diabetes mellitus is proposed.
Introduction. The transition in health care was first discussed in 1989 at the Unites States Surgeon General Conference. Transition is the active, gradual and multidisciplinary process that comprises the medical, psychosocial and educational needs of the adolescent, aiming to promote his autonomy and adjustment to the Adult Health Care Service. The transfer of paediatric patients with type 1 Diabetes mellitus to adult health care may have adverse health outcomes if transition is not done properly. This change takes place during adolescence which is a critical stage for metabolic control due to both psychological and physiological aspects, therefore increasing the risk of chronic complications and hospitalisations related do type 1 Diabetes mellitus. The change of the care team is also associated with greater loss to follow-up and poor metabolic control in these patients. The development of a transition programme can overcome many of the problems that arise from the transition between two different types of care system. Objectives. This dissertation intends to review the publications relating to the transition of adolescents with type 1 Diabetes mellitus from the paediatric to the adult health care service. After assembling the existing recommendations, the publications that assess specific transition programmes and their outcomes will be examined and a transition model will be proposed based on the findings. Methods. A search of the literature was performed with PubMed with additional research on Scientific Societies’ documents concerning the transition of care in adolescents with type 1 Diabetes mellitus. Results. Although clinical recommendations for the transition process of adolescents with type 1 Diabetes mellitus exist, published evidence-based practices are limited. The transition programmes found in the literature are initiatives of each care unit instead of structured protocols from local or regional health authorities. Few studies have evaluated, systematically, the effectiveness of the transition programmes carried out. In Portugal there aren’t any guidelines concerning the transitional care of these youths. Conclusions. In spite of different methodologies, the transition programmes examined showed improvements of the metabolic control and clinical attendance at the Adult Service and decrease of the acute complications rate. A transition model for adolescents with type 1 Diabetes mellitus is proposed.
Description
Keywords
Adolescentes Diabetes Mellitus Tipo1 Medicina de Adultos Pediatria Transição