The Impact of a Patient Navigator on Readiness Assessment Scores in Youth Transitioning to Adult Health Care in Alberta
Date
2024-07-01
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Abstract
Purpose At 16-19 years of age, youth with chronic medical conditions transition from their pediatric specialist to an adult specialist. Youth often feel unprepared for this transfer of care making transition preparations crucial. Transition readiness assessments may have a role in guiding transition preparation. The Transition Readiness Assessment Questionnaire (TRAQ) is the most strongly validated readiness measurement, however, longitudinal examination of TRAQ scores is required to investigate the tool’s suitability to assist in a successful transition. Methods With a patient-oriented approach, this dissertation explored the impact of a patient navigator on TRAQ scores at three-time points within the Transition Navigator Trial (TNT). Transition Research Advisory Council (TRAC) members were partners in this work to highlight the perspectives, opinions, and expertise of those with lived experience of transitioning to the adult health care system. Guiding principles of patient-oriented research (POR) were applied to engage TRAC members meaningfully throughout all phases of the research. Special considerations must be made when engaging youth such as allowing for flexibility throughout the partnership, ample opportunities for mentorship, and reciprocal learning, as such the Youth Engagement Conceptual Model was implemented in conjunction with the guiding principles. This study used data collected as part of the TNT, a pragmatic randomized controlled trial testing the effectiveness of a patient navigator intervention for youth transitioning to adult healthcare. A total of 129 participants were included in this quantitative analysis. Comparisons between the control and intervention group were performed with a Mann-Whitney U test. A mixed-model analysis with random intercepts was used to explore the relationship between access to a patient navigator, time, and TRAQ scores. Results At baseline, there was no significant difference in mean TRAQ scores between the intervention and control group (β=0.05, p = 0.58, 95% CI -0.12, 0.22). Irrespective of treatment allocation, mean TRAQ scores did increase over time between both baseline to 12 months (β=0.54, p<0.001, 95% CI 0.44, 0.63), and baseline to 24 months (β =0.68, p<0.001, 95% CI 0.59, 0.78). In our sample alarmingly we note that only 56% of AYA were scoring > 4.0 (‘ready’ for transition as defined by the TRAQ) 24-months post enrollment into the study, which is between one to two years after their transition to adult care. Youth partners played a crucial role in providing insights into the study results, particularly in understanding the lack of significant findings. Discussion This study sought to examine the change in TRAQ scores in a longitudinal study between those assigned to a patient navigator intervention versus care as usual. We found that access to a patient navigator intervention did not significantly impact the rate of change in TRAQ scores. Our study underscores the criticality of partnering with youth in quantitative studies to ensure outcomes and analyses are relevant and impactful in addressing the needs of this population.
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Keywords
transition to adult health care, patient oriented research, youth engagement, quantitative research, transitions in care, chronic health conditions
Citation
Patton, M. (2024). The impact of a patient navigator on readiness assessment scores in youth transitioning to adult health care in Alberta (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.