Does the current transfer process of youth with chronic lung disease to adult services impact on health outcomes and service engagement?

Abstract

Aim: To determine whether the transfer of young people with Cystic Fibrosis (CF) or Bronchiectasis (BX) from paediatric to adult services is associated with changes in service engagement and/or health outcomes. Methods: Young people aged ≥15 years of age with CF or BX who transferred from Starship Children's Hospital to Adult Respiratory Services in the Auckland region between 2005 and 2012, were identified and included if they had three years pre-transfer care and remained in Auckland for three years post-transfer. Those with CF were transferred to Auckland District Health Board (ADHB) according to transfer guidelines, those with BX were either transferred to Counties Manukau District Health Board (CMDHB) with a multi-disciplinary meeting (BX1), or to ADHB and Waitemata District Health Board (WDHB) (BX2) by referral letter only. Transfer preparation, service engagement (clinics scheduled, clinics attended), and health outcomes (lung function, hospitalisations, antibiotic use) were collected annually. Findings: 79 young people transferred in this period with 46 meeting inclusion criteria (CF n = 20, BX1 n = 14, BX2 n = 12). The CF group had better transfer documentation, were 28.5 times more likely to attend clinics, had better 'average' and 'best' FEV1 and a higher hospitalisation rate post-transfer compared to both BX groups. BX2 were the least likely to attend clinics post-transfer and were more frequently lost to follow-up. Lung function parameters were not affected by transfer, yet the CF group were offered 4 more clinic appointments per year despite having less severe respiratory disease as measured by FEV1. Conclusions: The transfer of young people with CF to adult services did not impact health engagement or outcomes, in contrast to those with BX. Use of a formalised transfer process, more clinic appointments offered, and greater team and community resources for CF may be responsible for this difference. Equitable transfer processes, access to healthcare offered and similar hospital resourcing and community support should be made available to those with BX to improve youth outcomes.