A timely, smooth transition from pediatric- to adult-focused primary care is an important part of high-quality health care, especially for youths with chronic health conditions. Current recommendations suggest that primary-care transfers for youths occur between 18 and 21 years of age. However, the current epidemiology of transfer timing is unknown.
This retrospective cohort study design looked at 60,233 adolescents who were insured by Harvard Pilgrim Health Care (HPHC), a large not-for-profit health plan, from age 16 to at least 18 years of age between January 2000 and December 2012.
A multivariable Cox proportional hazards regression was used to model age at first adult-focused PCP visit and time from the last pediatric-focused to the first adult-focused PCP visit (gap) for any type of office visit and, specifically, preventive visits.
Results indicated that younger age at transfer was seen for female youths, and those who had complex or noncomplex chronic conditions compared with those who had no chronic conditions. Youths who lived in lower-income neighborhoods experienced a transfer at older ages as compared to those who lived in higher-income neighborhoods. The gap between last pediatric-focused to first adult-focused PCP visit was shorter for female than male youths and youths with complex or noncomplex chronic conditions. The gap was longer for youths living in lower-income neighborhoods than for those living in higher-income neighborhoods. Multivariable models showed an adjusted median age at transfer of 21.8 years for office visits and 23.1 years for preventive visits and an adjusted median gap length of 20.5 months for office visits and 41.6 months for preventive visits.
Lead author and DPM Research Fellow, Lauren Wisk, PhD concludes that most youths are transferring care later than recommended and with gaps of more than a year. While young patients with chronic conditions have shorter gaps, they may need even shorter transfer intervals to ensure continuous access to care. More work is needed to determine whether youths are experiencing clinically important lapses in care or other negative health effects due to the delayed timing of transfer.
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