Adult Care Providers Research Articles

Opportunities for Inclusion and Engagement in the Transition of Autistic Youth from Pediatric to Adult Healthcare: A Qualitative Study

Transitioning autistic youth from pediatric to adult healthcare requires coordination of multiple stakeholders, including youth, caregivers, and pediatric and adult care providers, whose interests at times overlap but often differ. To understand barriers and facilitators to inclusive transition experiences, we conducted thematic analysis of interviews with 39 stakeholders from the same large, integrated healthcare system. We identified three major themes: (1) Navigating the healthcare transition without guidance, (2) Health consequences of a passive healthcare transition, and (3) Strategies for inclusion and continuous engagement. Facilitators included gradual transition planning, a warm handoff between providers, and support of shared healthcare decision-making. Providers also sought clinical tools and logistical supports such as care coordinators and longer transition-specific visit types to enhance patient-centered care.

Improving Organizational Sustainability of an Urban Indian Health Clinic With an Innovative Pharmacy Model.

Introduction:To increase access to care for the urban American Indian population, a collaboration was developed between an Urban Indian Health Clinic (UIHC) and Federally Qualified Healthcare Center (FQHC) to reduce financial barriers, increase patient access to affordable medications, and augment the integrated model of care.Objective:To describe the design and implementation of an innovative pharmacy model through a partnership between an UIHC and a FQHC.Methods:A collaborative partnership between an UIHC and a FQHC was developed to spread scarce 340B federal resources as a method to enhance patient care. The innovative practice model included the development of processes to (1) increase medication access to all patients by providing access to affordable medications at clinic and the provision of mail order services, (2) minimize program expenses through cost-sharing of a pharmacist salary, (3) expand clinical pharmacy programs (collaborative drug therapy management) to augment integrated patient care, and (4) optimize 340B cost savings for the clinic by establishing contracts and implementing adjudication software to obtain medication reimbursement from Medicaid and other third party insurances.Results:Through the cost-sharing of a pharmacist salary and use of remote verification, the majority of prescription medications were available to patients at the UIHC through implementation and expansion of an other outlet. Collaborative drug therapy management (CDTM) protocols were successfully implemented which allowed clinical pharmacy services to collaboratively manage chronic conditions. All adult primary care providers adopted the integrated patient care model. Third-party pharmacy insurance contracts were obtained and computer software was installed to allow for the adjudication of pharmacy claims, resulting in cost savings from medication reimbursement.Conclusion:The innovative collaborative partnership between an UIHC and an FQHC demonstrated how scarce federal resources can be leveraged using the 340B program to increase patient access to affordable medications. This innovative model reduced financial barriers to the clinic, and allowed for expansion of pharmacist led CDTM programs and augmentation of integrated clinical services. The cost savings observed from this novel program additionally fueled programmatic sustainability through reinvestment into the pharmacy program and is expected to continue to fund the program in the future.

A qualitative analysis of communication workflows between adult day service centers and primary care providers.

ObjectivesOur study documented communication workflows across adult day care centers (ADCs) and primary care providers (PCPs) around complex needs of persons living with dementia (PLWD). We also identified barriers and facilitators to productive communication in clinical decision support and clinical information systems.Materials and MethodsWe conducted 6 focus groups with ADC staff (N = 33) and individual semistructured interviews with PCPs (N = 22) in California. The eHealth Enhanced Chronic Care Model was used to frame the directed qualitative content analysis.ResultsOur results captured cumbersome and ineffective workflows currently used to exchange information across PCPs and ADCs. Stakeholders characterized current communication as (1) infrequent, (2) delayed, (3) incomplete, (4) unreliable, (5) irrelevant, and (6) generic. Conversely, communication that was bidirectional, relevant, succinct, and interdisciplinary was needed to elevate the standard of care for PLWD.Discussion and ConclusionADCs possess a wealth of information that can support clinical decision-making across community-based providers involved in the care of PLWD, especially PCPs. However, effective information exchange is mired by complicated workflows that rely on antiquated technologies (eg, facsimile) and standard templates. Current information exchange largely focuses on satisfying regulatory guidelines rather than supporting clinical decision-making. Integrating community-based services into the health care continuum is a necessary step in elevating the standard of care for PLWD. In the absence of interoperable electronic health records, which may not be financially viable for ADCs, other options, such as mobile health, should be explored to facilitate productive information exchange of personalized relevant information.

Adult Day Services as an Essential Service and Support

Throughout the COVID-19 pandemic, the significant challenges and gaps related to the care of older people in the U.S. were made distressingly apparent. This summary presentation will consider the effects of COVID-19 and associated shutdowns on older persons who use ADS programs, their family caregivers, and programs/staff themselves. Among recommendations to consider are the classification of adult day services and similar community-based long-term care providers as essential (and clarifying their difference from senior centers). In addition, considering new financing approaches and utilizing ADS or similar community-based programs as incubators of evidence-based innovation are options to consider to better align ADS with optimal dementia care.

Feasibility of the Savvy Caregiver program for care providers of LGBTQ adults living with Alzheimer’s disease and related dementias

AbstractBackgroundBy 2030, there will be nearly six million lesbian, gay, bisexual, transgender, and/or queer (LGBTQ) older adults aged 50 and older in the U.S.; this number will more than double by 2050. Approximately 350,000 LGBTQ older adults in the U.S. currently have Alzheimer’s disease and related dementias (ADRD), with projections nearing 1 million by 2030. LGBTQ older adults face distinct challenges impacting their ability to receive adequate and inclusive care, as well as services for informal caregivers due to living alone, the inability to rely on traditional family supports, higher risks for disability, and experiencing discrimination when seeking aging‐related social services.MethodsWe partnered with the Los Angeles LGBT Center, Senior Services to evaluate the: 1) Adaptation of the Savvy Caregiver training program for care providers of LGBTQ older adults living with AD; and 2) Determine the feasibility and acceptability of the Savvy program. Data comes from caregivers (n=18) who completed the 6 session, 12‐hour training for Savvy.ResultsThe average age of care providers was 66 (range: 52‐82), and over half (56%) identified as a LGB and 6% as transgender. Overall, care providers were very satisfied with the overall program, strategies, information, and activities of the tailored Savvy Caregiver program. For instance, all participants (100%) reported being more knowledgeable of dementia care and that they would recommend the program to others. Nearly 90% of participants found the content to be relevant to their personal situation, reported gaining new skills, and felt that the class format/number of sessions was appropriate.DiscussionWe developed a community partnership with the Los Angeles LGBT Center on the needs of LGBTQ older adults living with ADRD and their care providers. This is the first known study regarding the adaptability and feasibility of the Savvy Caregiver program for care providers of LGBTQ older adults living with ADRD. There is need for additional research to promote culturally relevant aging services and behavioral interventions for care providers of LGBTQ older adults living with ADRD.

Growing Up With Sickle Cell Disease: Hospital Medicine and Health Care Transitions.

Growing Up With Sickle Cell Disease: Hospital Medicine and Health Care Transitions.

Evaluation of a pharmacist‐led intervention on naloxone co‐prescribing in patients receiving chronic opioid therapy

AbstractIntroductionAlthough both the 2016 Centers for Disease Control and Prevention (CDC) guidelines and the 2020 Food and Drug Administration (FDA) safety announcement recommend naloxone co‐prescribing to patients receiving long‐term opioid therapy (LTOT) for non‐cancer pain, the rate of naloxone co‐prescription in this population remains low.ObjectivesThe primary objective of this project was to determine whether a pharmacist intervention would lead to increased rates of naloxone co‐prescribing among providers.MethodsThis was a before‐and‐after interventional study to evaluate changes in naloxone co‐prescribing rates in response to clinical pharmacist recommendation of naloxone for LTOT patients to providers. The primary end point was rate of naloxone co‐prescription after pharmacist intervention. Providers of LTOT patients were emailed patient‐specific recommendations. Additional end points included calculation of the naloxone possession rate among patients and identification of patient‐specific predictors for not having naloxone co‐prescribed at baseline.ResultsA total of 152 patients met inclusion criteria throughout the intervention period. Out of the 152 patients who were eligible for naloxone, 90 (59.2%) were prescribed naloxone before the intervention and 131 (86.2%) were prescribed naloxone after the pharmacist provided interventions. This increase in naloxone prescription (27%) was statistically significant (P < .001). Our results also showed that LTOT patients who were prescribed opioids by adult primary care providers were at risk for lack of naloxone co‐prescribing at baseline (adjusted odds ratio [aOR] 3.66, P = .013) as compared with patients taking opioids prescribed by a pain management provider. The overall possession rate among patients with naloxone co‐prescribed by the end of the intervention period was 56.4% (74/131 patients).ConclusionA pharmacist‐led intervention was found to increase the naloxone co‐prescribing rate for LTOT patients. However, co‐prescribing naloxone does not guarantee patient possession; only 56.4% of patients with a naloxone prescription appeared to have naloxone at home. Future studies should explore ways to increase naloxone possession rates.

The transition to independence and adult care for women with Turner syndrome: Current status and priorities of 1338 women and parents.

Transitioning to adult health care and functioning is crucial for youth and young adults with special health care needs, such as those with Turner syndrome (TS). The International Turner Syndrome Consensus Group developed clinical practice guidelines to improve this transition. This study sought to evaluate how effectively they have been implemented and whether they align with the priorities of women with TS and families of girls and women with TS. A web-based survey was offered to those affiliated with major TS support organizations, with 1338 successfully responding (n= 543 women [≥18 years]; n= 232 parents of a woman [≥18 years]; and n= 563 parents of a girl with TS [<18 years]). Findings demonstrated that while most women transitioned to adult primary care providers, follow-up with key specialists was lacking. Women and families prioritized flexibility in appointments and designating one provider to oversee all their TS-related care. They identified health care coverage as a barrier to receiving care. The transition process to adult care and independence commonly occurred after girls become legal adults. Together, these findings serve to inform strategies to improve the delivery of transitional care for girls and women with TS.

Organizational Responsiveness to the COVID-19 Pandemic: a Mixed Methods Social Validity Assessment of Human Services Care Providers.

ObjectivesThe COVID-19 pandemic posed many challenges to human services organizations serving persons with pre-existing conditions and health concerns. Study objectives were to assess organizational responsiveness to the pandemic through training, safety, and risk mitigation initiatives at community-based group homes for adults with intellectual disability (ID) and acquired brain injury (ABI).MethodThis was a two-phase mixed methods study with human services care providers. In phase 1, 54 focus group participants responded to standardized interviews about leadership actions in the early months of the COVID-19 pandemic and discussed implementation effectiveness. These qualitative findings informed the design and distribution of a multi-item questionnaire in phase 2 that quantified acceptance and approval of leadership actions among 498 participants.ResultsBoth focus group and questionnaire participants identified several consistent leadership actions that had a positive impact on risk mitigation, health promotion, and participant satisfaction. Participants also converged on priority needs and recommendations for performance improvement.ConclusionsThe study supports previous research on the effects of pandemic health crises among frontline healthcare workers and more definitively the impact on direct care providers of adults with ID and ABI during COVID-19. Care providers were able to judge organizational effectiveness and provide feedback to aide strategic planning. Mixed methods research provides an approach to large-scale program evaluation through integrated qualitative and quantitative analyses.

Recommendations to optimize life-long health and wellbeing for people born preterm

The preterm birth rate in the United States is 10%, with 8% being born between 36 and 32 weeks of gestation, and the remaining 2% born less than 31 weeks of gestation. The global preterm birth rate varies from 5% to 18%, with varying survival rates. These percentages signify a population of people that will receive health care across the life course without ever being asked about a preterm birth history. With a steady rise in the survival rate of preterm infants being discharged home from the neonatal intensive care unit, with limited referrals for neonatal or developmental follow up, it is essential adult care providers ask the right questions and identify risk factors for this vulnerable population. This review describes the recently published, evidence-based recommendations for addressing preterm history across the life course. A robust review of the literature has demonstrated that the long-term sequelae of being born preterm can adversely affect health and quality of life. The following will offer preterm birth history recommendations based on assessment and diagnosis, prevention and management and referral and treatment. The goal of the recommendations is to create awareness among adult health providers in acknowledging a past medical history of preterm birth and providing appropriate preventive care, therefore shifting the paradigm of care from reactive intervention to proactive care.

Health Care Transition for Children with Medical Complexity: Challenges and Lessons Learned

BackgroundTransition from pediatric to adult health care is a pivotal process for young adults, especially those with complex medical needs. Despite advancements in the medical care provided to children with medical complexity (CMC), there is a lack of systematic approaches and guidance for patients and families transitioning from pediatric to adult health care. MethodsHealth care providers and nurse case managers in the Complex Care Program (CCP) evaluated health care transition practices prior to 2019, and initiated quality improvement efforts to standardize transition guidance, planning, and documentation from 2019 to 2020 within the CCP. FindingsChallenges identified with transitioning CMC include: 1) Varied approaches and timelines for health care providers, 2) Documentation in the EMR, and 3) Connecting to adult health care systems. Throughout this work, CCP staff have learned lessons to effectively transition CMC. Themes included: 1) Transition from a pediatric to an adult primary care provider first, 2) Start transition conversations early, 3) Identify a universal location to document transition planning, and 4) Importance of family involvement. Implications for practiceTo effectively transition CMC, health care staff must start conversations early, engaging all primary and specialty providers, patients, and families to create safe transition plans.

Improving the Transition of Adolescents from Disadvantaged Backgrounds from Pediatric to Adult Primary Care Providers

BackgroundThe lack of structured transition interventions for adolescents aging out of pediatric care is associated with poor health outcomes. MethodsWe assessed the effectiveness of a transition protocol that aimed to improve the transfer of adolescents to adult primary care. Chart reviews were conducted on 21- and 22-year-old patients seen 18 months before and after protocol implementation. Completion of an adult medicine appointment scheduled within 6 months from the last pediatric visit was the primary outcome of interest. FindingsIn pre-implementation period, 20.9% of patients versus 39.3% in post-implementation period were transferred. Transfer was higher in patients who had a dedicated transition visit, had a transition order placed, and were tracked during the transfer process. DiscussionA transition protocol can increase the number of adolescents who transfer to adult care. Once a patient is ready to transition, a dedicated transition visit is ideal; however, providers should incorporate transition care during any clinical encounter. While an electronic transition order can facilitate appointment scheduling, patient tracking and appointment reminders can help ensure appointment completion. In addition, all clinical staff should receive transition training and clinicians should be frequently reminded about the need to transition their patients. However, even with these efforts to support transition, the majority of patients did not do so, which indicates a continued need to develop and evaluate transition interventions. Practice implicationsImplementing a transition protocol in pediatric clinics can improve the transition of adolescents aging out of pediatric care and may diminish gaps in medical care that can be associated with poor health outcomes.

Factors Related to Iron Chelation Therapy Adherence in Young Adults with Thalassemia: A Framework from the Patient Perspective

Background: Adherence to iron chelation therapy (ICT) is essential to the health and survival of patients with transfusion-dependent thalassemia. In recent years, the advent of oral chelators has improved the ease with which ICT is administered. Despite these changes, adherence to ICT among patients with thalassemia remains suboptimal. Age has been found to be associated with ICT adherence, and young adult patients have been found to be at higher risk of nonadherence compared to other age groups. Young adulthood is a critical transitional stage, both with regards to life pursuits, as well as to clinical and self-management of chronic illness. Consequently, there is a need to study the underlying factors related to adherence within the context of young adulthood.Objective: To identify the barriers and promoters to ICT adherence from the perspective of young adult patient with thalassemia.Methods: Ten transfusion-dependent patients with thalassemia (Table 1) were recruited at UCSF Benioff Children's Hospital Oakland (BCHO) to participate in individual interviews. Participants were ages 18 to 35 years and prescribed some type of ICT. A semi-structured interview guide was developed based on existing literature, and participants were asked questions regarding their general experience of thalassemia, the transition from childhood to adulthood as related to thalassemia, and promoters and barriers to ICT adherence. Interviews were audio-recorded, transcribed, and imported into NVivo software for analysis using grounded theory methodology. Codes were developed iteratively and classified into overarching themes, which were then mapped to form a cohesive framework.Results: The young adult patients described thalassemia as comprehensively impactful on their lives. Consequently, patient narratives focused largely on the minimization of the thalassemia impact , which was an overarching driver both to adherence and nonadherence to ICT; nonadherence resulted from a conception of ICT administration as a departure from normalcy, while adherence resulted from a conception of ICT administration as a necessary facilitator of normalcy. Conceptions of chelation as a necessity to normalcy was informed by four driving factors: (1) a high degree of integration of thalassemia into participants' lives, (2) a low degree of perceived burden from the chelation process , (3) a view of the chelation process as independent or self-motivated , and (4) an effective understanding of ICT necessity to prevent iron overload. The inverse of each of these four factors promoted a view of ICT as a hindrance to normalcy which facilitated nonadherence. The driving factors in turn were found to be influenced by external mediators including chelation type/characteristics, degree of chelation habituation, life stage characteristics, clinical support, and parental involvement/support.Conclusion: This study provides a framework that identifies four driving factors whose alignment is necessary for ICT adherence. By mapping how these core factors are influenced by external mediators, this framework provides an understanding of key indicators and pathways to adherence and nonadherence for young adults with thalassemia. For instance, the relative ease of oral chelators and increased habituation of chelation may decrease the perceived burden of the chelation process, improving adherence. Extensive parental involvement in managing chelation during childhood may be more complexly related to adherence - decreasing the burden of the chelation process, yet hindering the perception the patients' view of chelation as an independent process. Clinicians may play a crucial role in facilitating perception of ICT as necessary and efficacious by tracking iron status with patients - an effective motivator that also appeals to patients' desire to view adherence as a largely independent and self-motivated process. Furthermore, clinical staff like health navigators or community health workers who lower systemic barriers to care may be influential in enabling integration of thalassemia into daily life, promoting adherence. Ultimately this framework provides guidance for future empirical and interventional studies addressing ICT adherence. Further research is also needed to explore perceptions and practices regarding ICT adherence from the perspective of parents and health care providers of young adults with thalassemia. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

562-P: Transition of Care in Type 1 Diabetes and Association with Student and Employment Status

Transition between pediatric and adult diabetes care is often associated with new responsibilities in diabetes care and increased risk of acute complications. This study examines post-transition rates of acute complications and independence in diabetes self-care as a function of student and employment status based on time since transfer. The study included young adults with type 1 diabetes (T1D) between 18-26 years of age who completed a SEARCH for Diabetes in Youth Study visit between 2016-2019. Subgroup analysis compared those that transitioned care to an adult provider in the past 2 years to those who had transitioned ≥2 years prior. Chi-squared tests and linear and logistic regression models were applied. The models for diabetes complications and care included an interaction term between student and employment status and adjusted for gender, race/ethnicity, age, education level, insurance type, diabetes duration, and site. 1,043 participants were included in the analysis (56.6% female, mean age 22.2±2.5 years, mean T1D duration 11.7±3.0 years). Overall, 65.9% of participants had transferred to an adult diabetes care provider prior to their study visit. Among those who transitioned within the past two years (N=254), unemployed non-students were significantly more likely to experience diabetic ketoacidosis or severe hypoglycemia than unemployed students (p=0.01). Non-students who transferred within the past two years were less likely to be performing all diabetes self-care independently (p=0.03). In conclusion, recent transition from pediatric to adult diabetes care represents a high-risk period for acute complications, specifically for non-students who are unemployed. For those who had transitioned in the past 2 years, students were more likely to be independent in their diabetes self-care. Additional support may be needed in this group to improve independent diabetes care and reduce the risk for acute complications. Disclosure S. Majidi: Advisory Panel; Self; Companion Medical. R. Wadwa: Consultant; Self; Tandem Diabetes Care, Research Support; Self; Dexcom, Inc., Eli Lilly and Company, Tandem Diabetes Care. C. Pihoker: None. A. J. Roberts: None. C. Suerken: None. B. A. Reboussin: None. F. Malik: None. S. M. Marcovina: None. S. Corathers: None. K. Reynolds: Research Support; Self; Merck &amp; Co., Inc. G. Imperatore: None. Funding National Institutes of Health (1UC4DK108173, 1U18DP006131, U18DP006133, U18DP006134, U18DP006136, U18DP006138, U18DP006139); Centers for Disease Control and Prevention

Time to integrate oral health screening into medicine? A survey of primary care providers of older adults and an evidence-based rationale for integration.

Primary care providers were assessed regarding their training and interest to screen oral conditions in patients ≥55years old. Oral health (OH) is an essential component of overall health and can affect systemic health. Medical/dental integration in older adults is underdeveloped. A brief survey assessed primary care providers' self-reported skills, practices and barriers towards integrating OH screening into adult primary care. Data were collected using Survey Monkey® . Respondents were physicians and advanced practice providers (APPs) working at a large mid-western safety-net hospital. Descriptive statistics, T-tests and Chi-squared tests were reported. Eighty-two of 202 participants (41%) completed the survey. Most respondents were female (75%). A majority were physicians (68%); the remainder APPs. All providers (100%) reported OH was important or extremely important to overall health. More physicians (93%) reported not being well-trained to address adult OH issues and perceived less medical-oral health integration in their practice (16%) compared to APPs (P<.05). Time was more of a barrier with APPs (74%), compared to physicians (51%), to integrate OH screening activities (P<.05). Most providers reported other barriers such as inadequate OH training and insurance coverage. Providers endorsed that OH should be assessed frequently (56%) including providing referrals to dentists (77%) and educating patients on oral-systemic issues (63%). More female than male providers endorsed dental referrals and educating patients (P<.05). Primary care providers embraced greater medical/dental integration for older adults. Instituting OH activities appears to be supported. Future interventions that are feasible in primary care settings are examined.

A Provider-Facing eHealth Tool for Transitioning Youth With Special Health Care Needs From Pediatric to Adult Care: Mixed Methods, User-Engaged Usability Study.

BackgroundThere is a need for medical education on health care transitions for youth with special health care needs. The Texas Transition Toolkit (the tool) supports providers through a one-stop shop for researching literature on care transitions, a catalog of care transition tools, and guides for developing care transition programs.ObjectiveThis study aims to assess the functionality and usability of the tool with providers working with transition-aged children and youth with special health care needs (representative users).MethodsThe tool was evaluated using a triangulated mixed methods case study approach consisting of a concurrent think-aloud phase, a satisfaction survey, and a survey of problem relevance and task performance to operationalize and capture functionality and usability. Our mixed methods deep dive into the functionality and usability of the tool focused on 10 representative users from one medical home in Texas and 5 website design experts.ResultsRepresentative users found the tool to be highly relevant, as demonstrated by the satisfaction score for relevance (138/150, 92%). According to the users, the tool provided comprehensive information related to health care transitions for youth with special health care needs, with a satisfaction score of 87.3% (131/150) for comprehensive. Overall satisfaction with the tool was high at 81.92% (1065/1300) with a cutoff score of 73.33% (953.4/1300) indicating high satisfaction, but users reported relatively lower satisfaction with search (114/150, 76%) and navigation (ease of use: 114/150, 76%; hyperlinks: 163/200, 81.5%; structure: 159/200, 79.5%). They experienced search- and navigation-related problems (total problems detected: 21/31, 68%) and, based on quality checks, had a relatively low task completion rate for tasks involving finding information (60/80, 75%), which required searching and navigation. The problems identified around search and navigation functionality were relevant (relevance scores ranging from 14.5 to 22, with a cutoff score of 11.7 indicating relevance).ConclusionsThe tool may help bridge the gaps in training on health care transitions for youth with special health care needs in US medical education. The tool can be used to create structured protocols to help improve provider knowledge, collaboration across pediatric and adult care providers, and the continuity of care as youth with special health care needs transition from pediatric to adult care. The results provided a road map for optimizing the tool and highlighted the importance of evaluating eHealth technologies with representative users.

Adult Provider Perspectives on Transition and Transfer to Adult Care: A Multi-Specialty, Multi-Institutional Exploration

PurposeTo identify barriers that transcend multiple adult care specialties and identify potential solutions. Design and methodsTwenty-one adult care providers practicing in the specialty areas of internal medicine, family medicine, gastroenterology, endocrinology, and neurology participated in one of six semi-structured focus group interviews. Data were coded and analyzed according to the Socio-ecological Model of Adolescent/Young Adult Readiness for Transition (SMART). ResultsThree themes and one subtheme emerged from the data. These fell within the beliefs/expectations, knowledge, access/insurance, and relationships (subtheme) domains of the SMART model. Family beliefs/expectations regarding the provider role, difficulty accessing reliable information, and limited access to mental health and behavioral providers reportedly affect providers' ability to provide optimal health care. ConclusionsAdult providers identified several barriers affecting their ability to care for newly transferred patients. Increased education of families and improved methods of communication between providers were recommended. Barriers related to access and insurance are common and require larger systems-level collaborations between health care systems and payor sources. Practical implicationsSome recommendations (e.g., educating families on the distinct roles of the PCP vs. specialist, highlighting new treatment opportunities in adult care, conveying trust and endorsing the new provider), represent concrete steps pediatric providers can immediately take to improve transfer. Other steps will require forging bridges across the pediatric and adult care world to expand patient access to medical, mental health, and behavioral services.

Experiences of black women adult foster care providers for aging adults: negotiating power and care

ABSTRACT This study explored experiences of 23 Black women owners and operators of Adult Foster Care (AFC) homes for midlife and older adults. Semi-structured interview data focusing on multiple dimensions of the care context were analyzed using grounded theory methods. Women leveraged their resources as they invested their expertise, time, and relationships to support their residents and embraced the value of residents for their contribution to the success of AFC settings. The findings underline the critical roles of these AFC providers in maintaining safe and home-like care contexts for aging adults, in the face of systemic challenges.

A Simulation-Based Empathy Enhancement Program for Non-Medical Care Providers of Older Adults: A Mixed-Methods Study.

ObjectiveStudies using simulation-based programs for empathy enhancement have been conducted mostly for health profession students and medical care providers in Western countries. No empirical research has been conducted for non-medical care providers of older adults in community settings in Asian countries. The purposes of this mixed-methods study were: to explore experiences and perceived usability of non-medical care providers of older adults in a simulation-based empathy enhancement program; and to examine if the program is effective in improving empathy and relevant outcomes. Methods104 non-medical care providers of older adults in South Korea participated in a simulation-based empathy enhancement program in 2018. Data were collected using self-reported questionnaires for effectiveness testing, a program evaluation questionnaire, and individual interviews and analyzed using statistical tests and thematic analysis. ResultsCare providers showed higher levels of empathy and lower levels of stress and burnout after the program participation (p<0.05). Qualitative findings supported the improved attitude and care strategies, increased empathy towards older adults, preparing for their own aging, and restoration of emotional stability through the participation in the program. ConclusionThis study suggests that the simulation-based program is useful in promoting empathic responses of non-medical care providers working with older adults.

Differences in Healthcare Transition Views, Practices, and Barriers Among North American Pediatric Rheumatology Clinicians From 2010 to 2018.

Since 2010, the rheumatology community has developed guidelines and tools to improve healthcare transition. In this study, we aimed to compare current transition practices and beliefs among Childhood Arthritis and Rheumatology Research Alliance (CARRA) rheumatology providers with transition practices from a provider survey published in 2010. In 2018, CARRA members completed a 25-item online survey about healthcare transition. Got Transition's Current Assessment of Health Care Transition Activities was used to measure clinical transition processes on a scale of 1 (basic) to 4 (comprehensive). Bivariate analyses were used to compare 2010 and 2018 survey findings. Over half of CARRA members completed the survey (202/396), including pediatric rheumatologists, adult- and pediatric-trained rheumatologists, pediatric rheumatology fellows, and advanced practice providers. The most common target age to begin transition planning was 15-17 years (49%). Most providers transferred patients prior to age 21 years (75%). Few providers used the American College of Rheumatology transition tools (31%) or have a dedicated transition clinic (23%). Only 17% had a transition policy in place, and 63% did not consistently address healthcare transition with patients. When compared to the 2010 survey, improvement was noted in 3 of 12 transition barriers: availability of adult primary care providers, availability of adult rheumatologists, and pediatric staff transition knowledge and skills (P < 0.001 for each). Nevertheless, the mean current assessment score was < 2 for each measurement. This study demonstrates improvement in certain transition barriers and practices since 2010, although implementation of structured transition processes remains inconsistent.