Transition of pediatric patients with bronchiectasis to adult medical care in the Northern Territory: A retrospective chart audit

Kobi L Schutz; Nicholas Fancourt; Anne B Chang; Peter Morris; Rachel Buckley; Edwina Biancardi; Kathryn Roberts; James Cush; Subash Heraganahally; Gabrielle B McCallum

doi:10.3389/fped.2023.1184303

Transition of pediatric patients with bronchiectasis to adult medical care in the Northern Territory: A retrospective chart audit

Front Pediatr. 2023 Apr 28:11:1184303. doi: 10.3389/fped.2023.1184303. eCollection 2023.

Authors

Kobi L Schutz^{1

2}, Nicholas Fancourt¹, Anne B Chang^{1

3}, Peter Morris¹, Rachel Buckley⁴, Edwina Biancardi⁵, Kathryn Roberts⁶, James Cush⁶, Subash Heraganahally^{5

7}, Gabrielle B McCallum¹

Affiliations

¹ Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
² School of Nursing, Charles Darwin University, Darwin, NT, Australia.
³ Department of Respiratory and Sleep Medicine, Queensland Children's Hospital Queensland University of Technology, Brisbane, QLD, Australia.
⁴ Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia.
⁵ Department of Respiratory and Sleep Medicine, Royal Darwin Hospital, Darwin, NT, Australia.
⁶ Department of Paediatrics, Royal Darwin Hospital, Darwin, NT, Australia.
⁷ College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.

Abstract

Background: Bronchiectasis is increasingly being recognized to exist in all settings with a high burden of disease seen in First Nations populations. With increasing numbers of pediatric patients with chronic illnesses surviving into adulthood, there is more awareness on examining the transition from pediatric to adult medical care services. We undertook a retrospective medical chart audit to describe what processes, timeframes, and supports were in place for the transition of young people (≥14 years) with bronchiectasis from pediatric to adult services in the Northern Territory (NT), Australia.

Methods: Participants were identified from a larger prospective study of children investigated for bronchiectasis at the Royal Darwin Hospital, NT, from 2007 to 2022. Young people were included if they were aged ≥14 years on October 1, 2022, with a radiological diagnosis of bronchiectasis on high-resolution computed tomography scan. Electronic and paper-based hospital medical records and electronic records from NT government health clinics and, where possible, general practitioner and other medical service attendance were reviewed. We recorded any written evidence of transition planning and hospital engagement from age ≥14 to 20 years.

Results: One hundred and two participants were included, 53% were males, and most were First Nations people (95%) and lived in a remote location (90.2%). Nine (8.8%) participants had some form of documented evidence of transition planning or discharge from pediatric services. Twenty-six participants had turned 18 years, yet there was no evidence in the medical records of any young person attending an adult respiratory clinic at the Royal Darwin Hospital or being seen by the adult outreach respiratory clinic.

Conclusion: This study demonstrates an important gap in the documentation of delivery of care, and the need to develop an evidence-based transition framework for the transition of young people with bronchiectasis from pediatric to adult medical care services in the NT.

Keywords: adult care; bronchiectasis; pediatric care; transition; transition plan.

Grants and funding

ABC was supported by an NHMRC fellowship (1058213). KLS is supported by an Australian Government Research Training Program Scholarship, administered by Charles Darwin University.