Primary care interventions to improve transition of youth with chronic health conditions from paediatric to adult healthcare: a systematic review

OBJECTIVE: To determine effective interventions to improve primary care provider involvement in transitioning youth with chronic conditions from paediatric to adult care. DESIGN: Systematic review. Multiple electronic databases were searched including Ovid MEDLINE, EMBASE and Web of Science (from 1 January 1947 to 5 August 2015). Evidence quality was assessed using a 36-point scoring system for disparate study designs. SETTING: Studies with paediatric-to-adult transition programmes and interventions involving primary care providers or in primary care settings. PARTICIPANTS: Youth aged 16 years and over. OUTCOMES: Relevant outcomes were grouped into 3 main domains based on the Triple Aim Framework: experience of care, population health, cost. RESULTS: A total of 1888 unique citations were identified, yielding 3 studies for inclusion. Overall, primary care provider roles were not well defined. 2 studies used case managers to facilitate referrals to primary care, and the remaining study was the only 1 situated in a primary care setting. None of the studies examined transition in all 3 Triple Aim Framework domains. The most commonly reported outcomes were in the cost domain. CONCLUSIONS: There is limited empiric evidence to guide primary care interventions to improve transition outcomes for youth with chronic conditions. Future research and policy should focus on developing and evaluating coordinated transition interventions to better integrate primary care for high need populations.