Evaluation of a new transition organization for young adults with endocrine or metabolic diseases

in European Journal of Endocrinology
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  • 1 E Le Roux, Université de Paris, ECEVE UMR 1123, INSERM, Paris, France
  • | 2 A Turpin, Unité d’épidémiologie clinique, Inserm, CIC 1426, AP-HP.Nord-Université de Paris, Hôpital Universitaire Robert Debré, Paris, France
  • | 3 M Michel, Université de Paris, ECEVE UMR 1123, INSERM, Paris, France
  • | 4 I Tejedor, Hôpital Universitaire Pitié Salpêtrière, Service d'Endocrinologie et médecine de la reproduction ; Centre de maladies endocriniennes rares de la croissance et du développement; Centre de pathologies gynécologiques rares, HCP-ENDO European Reference Network, AP-HP. Sorbonne Université, Paris, France
  • | 5 F Menesguen, Hôpital Universitaire Pitié Salpêtrière, Service d'Endocrinologie et médecine de la reproduction ; Centre de maladies endocriniennes rares de la croissance et du développement; Centre de pathologies gynécologiques rares, HCP-ENDO European Reference Network, AP-HP. Sorbonne Université, Paris, France
  • | 6 S Malivoir, Hôpital Universitaire Pitié Salpêtrière, Service d'Endocrinologie et médecine de la reproduction ; Centre de maladies endocriniennes rares de la croissance et du développement; Centre de pathologies gynécologiques rares, HCP-ENDO European Reference Network, AP-HP. Sorbonne Université, Paris, France
  • | 7 S Bottuis, Hôpital Universitaire Pitié Salpêtrière, Service d'Endocrinologie et médecine de la reproduction ; Centre de maladies endocriniennes rares de la croissance et du développement; Centre de pathologies gynécologiques rares, HCP-ENDO European Reference Network, AP-HP. Sorbonne Université, Paris, France
  • | 8 H Mellerio, GRMSA, Groupe de recherche en médecine et santé de l'adolescent, Paris, France
  • | 9 M Polak, Paediatric Endocrinology, Gynaecology and Diabetology, IMAGINE Institute, ENDO-European Reference Network Team, AP-HP.Centre-Université de Paris, Hopital Universitaire Necker-Enfants Malades, Paris, France
  • | 10 P Touraine, Hôpital Universitaire Pitié Salpêtrière, Service d'Endocrinologie et médecine de la reproduction ; Centre de maladies endocriniennes rares de la croissance et du développement; Centre de pathologies gynécologiques rares, HCP-ENDO European Reference Network, AP-HP. Sorbonne Université, Paris, France

Correspondence: Enora Le Roux, Email: enora.leroux2@aphp.fr
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Objective. To evaluate the effect of a new care organisation on multiple outcomes of transition success and its cost-effectiveness in patients with any endocrine or metabolic disease diagnosed during childhood and transferred to adult care.

Design. Non-randomized controlled trial in a French University Hospital.

Methods. Patients transferred to adult care during the control period (04/2014-08/2016) and the intervention period (09/2016-06/2018) were included. The intervention is based on case management involving liaising with paediatric services, personalising care pathways, and liaising with structures outside hospital (general practitioner, educational and social sector). The primary endpoint was the percentage of patients lost to follow-up at 24 months post transfer. Other outcomes were collected from medical files, consultation software, and questionnaires. A cost analysis was performed.

Results. 202 patients were included (101 per period) , the most represented pathologies were congenital and non-congenital hypopituitarism (respectively n=34 (17%) and n=45 (22%)) and thyroid diseases (n=21, 10%). Patients were aged 22.5 in median at 24 months post transfer where 12 were lost to follow up in the control group versus 9 with the intervention (p=0.49). The percentage of honoured consultation among those planned during 24 months was higher with intervention (p=0.0065). Patient satisfaction, physician trust, transfer delay did not differ between the groups. The incremental cost-effectiveness ratio was €179 per patient not lost to follow-up.

Conclusions. At 24 months post transfer the rate of lost to follow-up does not differ significantly, but indicators of a steadier follow-up are increased and the intervention appears to be cost-effective.

 

     European Society of Endocrinology