Preventing Chronic Disease | Socioecologic Factors as Predictors of Readiness for Self-Management and Transition, Medication Adherence, and Health Care Utilization Among Adolescents and Young Adults With Chronic Kidney Disease - CDC
Socioecologic Factors as Predictors of Readiness for Self-Management and Transition, Medication Adherence, and Health Care Utilization Among Adolescents and Young Adults With Chronic Kidney Disease
Karina Javalkar; Nicole Fenton, MA; Sarah Cohen; Maria Ferris, MD, PhD, MPH
Suggested citation for this article: Javalkar K, Fenton N, Cohen S, Ferris M. Socioecologic Factors as Predictors of Readiness for Self-Management and Transition, Medication Adherence, and Health Care Utilization Among Adolescents and Young Adults With Chronic Kidney Disease. Prev Chronic Dis 2014;11:140072. DOI: http://dx.doi.org/10.5888/pcd11.140072
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Abstract
Introduction
The objective of our study was to determine the socioecologic factors that predict readiness for self-management and transition from pediatric to adult health care services, adherence to taking medications, and health care utilization among adolescents and young adults with chronic kidney disease.
The objective of our study was to determine the socioecologic factors that predict readiness for self-management and transition from pediatric to adult health care services, adherence to taking medications, and health care utilization among adolescents and young adults with chronic kidney disease.
Methods
We enrolled 52 adolescents and young adults aged 13 to 21 (96.5% participation). Participants were administered measures that examined: socioecologic factors, individualized education plans or 504 plans, readiness for self-management and transition (the University of North Carolina TRxANSITION scale), triangulated measures of adherence to taking medications (parent reported, physician reported, and medication-possession ratios), and health care utilization (number of visits to the emergency department, number of inpatient admissions, and number of inpatient days in the previous year).
We enrolled 52 adolescents and young adults aged 13 to 21 (96.5% participation). Participants were administered measures that examined: socioecologic factors, individualized education plans or 504 plans, readiness for self-management and transition (the University of North Carolina TRxANSITION scale), triangulated measures of adherence to taking medications (parent reported, physician reported, and medication-possession ratios), and health care utilization (number of visits to the emergency department, number of inpatient admissions, and number of inpatient days in the previous year).
Results
Overall, our sample had moderate levels of readiness for self-management and transition, high rates of parent- and physician-reported medication adherence, and high rates of health care utilization. Age was a significant positive predictor of readiness for self-management and transition. Compared with participants who had private health insurance, participants who had public insurance had more emergency department visits, inpatient admissions, and inpatient days, and lower rates of physician-reported medication adherence. Participants who did not have an individualized education plan or 504 plan had significantly more emergency department visits, inpatient admissions, and inpatient days.
Overall, our sample had moderate levels of readiness for self-management and transition, high rates of parent- and physician-reported medication adherence, and high rates of health care utilization. Age was a significant positive predictor of readiness for self-management and transition. Compared with participants who had private health insurance, participants who had public insurance had more emergency department visits, inpatient admissions, and inpatient days, and lower rates of physician-reported medication adherence. Participants who did not have an individualized education plan or 504 plan had significantly more emergency department visits, inpatient admissions, and inpatient days.
Conclusion
Socioecologic factors play an important role in readiness for self-management and transition, medication adherence, and health care utilization in pediatric patients with chronic kidney disease. Age, insurance status, and having an individualized education plan or 504 plan may be key factors.
Socioecologic factors play an important role in readiness for self-management and transition, medication adherence, and health care utilization in pediatric patients with chronic kidney disease. Age, insurance status, and having an individualized education plan or 504 plan may be key factors.
Acknowledgments
This investigation was partially funded by the UNC Kidney Center and the Renal Research Institute. We express our appreciation to Dr William Primack and Dr Keisha Gibson for their assistance in recruiting participants for this study.
Author Information
Corresponding Author: Maria Ferris, MD, PhD, MPH, Division of Pediatric Nephrology, Department of Medicine and Pediatrics, University of North Carolina School of Medicine, CB# 7155, Chapel Hill, NC 27599-7155. Telephone: 919-966-2561, ext 237. E-mail: maria_ferris@med.unc.edu.
Author Affiliations: Karina Javalkar, Sarah Cohen, University of North Carolina–Chapel Hill, Chapel Hill, North Carolina; Nicole Fenton, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania.
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