Title | Patterns of Health Care Utilization and Medication Adherence Among Youth with Systemic Lupus Erythematosus During Transfer from Pediatric to Adult Care. |
Publication Type | Journal Article |
Year of Publication | 2020 |
Authors | Chang JC, Knight AM, Lawson EF |
Journal | J Rheumatol |
Date Published | 2020 Feb 01 |
ISSN | 0315-162X |
Abstract | OBJECTIVE: Youth with systemic lupus erythematosus (SLE) transferring from pediatric to adult care are at risk for poor outcomes. We describe patterns of rheumatology/nephrology care and changes in health care utilization and medication adherence during transfer. METHODS: We identified youth ages 15-25 with SLE using US private insurance claims from Optum's de-identified Clinformatics® Data Mart. Rheumatology/nephrology visit patterns were categorized as 1) unilateral transfers to adult care within 12 months, 2) overlapping pediatric and adult visits, 3) lost to follow-up, or 4) continuing pediatric care. We used negative binomial regression and paired t-tests to estimate changes in health care utilization and medication possession ratios (MPR) after the last pediatric (index) visit. We compared MPRs between youth who transferred and age-matched peers continuing pediatric care. RESULTS: 184 youth transferred out of pediatric care, of which 41.8% transferred unilaterally, 31.5% had overlapping visits over a median of 12 months before final transfer, and 26.6% were lost to follow-up. We matched 107 youth continuing pediatric care. Overall ambulatory utilization decreased among those lost to follow-up. Acute care utilization decreased across all groups. MPRs after the index date were lower in youth lost to follow-up (mean 0.24) compared to peers in pediatric care (0.57, p<0.001). CONCLUSION: Youth with SLE with continuous private insurance coverage do not use more acute care after transfer to adult care. However, a substantial proportion fail to see adult subspecialists within 12 months and have worse medication adherence, placing them at higher risk for adverse outcomes. |
DOI | 10.3899/jrheum.191029 |
Alternate Journal | J. Rheumatol. |
PubMed ID | 32007936 |