title: Transition of care to an adult spina bifida clinic: patient perspectives and medical outcomes.
abstract: OBJECTIVE
  Transitioning care of patients with spina bifida to adult centers poses a challenge. We sought patient and parent perspectives on the transition process at our center and correlated these perspectives with medical outcomes.
  
  
  METHODS
  Patients who attended the adult spina bifida clinic at our institution were invited to complete SF-36®, the Ambulatory Care Experience Survey and a Transition of Care Survey. Urological and neurosurgical medical outcomes were correlated with health status, clinic experience and perspectives on the transition process. Statistical analysis was done using SPSS®, version 16.0.
  
  
  RESULTS
  Of 105 patients with spina bifida 24 participated in the study. SF-36 results showed that the physical health domain correlated with lack of employment (p = 0.006). Patients whose parents completed the surveys on their behalf were more likely to have physical limitations than the patients who completed surveys (p = 0.011). Urological and neurosurgical outcomes did not significantly affect SF-36, Ambulatory Care Experience Survey or Transition of Care Survey scores in this patient population. Patients and caregivers identified similar key elements and barriers in the transition process. Satisfaction with care at the pediatric center was higher than at the adult center.
  
  
  CONCLUSIONS
  Transitioning care of patients with spina bifida from pediatric to adult care poses challenges for the health care system. Medical outcomes do not impact the patient perspective of the transition process. To optimize the transition of care we must address the barriers identified by patients and their caregivers.
authors.affiliation: Department of Urology, QEII Health Science Centre, Halifax, Nova Scotia, Canada.
authors.forename: Ashley
authors.initials: A
authors.lastname: Cox
authors.forename: Lynn
authors.initials: L
authors.lastname: Breau
authors.forename: Liette
authors.initials: L
authors.lastname: Connor
authors.forename: P Daniel
authors.initials: PD
authors.lastname: McNeely
authors.forename: Peter A
authors.initials: PA
authors.lastname: Anderson
authors.forename: Dawn L
authors.initials: DL
authors.lastname: MacLellan
mesh_terms: D000328:Adult; D000368:Aged; D003266:Continuity of Patient Care / Q000458:organization & administration*; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009674:Nova Scotia; D012189:Retrospective Studies; D016135:Spinal Dysraphism / Q000503:physiopathology / Q000628:therapy*; D011795:Surveys and Questionnaires; D014551:Urinary Tract / Q000503:physiopathology*; D014563:Urodynamics / Q000502:physiology*; D055815:Young Adult