title: 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.
abstract: BACKGROUND
  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).
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of North Carolina-Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Karina
authors.initials: K
authors.lastname: Javalkar
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Nicole
authors.initials: N
authors.lastname: Fenton
authors.affiliation: University of North Carolina-Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Sarah
authors.initials: S
authors.lastname: Cohen
authors.affiliation: Division of Pediatric Nephrology, Department of Medicine and Pediatrics, University of North Carolina School of Medicine, CB# 7155, Chapel Hill, NC 27599-7155. E-mail: maria_ferris@med.unc.edu.
authors.forename: Maria
authors.initials: M
authors.lastname: Ferris
mesh_terms: D000293:Adolescent; D000328:Adult; D003266:Continuity of Patient Care; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006296:Health Services / Q000706:statistics & numerical data; D019456:Health Transition; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D008297:Male; D009657:North Carolina / Q000453:epidemiology; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000706:statistics & numerical data; D010360:Patient Transfer; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D012648:Self Care / Q000523:psychology*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult; D016903:Drug Monitoring