Healthcare utilization during transition to adult care in patients with spina bifida

Abstract

Introduction: Individuals with spina bifida (SB) may experience negative health outcomes because of an informal transition from pediatric to adult care that results in using the emergency room (ER) for non-acute health problems. Methods: We conducted a retrospective population-based cohort study of all people with SB in Ontario, Canada turning 18 years old between 2002 and 2011. These patients were followed for five years before and after age 18. Primary outcome was the annual rate of ER visits. Secondary outcomes included rates of hospitalization, surgery, primary care, and specialist outpatient care. We estimated the association between age with primary and secondary outcomes using negative binomial growth curve models, adjusting for patient-level baseline covariates. Results: Among the 1215 individuals with SB, there was no trend of ER visits seen with increasing age (relative risk [RR] 0.99, 95% confidence interval [CI] 0.98–1.02); however, there was a significant increase in the rate of ER visits associated with turning 18 years (RR 1.14, 95% CI 1.03–1.27). Turning 18 years old was also associated with a decreased rate of hospital admissions (RR 0.79, 95% CI 0.66–0.95) and no change in surgeries (RR 0.80, 95% CI 0.64–1.02). Visits to primary care physicians remained stable over the same period (RR 0.96, 95% CI 0.90–1.01), while visits to SB-focused specialists decreased after age 18 (RR 0.81, 95% CI 0.75–0.87). Conclusions: In patients with SB, the rate of ER visits increased significantly at 18 years old, while hospital admissions and specialist physician visits decreased at the same time. Models of transitional care can aim to reduce non-urgent ER visits and facilitate regular specialist care.