P2.050: A Tri-Partnership Virtual Handover Intervention to Optimize Transition to Adult Primary Care for Youth with Medical Complexity

Background: Transitioning youth with medical complexity (YMC) from pediatric to adult health care poses significant challenges, demanding extensive effort and collaboration among the pediatric team, family physician (FP), YMC and their caregivers. These challenges include the transitional planning required due to multi-subspecialty involvement, the lack of Complex Care medical home programs within adult care, and the increased demands placed on FPs who may not be trained in the care of YMC. At present, there is a lack of standardized transition processes within Complex Care, and the current hospital standard of practice (i.e. transferring written medical records), may be insufficient to address the holistic needs of YMC.

This study aimed to: 1) assess the feasibility and acceptability of implementing tri-partnership virtual handovers involving the pediatric team, FPs and YMC/caregivers, and 2) explore participant experiences with the intervention.

Methods: A descriptive, pre-post, mixed methods, prospective study design was utilized. The tri-partnership virtual handover intervention occurred through a tertiary pediatric hospital’s Complex Care program, and consisted of a 45-60 minute pre-transition telemedicine visit with the caregivers, FPs, and Complex Care team. The visit provided a comprehensive overview of: (1) the YMC’s personalized care plan, medications and technologies, (2) sub-specialist referrals, (3) allied health and community resources, (4) funding applications, and (5) questions and action items. A combination of pre-visit/demographics questionnaires, post-visit questionnaires, and qualitative interviews exploring perceptions and satisfaction related to the visit, were completed by caregivers, Complex Care team and FPs.

Quantitative data were analyzed using descriptive statistics, to assess the feasibility, acceptability, and integration of the intervention, compared against a priori criteria for success defined by the research team. Qualitative interviews were analyzed using content analysis, with consensus among three reviewers to identify emerging themes.

Results: Twenty virtual handovers were completed between 2021 and 2023. The intervention surpassed several predefined thresholds for acceptability, feasibility, and integration (Table 1). Regarding acceptability, 100% of caregivers would choose to have another telemedicine visit, and 71.4% of FPs would participate in future telemedicine visits. In terms of feasibility, 100% of caregivers and 92.9% of FPs reported that the virtual care visit technology worked well. Overall, 100% of caregiver and FP respondents were satisfied with the intervention.

Qualitative interviews with caregivers, Complex Care team members, and FPs identified preliminary themes including strengthened communication, confidence, care planning, accessibility/convenience, and mutual understanding.

Conclusion: This study provides evidence supporting the acceptability and feasibility of tri-partnership virtual handovers in transitioning YMC to adult care. It has informed new transition practices at The Hospital for Sick Children, and supported the creation of an ongoing randomized controlled trial investigating YMC transition support programs.