Endocrinologists in adult clinics

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* 1. What is your gender?

Male

Female

Other / don’t want to tell

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* 2. What is your age?

25-35 y.o.

35-45 y.o.

45-55 y.o.

55-65 y.o.

65 y.o. or more

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* 3. Where do you predominantly practice?

Hospital-based clinic in a non-academic center

Hospital-based clinic in an academic center

Private consultations

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* 4. How many adult diabetologists are working in your hospital?

Other (please specify)

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* 5. How many patients with diabetes (T1&T2) do you follow?

>400

201-400

101-200

51-100

26-50

<25

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* 6. What proportion of your patient population are patients with type 1 DM?

< 10%

10-25%

25-50%

50-75%

> 75%

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* 7. Are you working in the context of a RIZIV convention for diabetes?

Yes

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* 8. Does your hospital have a pediatric diabetes convention?

Yes

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* 9. How many pediatric diabetologists are working in your hospital?

Other (please specify)

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* 10. Your multidisciplinary diabetic team consists of (please choose all that apply)

A (pediatric) endocrinologist

A nurse practioner

A psychologist

A social assistant

A dietician

A secretary

A transition coordinator

Other (please specify)

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* 11. Are there adult diabetologists who serve as a contact point for young adults in your center and are therefore responsible for the care of new young adult in your clinic?

Yes, 1 doctor

Yes, more than 1 doctor

No, we don’t specifically have 1 doctor who is responsible

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* 12. Do you have a transition coordinator?

Yes

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* 13. The transition coordinator is

A (pediatric) endocrinologist

A nurse

An office manager/administrative assistant

A doctor

A social worker

A dietician

No transition coordinator

Other (please specify)

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* 14. What are the responsibilities of the transition coordinator? (please choose all that apply)

Orienting patients transferred to your clinic

Ensuring receipt/prepare of a complete transfer package

Calling patients to remind them of their upcoming appointments

Calling patients who missed their appointments to rebook or redirect care

Participating in clinic care and education

Communicating with the pediatric / adult team to confirm follow-up on transition

Other (please specify)

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* 15. What is to your opinion the ideal age range for transition?

12 – 14 y.o.

14 – 16 y.o.

16 – 18 y.o.

18 – 20 y.o.

Other (please specify)

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* 16. At what age does the actual transfer from pediatrics to adult endocrinology take place in your center?

12 – 14 y.o.

14 – 16 y.o.

16 – 18 y.o.

18 – 20 y.o.

Other (please specify)

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* 17. Do you use a written structured transition program?

Yes

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* 18. What do you think is important for the adolescent in transition? (please choose all that apply)

To be well prepared to have knowledge and skills to self-manage their diabetes

To be well prepared to organize the practical things such as planning appointments, renew theirmedication/devices and understand about their social insurance and rights

Adult health care provider has to know their medical history, family context and social background

To know how the care by the adult team is managed

Personal approach by the adult endocrinologist

To be seen by the same doctor

Possibility to have contact with the adult diabetic team in between appointments

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* 19. What do you think is the best measure of a successful transition?

A. Patient’s satisfaction with the transition process

B. HbA1C pre- and post-transfer equal or improved

C. No delay between last paediatric visit and first adult visit of more than 6 months

D. No increase of Diabetic keto-acidosis hospitalizations or increase in emergency visits

A and B

A and C

A and D

B and C

B and D

C and D

A, B, C and D

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* 20. What do you think are the barriers for a successful transition?

	Strongly disagree	Disagree	Undecided	Agree	Strongly agree
Lack of time and resources for organising transition care	Lack of time and resources for organising transition care Strongly disagree	Lack of time and resources for organising transition care Disagree	Lack of time and resources for organising transition care Undecided	Lack of time and resources for organising transition care Agree	Lack of time and resources for organising transition care Strongly agree
Less frequent consultations in adult-oriented care	Less frequent consultations in adult-oriented care Strongly disagree	Less frequent consultations in adult-oriented care Disagree	Less frequent consultations in adult-oriented care Undecided	Less frequent consultations in adult-oriented care Agree	Less frequent consultations in adult-oriented care Strongly agree
Less support in-between appointments in adult-oriented care	Less support in-between appointments in adult-oriented care Strongly disagree	Less support in-between appointments in adult-oriented care Disagree	Less support in-between appointments in adult-oriented care Undecided	Less support in-between appointments in adult-oriented care Agree	Less support in-between appointments in adult-oriented care Strongly agree
Different approach by adult endocrinologist	Different approach by adult endocrinologist Strongly disagree	Different approach by adult endocrinologist Disagree	Different approach by adult endocrinologist Undecided	Different approach by adult endocrinologist Agree	Different approach by adult endocrinologist Strongly agree
Lack of understanding of the vulnerability of the young adult patient.	Lack of understanding of the vulnerability of the young adult patient. Strongly disagree	Lack of understanding of the vulnerability of the young adult patient. Disagree	Lack of understanding of the vulnerability of the young adult patient. Undecided	Lack of understanding of the vulnerability of the young adult patient. Agree	Lack of understanding of the vulnerability of the young adult patient. Strongly agree
Lack of transition protocols	Lack of transition protocols Strongly disagree	Lack of transition protocols Disagree	Lack of transition protocols Undecided	Lack of transition protocols Agree	Lack of transition protocols Strongly agree
Patient related factors (lack of interest, motivation,…)	Patient related factors (lack of interest, motivation,…) Strongly disagree	Patient related factors (lack of interest, motivation,…) Disagree	Patient related factors (lack of interest, motivation,…) Undecided	Patient related factors (lack of interest, motivation,…) Agree	Patient related factors (lack of interest, motivation,…) Strongly agree

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* 21. During the transition period the adolescent is seen (please choose all that apply):

Part of the consultation without his parents by the paediatric endocrinologist

Before transfer a nurse practitioner of the adult-health-care team joins the paediatric clinic or has a dedicated appointment with the patient

A joint paediatric-adult clinic appointment

In a young adult clinic

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* 22. How often do you see adolescents with type 1 diabetes type?

Every 2 months

Every 3 months

Every 4 months

Every 6 months

Other (please specify)

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* 23. Did you have a special training in transition care?

Yes

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* 24. When/how did you receive this training?

During general training

Residency/fellowship training

During a congress/symposium, by own choice

Experience with my own patients

Informal discussions with colleagues

No special training

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* 25. How do most referred patients get to your clinic?

Usually always sent by the same in house paediatric clinic

My clinic is chosen based on the patient’s place of residence

My clinic is the explicit choice of the patient and family

Other (please specify)

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* 26. When welcoming a young adult with type 1 diabetes transitioning to your care from pediatric care, you are

Enthusiastic about accepting the patient

Willing to accept the patient

Neutral

Reluctant to accept the patient

Refusing the consult

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* 27. What information would you like to receive from the pediatric team about a patient that is transferred to your care? (please choose all that apply)

A referral addressed to you specifically

A written medical summary

A written psychosocial summary

A transition readiness assessment checklist

A phone communication

A joint consultation

No communication

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* 28. What information do you receive from the pediatric team about a patient that is transferred to your care?

	Rarely-never	Sometimes	Most of the time
A referral addressed to you specifically	A referral addressed to you specifically Rarely-never	A referral addressed to you specifically Sometimes	A referral addressed to you specifically Most of the time
A written medical summary	A written medical summary Rarely-never	A written medical summary Sometimes	A written medical summary Most of the time
A written psychosocial summary	A written psychosocial summary Rarely-never	A written psychosocial summary Sometimes	A written psychosocial summary Most of the time
A transition readiness assessment checklist	A transition readiness assessment checklist Rarely-never	A transition readiness assessment checklist Sometimes	A transition readiness assessment checklist Most of the time
A phone communication	A phone communication Rarely-never	A phone communication Sometimes	A phone communication Most of the time
A joint consultation	A joint consultation Rarely-never	A joint consultation Sometimes	A joint consultation Most of the time
No communication	No communication Rarely-never	No communication Sometimes	No communication Most of the time

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* 29. How satisfied are you with the communication with the pediatric team?

Very unhappy

Neutral

Couldn't be better

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 30. In your opinion, how much room is there for improvement in this communication?

It's perfect

Neutral

Everything has to change

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 31. What are the positive aspects of pediatric diabetes clinics in general according to your perception?

	Strongly disagree	Disagree	Undecided	Agree	Strongly agree
Longterm comfortable relationship with pediatric health care provider	Longterm comfortable relationship with pediatric health care provider Strongly disagree	Longterm comfortable relationship with pediatric health care provider Disagree	Longterm comfortable relationship with pediatric health care provider Undecided	Longterm comfortable relationship with pediatric health care provider Agree	Longterm comfortable relationship with pediatric health care provider Strongly agree
Holistic approach, multidisciplinary and focused on family involvement	Holistic approach, multidisciplinary and focused on family involvement Strongly disagree	Holistic approach, multidisciplinary and focused on family involvement Disagree	Holistic approach, multidisciplinary and focused on family involvement Undecided	Holistic approach, multidisciplinary and focused on family involvement Agree	Holistic approach, multidisciplinary and focused on family involvement Strongly agree
Receiving a lot of support and guidance	Receiving a lot of support and guidance Strongly disagree	Receiving a lot of support and guidance Disagree	Receiving a lot of support and guidance Undecided	Receiving a lot of support and guidance Agree	Receiving a lot of support and guidance Strongly agree

Other (please specify

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* 32. What are the negative aspects or points of improvement of pediatric diabetes clinics according to your perception?

	Strongly disagree	Disagree	Undecided	Agree	Strongly agree
To liberal use of exchange values	To liberal use of exchange values Strongly disagree	To liberal use of exchange values Disagree	To liberal use of exchange values Undecided	To liberal use of exchange values Agree	To liberal use of exchange values Strongly agree
Continued use of snacks	Continued use of snacks Strongly disagree	Continued use of snacks Disagree	Continued use of snacks Undecided	Continued use of snacks Agree	Continued use of snacks Strongly agree
To little focus on the concept of healthy food	To little focus on the concept of healthy food Strongly disagree	To little focus on the concept of healthy food Disagree	To little focus on the concept of healthy food Undecided	To little focus on the concept of healthy food Agree	To little focus on the concept of healthy food Strongly agree
Continued involvement of parents	Continued involvement of parents Strongly disagree	Continued involvement of parents Disagree	Continued involvement of parents Undecided	Continued involvement of parents Agree	Continued involvement of parents Strongly agree

Other (please specify)

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* 33. Do you give written feedback to the pediatric provider after the transferred care?

Most of the time

Sometimes

Rarely / never

No, but I call the pediatric provider

Other (explain)

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* 34. Do you follow a fixed protocol when seeing a young adult with type 1 diabetes for the first time?

Yes

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* 35. What items do you discuss with the patient during the transition period? (please choose all that apply)

Assessment of diabetic knowledge and self-management skills

Assessment of self-management skills in booking appointments, renewing medications and supplies and in knowing how to contact their diabetes health care providers

Alcohol and smoking in the context of having diabetes

Driving in the context of having diabetes

Birth control and pregnancy in the context of having diabetes

Other (please specify)

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* 36. Indicate your interest in using the following transition-specific staff and / or resources for your practice

	Already in use	Would use if available	Would not use	Need to know more about this tool before using it
Information brochure explaining your approach to diabetes care and transition, services offered in your practice and contact information	Information brochure explaining your approach to diabetes care and transition, services offered in your practice and contact information Already in use	Information brochure explaining your approach to diabetes care and transition, services offered in your practice and contact information Would use if available	Information brochure explaining your approach to diabetes care and transition, services offered in your practice and contact information Would not use	Information brochure explaining your approach to diabetes care and transition, services offered in your practice and contact information Need to know more about this tool before using it
Transition care coordinator / dedicated transition nurse	Transition care coordinator / dedicated transition nurse Already in use	Transition care coordinator / dedicated transition nurse Would use if available	Transition care coordinator / dedicated transition nurse Would not use	Transition care coordinator / dedicated transition nurse Need to know more about this tool before using it
A person dedicated to booking and confirming appointments	A person dedicated to booking and confirming appointments Already in use	A person dedicated to booking and confirming appointments Would use if available	A person dedicated to booking and confirming appointments Would not use	A person dedicated to booking and confirming appointments Need to know more about this tool before using it
A self-care management checklist that assesses patient’s knowledge, skills and experiences in diabetes self-care	A self-care management checklist that assesses patient’s knowledge, skills and experiences in diabetes self-care Already in use	A self-care management checklist that assesses patient’s knowledge, skills and experiences in diabetes self-care Would use if available	A self-care management checklist that assesses patient’s knowledge, skills and experiences in diabetes self-care Would not use	A self-care management checklist that assesses patient’s knowledge, skills and experiences in diabetes self-care Need to know more about this tool before using it
A health care passport which includes a written medical summary and emergency care plan to share with the patient that is updated and printed in a portable format	A health care passport which includes a written medical summary and emergency care plan to share with the patient that is updated and printed in a portable format Already in use	A health care passport which includes a written medical summary and emergency care plan to share with the patient that is updated and printed in a portable format Would use if available	A health care passport which includes a written medical summary and emergency care plan to share with the patient that is updated and printed in a portable format Would not use	A health care passport which includes a written medical summary and emergency care plan to share with the patient that is updated and printed in a portable format Need to know more about this tool before using it
A tool to monitor progress of each patient during the transition process	A tool to monitor progress of each patient during the transition process Already in use	A tool to monitor progress of each patient during the transition process Would use if available	A tool to monitor progress of each patient during the transition process Would not use	A tool to monitor progress of each patient during the transition process Need to know more about this tool before using it
A registry to track attendance and loss to follow-up	A registry to track attendance and loss to follow-up Already in use	A registry to track attendance and loss to follow-up Would use if available	A registry to track attendance and loss to follow-up Would not use	A registry to track attendance and loss to follow-up Need to know more about this tool before using it
Feedback survey for young adults to complete about their experience with the new adult care team	Feedback survey for young adults to complete about their experience with the new adult care team Already in use	Feedback survey for young adults to complete about their experience with the new adult care team Would use if available	Feedback survey for young adults to complete about their experience with the new adult care team Would not use	Feedback survey for young adults to complete about their experience with the new adult care team Need to know more about this tool before using it