# Which factors affect post-transfer gaps in follow-up care? A qualitative study of the insights of healthcare providers in Sweden and Belgium

## TL;DR

This study explores factors influencing continued follow-up care for young adults with congenital heart disease after transitioning from pediatric to adult care.

## Contribution

The study provides new insights into hospital and healthcare system factors affecting post-transfer follow-up care, beyond previously known patient-related factors.

## Key findings

- Three main categories of factors were identified: care structure, care processes, and patient characteristics.
- Process-related and structure-related aspects of care were perceived as more influential than individual patient characteristics.
- Success in continued follow-up care emphasized collaboration, organization, and transitional care interventions.

## Abstract

Young people with congenital heart disease (CHD) are frequently affected by discontinued follow-up when transferring from paediatric to adult care. Identified predictors for discontinuation include mostly patient-related factors, and further knowledge of hospital and healthcare system factors is needed.

This study aims to explore patient-related, hospital-related and healthcare system-related factors affecting continued follow-up care after transfer, as perceived and experienced by paediatric cardiology and adult CHD (ACHD) healthcare providers (HCPs) in Sweden and Belgium.

This descriptive qualitative study included individual interviews with cardiologists, nurses and administrative staff, subjected to qualitative content analysis. A total of 30 HCPs from 13 specialist care outpatient clinics at 8 different centres in Sweden and Belgium were interviewed. HCPs were included if they had direct contact with patients and had at least 1 year of work experience.

The findings illuminate three main categories of factors perceived by HCPs to affect continued follow-up care after transfer, including ‘care structure’, ‘care processes’ and ‘patient characteristics and circumstances’. Success was described as multifactorial, emphasising processes and structures of care, with a focus on collaboration, organisation, joint responsibility, resources, care relationships and transitional care interventions. Few differences appeared between paediatric and ACHD HCPs and between Swedish and Belgian HCPs.

HCPs perceived factors on patient, hospital and healthcare system levels to influence continued follow-up. Process-related and structure-related aspects of care were perceived as more influential than individual patient characteristics. Hence, future research on discontinued follow-up care should focus on process-related and structure-related aspects of care delivery.