Trends in out-of-hospital healthcare use and costs in adolescents with complex conditions transitioning from pediatric care.

backgroundAdolescents with complex chronic conditions have substantial healthcare needs during the transition from pediatric to adult care, but out-of-hospital service use and costs are not well quantified.

methodsIn this prospective cohort study, adolescents attending the Transition Support Service clinic at the Royal Children's Hospital Melbourne were recruited. Linked Medicare data (2016-2021) were available for 161 participants, capturing 20,142 medical and 11,087 pharmaceutical records. Out-of-hospital service utilization and costs were analyzed annually before and after transition to adult care using MBS and PBS data, with descriptive analyses and interrupted time-series models.

resultsMean annual general practitioner visits increased from 4.7 pre-transfer to 6.3 in the year before transfer and stabilized thereafter. Specialist consultations remained high post-transfer, peaking at 4.5 visits per year. Annual pharmaceutical costs increased from A$1757 pre-transfer to A$7027 post-transfer. Nervous system medicines account for 20% of prescriptions throughout. Overall costs increased over time, with pharmaceuticals comprising 50% of total costs pre-transfer and approximately 90% post-transfer.

conclusionAdolescents with complex chronic conditions experience persistently high and increasing use of out-of-hospital care across the transition to adult care. Increases in utilization and costs begin prior to transfer and remain high throughout the transition period. IMPACT: This study provides robust evidence on patterns of out-of-hospital medical and pharmaceutical care use and expenditure pre and post transfer to adult care, using linked administrative Medicare data. Primary care use increased in the years preceding transfer and remained high following transition, indicating sustained reliance on primary care across the transition period. The rising use of specialist care, pathology, and diagnostic services, together with rising pharmaceutical expenditure, particularly for therapies accessed in adult care, highlights the clinical complexity for adolescents with chronic conditions during this critical period.