Transitional Care in Rheumatology: a Review of the Literature from the Past 5 Years

Abstract

Purpose of Review Effective transitional care for adolescents and young adults (AYA) with rheumatic musculoskeletal disease (RMD) is fundamental to rheumatology care provision. Here we review the recent evidence from the literature on transition in rheumatology and debate why universal implementation has yet to be recognised. Recent Findings Evidence of need for transitional care continues to be reported. The triphasic nature of transitional care remains poorly recognised, and the third phase following transfer to adult rheumatology is particularly under-researched in spite of the recognition of the age-related trajectories of transition skill development during young adulthood. Several rheumatology-specific transitional care interventions have now been evaluated but the search for valid measures including outcome continues. Finally, the need to study transition at a health system level is increasingly recognised. Summary Future research in this area should consider the developmental trajectories of AYA as well as the social-ecological model of transition readiness, which focuses on the interactions between AYA, caregivers and providers (and the systems they are part of) as these are the likely targets of any intervention to improve health transitions.

The readiness of pediatric rheumatology patients and their parents to transition to adult‐oriented treatment

“…17 Assessment of patient readiness for transition using a reliable and validated tool is important. There are several transition readiness assessment tools, 18 but only TRAQ was validated for use in Turkey. 6 The number of studies on rheumatic disease patient transition readiness are insufficient and mainly included patients with JIA irrespective of their biological therapy use.…”

National Priorities for High-quality Rheumatology Transition Care for Youth in Canada

“…There is growing evidence for the value of transition care in rheumatology outcomes (3), but most of the evidence supports that transition and transfer periods are high-risk periods for gaps in care leading to poor patient outcomes. Continuity of care is a key indicator of successful transition(4), yet 25-75% of youth with juvenile idiopathic arthritis (JIA) and other rheumatic diseases have a gap in their care or are lost to follow-up during transfer to adult services (5)(6)(7)(8).…”

“…The European League Against Rheumatism (EULAR)/Pediatric Rheumatology European Society (PReS) has published guidelines for the transition of children with juvenile-onset rheumatic diseases(10). Despite the increased attention to the practice of transition, barriers to providing optimal care remain, including education and exposure to high quality transition during training (11), and appropriate healthcare infrastructure and patient supports for the transition process (3). In a study including both American and Canadian pediatric rheumatologists, insufficient time to provide transition services, perceived insufficient readiness and self-management skills of adolescents, fragmentation and lack of primary and specialty adult care providers, and lack of knowledge about linkages to community resources that support young adults were reported (12).…”

<p>Young Minds: Mental Health and Transitional Care in Adolescent and Young Adult Rheumatology</p>

“…Transitional care in health addresses the medical as well as the psychological, social, and educational/vocational issues as the young person moves from pediatric to adult health care. 15 There are now international recommendations available for how such care should be provided 16 which state that it should be developmentally appropriate. 17 Rheumatology professionals are well placed both to identify and address mental health issues during adolescence and young adulthood in view of the frequent encounters and ongoing therapeutic relationships.…”