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Vindrola-Padros C, Ramsay AIG, Black G, Barod R, Hines J, Mughal M, Shackley D, Fulop NJ. Inter-organisational collaboration enabling care delivery in a specialist cancer surgery provider network: A qualitative study. J Health Serv Res Policy 2022; 27:211-221. [PMID: 35130097 PMCID: PMC9277336 DOI: 10.1177/13558196211053954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Objective To explore the processes, challenges and strategies used to govern and
maintain inter-organisational collaboration between professionals in a
provider network in London, United Kingdom, which implemented major system
change focused on the centralisation of specialist cancer surgery. Methods We used a qualitative design involving interviews with stakeholders
(n = 117), non-participant observations
(n = 163) and documentary analysis (n
= 100). We drew on an existing model of collaboration in healthcare
organisations and expanded this framework by applying it to the analysis of
collaboration in the context of major system change. Results Network provider organisations established shared goals, maintained central
figures who could create and sustain collaboration, and promoted distributed
forms of leadership. Still, organisations continued to encounter barriers or
challenges in relation to developing opportunities for mutual
acquaintanceship across all professional groups; the active sharing of
knowledge, expertise and good practice across the network; the fostering of
trust; and creation of information exchange infrastructures fit for
collaborative purposes. Conclusion Collaborative relationships changed over time, becoming stronger
post-implementation in some areas, but continued to be negotiated where
resistance to the centralisation remained. Future research should explore
the sustainability of these relationships and further unpack how hierarchies
and power relationships shape inter-organisational collaboration.
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Affiliation(s)
- Cecilia Vindrola-Padros
- Senior Research Fellow, Department of Targeted Intervention, University College London, London, UK
| | - Angus I G Ramsay
- Senior Research Fellow, Department of Applied Health Research, University College London, London, UK
| | - Georgia Black
- Principal Research Fellow, Department of Applied Health Research, 4919University College London, London, UK
| | - Ravi Barod
- Consultant Urological Surgeon, Specialist Centre for Kidney Cancer, 4965Royal Free London NHS Foundation Trust, London, UK
| | - John Hines
- Consultant Urological Surgeon and London Cancer Urology Pathway Board Director, Department of Urology, 8964University College London Hospitals NHS Foundation Trust, London, UK
| | - Muntzer Mughal
- Consultant General & Upper Gastrointestinal Surgeon, 8964University College London Hospitals NHS Foundation Trust, London, UK
| | - David Shackley
- Medical Director, Greater Manchester Cancer and Manchester Academic Health Science Centre, Christie NHS Foundation Trust, Manchester, UK
| | - Naomi J Fulop
- Professor of Health Care Organisation and Management, Department of Applied Health Research, University College London, London, UK
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2
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Johnson KR, Edens C, Sadun RE, Chira P, Hersh AO, Goh YI, Hui-Yuen J, Singer NG, Spiegel LR, Stinson JN, White PH, Lawson E. Differences in Healthcare Transition Views, Practices, and Barriers Among North American Pediatric Rheumatology Clinicians From 2010 to 2018. J Rheumatol 2021; 48:1442-1449. [PMID: 33526621 DOI: 10.3899/jrheum.200196] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Since 2010, the rheumatology community has developed guidelines and tools to improve healthcare transition. In this study, we aimed to compare current transition practices and beliefs among Childhood Arthritis and Rheumatology Research Alliance (CARRA) rheumatology providers with transition practices from a provider survey published in 2010. METHODS In 2018, CARRA members completed a 25-item online survey about healthcare transition. Got Transition's Current Assessment of Health Care Transition Activities was used to measure clinical transition processes on a scale of 1 (basic) to 4 (comprehensive). Bivariate analyses were used to compare 2010 and 2018 survey findings. RESULTS Over half of CARRA members completed the survey (202/396), including pediatric rheumatologists, adult- and pediatric-trained rheumatologists, pediatric rheumatology fellows, and advanced practice providers. The most common target age to begin transition planning was 15-17 years (49%). Most providers transferred patients prior to age 21 years (75%). Few providers used the American College of Rheumatology transition tools (31%) or have a dedicated transition clinic (23%). Only 17% had a transition policy in place, and 63% did not consistently address healthcare transition with patients. When compared to the 2010 survey, improvement was noted in 3 of 12 transition barriers: availability of adult primary care providers, availability of adult rheumatologists, and pediatric staff transition knowledge and skills (P < 0.001 for each). Nevertheless, the mean current assessment score was < 2 for each measurement. CONCLUSION This study demonstrates improvement in certain transition barriers and practices since 2010, although implementation of structured transition processes remains inconsistent.
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Affiliation(s)
- Kiana R Johnson
- K.R. Johnson, PhD, MSEd, MPH, Department of Pediatrics, East Tennessee State University, Johnson City, Tennessee;
| | - Cuoghi Edens
- C. Edens, MD, Departments of Medicine and Pediatrics, Sections of Rheumatology and Pediatric Rheumatology, University of Chicago, Chicago, Illinois
| | - Rebecca E Sadun
- R.E. Sadun, MD, PhD, Departments of Medicine and Pediatrics, Divisions of Rheumatology, Duke University Medical Center, Durham, North Carolina
| | - Peter Chira
- P. Chira, MD, Pediatric Rheumatology, University of California San Diego, Rady Children's Hospital, San Diego, California
| | - Aimee O Hersh
- A.O. Hersh, MD, Division of Pediatric Rheumatology, University of Utah, Salt Lake City, Utah
| | - Y Ingrid Goh
- Y.I. Goh, BS, Division of Rheumatology/Pediatrics, The Hospital for Sick Children, and Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Joyce Hui-Yuen
- J. Hui-Yuen, MD, MSc, FACR, FAAP, Pediatric Rheumatology, Cohen Children's Medical Center, New Hyde Park, New York
| | - Nora G Singer
- N.G. Singer MD, Departments of Medicine and Pediatrics, Division of Rheumatology, Metrohealth System and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Lynn R Spiegel
- L.R. Spiegel, MD, FRCPC, Division of Pediatrics/Rheumatology, University of Utah, Salt Lake City, Utah, USA, and Division of Rheumatology/Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jennifer N Stinson
- J.N. Stinson, RN-EC, PhD, CPNP, Division of Rheumatology/Pediatrics, The Hospital for Sick Children, and Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Patience H White
- P.H. White, MD, MA, FACP, FAAP, Got Transition, and Department of Medicine, Division of Rheumatology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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3
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Kelly A, Niddrie F, Tunnicliffe DJ, Matus Gonzalez A, Hanson C, Jiang I, Major G, Singh-Grewal D, Tymms K, Tong A. Patients' attitudes and experiences of transition from paediatric to adult healthcare in rheumatology: a qualitative systematic review. Rheumatology (Oxford) 2021; 59:3737-3750. [PMID: 32413124 DOI: 10.1093/rheumatology/keaa168] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/19/2020] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES We aimed to describe patients' attitudes and experiences of transition from paediatric to adult healthcare in rheumatology to inform patient-centred transitional care programmes. METHODS We searched MEDLINE, EMBASE, PsycINFO and CINAHL to August 2019 and used thematic synthesis to analyse the findings. RESULTS From 26 studies involving 451 people with juvenile-onset rheumatic conditions we identified six themes: a sense of belonging (comfort in familiarity, connectedness in shared experiences, reassurance in being with others of a similar age, desire for normality and acceptance); preparedness for sudden changes (confidence through guided introductions to the adult environment, rapport from continuity of care, security in a reliable point of contact, minimizing lifestyle disruptions); abandonment and fear of the unknown (abrupt and forced independence, ill-equipped to hand over medical information, shocked by meeting adults with visible damage and disability, vulnerability in the loss of privacy); anonymous and dismissed in adult care (deprived of human focus, sterile and uninviting environment, disregard of debilitating pain and fatigue); quest for autonomy (controlled and patronized in the paediatric environment, liberated from the authority of others, freedom to communicate openly); and tensions in parental involvement (overshadowed by parental presence, guilt of excluding parents, reluctant withdrawal of parental support). CONCLUSION Young people feel dismissed, abandoned, ill-prepared and out of control during transition. However, successful transition can be supported by preparing for changes, creating a sense of belonging and negotiating parental involvement and autonomy. Incorporating patient-identified priorities into transitional services may improve satisfaction and outcomes in young people with juvenile-onset rheumatic conditions.
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Affiliation(s)
- Ayano Kelly
- College of Health and Medicine, Australian National University.,Department of Rheumatology, The Canberra Hospital, Canberra, ACT.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead
| | - Fiona Niddrie
- Department of Rheumatology, Bone and Joint Centre, Royal Newcastle Centre/John Hunter Hospital, Newcastle
| | - David J Tunnicliffe
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead.,Sydney School of Public Health, The University of Sydney, Sydney
| | | | - Camilla Hanson
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead.,Sydney School of Public Health, The University of Sydney, Sydney
| | - Ivy Jiang
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead.,School of Medicine, University of New South Wales, Randwick
| | - Gabor Major
- Department of Rheumatology, Bone and Joint Centre, Royal Newcastle Centre/John Hunter Hospital, Newcastle.,School of Medicine and Public Health, University of Newcastle, Newcastle
| | - Davinder Singh-Grewal
- Department of Rheumatology, Bone and Joint Centre, Royal Newcastle Centre/John Hunter Hospital, Newcastle.,Department of Rheumatology, The Children's Hospital at Westmead, Westmead.,Discipline of Paediatrics and Child Health, The University of Sydney, Sydney.,School of Maternal and Child Health, University of New South Wales, Randwick.,Department of Rheumatology, Liverpool Hospital, Liverpool, NSW
| | - Kathleen Tymms
- College of Health and Medicine, Australian National University.,Department of Rheumatology, The Canberra Hospital, Canberra, ACT.,Canberra Rheumatology, Canberra, ACT, Australia
| | - Allison Tong
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead.,Sydney School of Public Health, The University of Sydney, Sydney
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4
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Jiang I, Major G, Singh-Grewal D, Teng C, Kelly A, Niddrie F, Chaitow J, O'Neill S, Hassett G, Damodaran A, Bernays S, Manera K, Tong A, Tunnicliffe DJ. Patient and parent perspectives on transition from paediatric to adult healthcare in rheumatic diseases: an interview study. BMJ Open 2021; 11:e039670. [PMID: 33397662 PMCID: PMC7783517 DOI: 10.1136/bmjopen-2020-039670] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES To describe the experiences, priorities, and needs of patients with rheumatic disease and their parents during transition from paediatric to adult healthcare. SETTING Face-to-face and telephone semistructured interviews were conducted from December 2018 to September 2019 recruited from five hospital centres in Australia. PARTICIPANTS Fourteen young people and 16 parents were interviewed. Young people were included if they were English speaking, aged 14-25 years, diagnosed with an inflammatory rheumatic disease (eg, juvenile idiopathic arthritis, juvenile dermatomyositis, systemic lupus erythematosus, panniculitis, familial Mediterranean fever) before 18 years of age. Young people were not included if they were diagnosed in the adult setting. RESULTS We identified four themes with respective subthemes: avoid repeat of past disruption (maintain disease stability, preserve adjusted personal goals, protect social inclusion); encounter a daunting adult environment (serious and sombre mood, discredited and isolated identity, fear of a rigid system); establish therapeutic alliances with adult rheumatology providers (relinquish a trusting relationship, seek person-focused care, redefine personal-professional boundaries, reassurance of alternative medical supports, transferred trust to adult doctor) and negotiate patient autonomy (confidence in formerly gained independence, alleviate burden on patients, mediate parental anxiety). CONCLUSIONS During transition, patients want to maintain disease stability, develop a relationship with their adult provider centralised on personal goals and access support networks. Strategies to comprehensively communicate information between providers, support self-management, and negotiate individualised goals for independence during transition planning may improve satisfaction, and health and treatment outcomes.
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Affiliation(s)
- Ivy Jiang
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Gabor Major
- Department of Rheumatology, Bone and Joint Centre, Royal Newcastle Centre, John Hunter Hospital, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle Faculty of Health and Medicine, Callaghan, New South Wales, Australia
| | - Davinder Singh-Grewal
- Department of Rheumatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Department of Rheumatology, The Sydney Children's Hospitals Network Randwick and Westmead, Westmead, New South Wales, Australia
| | - Claris Teng
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Ayano Kelly
- Rheumatology, Canberra Rheumatology, Canberra City, Australian Capital Territory, Australia
- College of Health and Medicine, Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Fiona Niddrie
- Department of Rheumatology, Bone and Joint Centre, Royal Newcastle Centre, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Jeffrey Chaitow
- Department of Rheumatology, Bone and Joint Centre, Royal Newcastle Centre, John Hunter Hospital, Newcastle, New South Wales, Australia
- Department of Rheumatology, The Sydney Children's Hospitals Network Randwick and Westmead, Westmead, New South Wales, Australia
| | - Sean O'Neill
- Department of Rheumatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Geraldine Hassett
- Department of Rheumatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Arvin Damodaran
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Rheumatology, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
| | - Sarah Bernays
- School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
- Global Health and Development, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Karine Manera
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - David J Tunnicliffe
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- University of Sydney, Sydney School of Public Health, New South Wales Ministry of Health, Sydney, New South Wales, Australia
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5
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Wigham S, Watts P, Zubala A, Jandial S, Bourne J, Hackett S. Using Arts-Based Therapies to Improve Mental Health for Children and Young People With Physical Health Long-Term Conditions: A Systematic Review of Effectiveness. Front Psychol 2020; 11:1771. [PMID: 33101097 PMCID: PMC7545424 DOI: 10.3389/fpsyg.2020.01771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/26/2020] [Indexed: 01/01/2023] Open
Abstract
Background: Children with physical health long-term conditions (LTCs) have increased risk of mental health difficulties relative to healthy peers. However, availability of psychological support integrated into pediatric physical health settings is limited, and there are long waiting times for access to child mental health services. Arts-based therapies involve using creative media to develop a therapeutic relationship, and offer a potential alternative to talking-based therapies. The aim of this systematic review is to establish the effectiveness of arts-based therapies for improving the mental health of children with physical health LTCs. Methods: The review protocol was published on PROSPERO. Four electronic databases were searched (Medline, Embase, Cinahl, and PsycINFO), plus hand searches of two key journals and relevant reviews, and forward/back citations searches of selected articles were conducted. The Effective Public Health Practice Project (EPHPP) Quality Assessment Tool was used to assess bias in selected articles. Second reviewers completed 10% of article screening and 20% of bias assessments. The findings were synthesized narratively. Results: Sixteen studies met inclusion criteria and demonstrated some improvements on indicators of mental health and well-being including quality of life, coping behaviors, anxiety, self-concept, and mood. However, replication across interventions and outcomes was absent. Overall, the quality of evidence of effectiveness in the studies reviewed was moderate/weak. This was due to bias in study design; other limitations included a lack of detail on intervention components, e.g., use of a manual, and single recruitment sites. Conclusions: The heterogeneity of existing research evaluating arts-based therapies for children with physical health LTCs limits conclusions about effectiveness. Suggestions are made to inform the design of future research studies to help build a robust evidence base.
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Affiliation(s)
- Sarah Wigham
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | | | - Ania Zubala
- Institute of Health Research and Innovation, University of the Highlands and Islands, Inverness, United Kingdom
| | - Sharmila Jandial
- Newcastle upon Tyne Hospital NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Jane Bourne
- Cumbria, Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Simon Hackett
- Faculty of Medical Sciences, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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6
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Dolezalova P, Anton J, Avcin T, Beresford MW, Brogan PA, Constantin T, Egert Y, Foeldvari I, Foster HE, Hentgen V, Kone-Paut I, Kuemmerle-Deschner JB, Lahdenne P, Magnusson B, Martini A, McCann L, Minden K, Ozen S, Schoemaker C, Quartier P, Ravelli A, Rumba-Rozenfelde I, Ruperto N, Vastert S, Wouters C, Zulian F, Wulffraat NM. The European network for care of children with paediatric rheumatic diseases: care across borders. Rheumatology (Oxford) 2020; 58:1188-1195. [PMID: 30668879 DOI: 10.1093/rheumatology/key439] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/25/2018] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To provide an overview of the paediatric rheumatology (PR) services in Europe, describe current delivery of care and training, set standards for care, identify unmet needs and inform future specialist service provision. METHODS An online survey was developed and presented to national coordinating centres of the Paediatric Rheumatology International Trials Organisation (PRINTO) (country survey) and to individual PR centres (centre and disease surveys) as a part of the European Union (EU) Single Hub and Access point for paediatric Rheumatology in Europe project. The survey contained components covering the organization of PR care, composition of teams, education, health care and research facilities and assessment of needs. RESULTS Response rates were 29/35 (83%) for country surveys and 164/288 (57%) for centre surveys. Across the EU, approximately one paediatric rheumatologist is available per million population. In all EU member states there is good access to specialist care and medications, although biologic drug availability is worse in Eastern European countries. PR education is widely available for physicians but is insufficient for allied health professionals. The ability to participate in clinical trials is generally high. Important gaps were identified, including lack of standardized clinical guidelines/recommendations and insufficient adolescent transition management planning. CONCLUSION This study provides a comprehensive description of current specialist PR service provision across Europe and did not reveal any major differences between EU member states. Rarity, chronicity and complexity of diseases are major challenges to PR care. Future work should facilitate the development, dissemination and implementation of standards of care, treatment and service recommendations to further improve patient-centred health care across Europe.
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Affiliation(s)
- Pavla Dolezalova
- Department of Paediatrics and Adolescent Medicine, General University Hospital, and 1st Faculty of Medicine, Charles University in Prague, Praha 2, Czech Republic
| | - Jordi Anton
- Department of Pediatric Rheumatology, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Tadej Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, University of Ljubljana and Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Michael W Beresford
- Department of Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Paul A Brogan
- Infection, Immunity and Inflammation, University College London Great Ormond St Institute of Child Health, London, UK
| | - Tamas Constantin
- 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | - Yona Egert
- European Network Childhood Arthritis Patient Organisation, Jerusalem, Israel
| | - Ivan Foeldvari
- Hamburg Centre for Pediatric and Adolescent Rheumatology, Hamburg, Germany
| | - Helen E Foster
- Newcastle University, and Great North Children's Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Veronique Hentgen
- Reference Center for Autoinflammatory Diseases, Versailles Hospital- CEREMAIA, Le Chesnay, Paris, France
| | - Isabelle Kone-Paut
- Pediatric Rheumatology and CEREMAIA, Le Kremlin-Bicêtre University Hospital, APHP, Paris-Sud University, Paris, France
| | - Jasmine B Kuemmerle-Deschner
- Division of Rheumatology, Department of Pediatrics, University Hospital Tuebingen, and Autoinflammation Reference Center Tuebingen, Tuebingen, Germany
| | - Pekka Lahdenne
- Pediatric Rheumatology, Helsinki Children's Hospital, Helsinki University Central Hospital, Finland
| | - Bo Magnusson
- Pediatric Rheumatology Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Alberto Martini
- Direzione Scientifica, Istituto Giannina Gaslini, Genoa, Italy
| | - Liza McCann
- Department of Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Kirsten Minden
- Department of Rheumatology and Clinical Immunology, German Rheumatism Research Centre Berlin, Charite University Medicine Berlin, Berlin, Germany
| | - Seza Ozen
- Department for Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Casper Schoemaker
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Kinderziekenhuis, University Medical Center Utrecht, Utrecht, Netherlands
| | - Pierre Quartier
- French Reference Centre RAISE, Paris-Descartes University, IMAGINE Institute, Necker Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Angelo Ravelli
- Clinica Pediatrica e Reumatologia and University of Genoa, Instituto Giannina Gaslini, Genoa, Italy
| | | | - Nicola Ruperto
- Clinica Pediatrica e Reumatologia, PRINTO Coordinating Centre, Instituto Giannina Gaslini, Genoa, Italy
| | - Sebastian Vastert
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Kinderziekenhuis, University Medical Center Utrecht, Utrecht, Netherlands
| | - Carine Wouters
- Department of Pediatrics, Division of Pediatric Rheumatology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Francesco Zulian
- Department of Woman and Child Health, University of Padova, Padova, Italy
| | - Nico M Wulffraat
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Kinderziekenhuis, University Medical Center Utrecht, Utrecht, Netherlands
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7
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Burke L, Kirkham J, Arnott J, Gray V, Peak M, Beresford MW. The transition of adolescents with juvenile idiopathic arthritis or epilepsy from paediatric health-care services to adult health-care services: A scoping review of the literature and a synthesis of the evidence. J Child Health Care 2018; 22:332-358. [PMID: 29355024 DOI: 10.1177/1367493517753330] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Young people with long-term health conditions (LTCs) can face challenges when making the transition to adult health services. This paper sought to identify studies that assess and explore transitional care for young people with LTCs. Two conditions were used as exemplars: juvenile idiopathic arthritis (JIA) and epilepsy. A scoping review of the literature was conducted by using search terms to search for papers in English between 2001 and 2016 concerning transitional care on four databases. Qualitative papers were reviewed and synthesized using thematic analysis. Quantitative papers using health outcomes were also synthesized. Twenty-eight papers were selected for review. Despite the wealth of literature concerning aspects of transitional care that are key to a successful transition for young people with JIA or epilepsy, there is a paucity of outcomes that define 'successful' transition and consequently a lack of reliable research evaluating the effectiveness of transitional care interventions to support young people moving to adult health services.
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Affiliation(s)
- Lauren Burke
- 1 Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Jamie Kirkham
- 1 Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Janine Arnott
- 2 School of Nursing, University of Central Lancashire, Preston, UK
| | - Victoria Gray
- 3 Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Matthew Peak
- 3 Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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8
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Walter M, Hazes JM, Dolhain RJ, van Pelt P, van Dijk A, Kamphuis S. Development of a clinical transition pathway for adolescents in the Netherlands. Nurs Child Young People 2018; 29:37-43. [PMID: 29115764 DOI: 10.7748/ncyp.2017.e932] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2017] [Indexed: 01/23/2023]
Abstract
AIMS To explore how young people with juvenile-onset rheumatic and musculoskeletal diseases (jRMDs) and their parent(s) experience care during preparation for the upcoming transfer to adult services, and to develop a clinical transition pathway. METHOD A survey was conducted with 32 young people aged between 14 and 20 years with jRMDs, and their parents ( n =33), treated at the department of paediatric rheumatology in a tertiary care children's hospital in the Netherlands. RESULTS More than 30% of young people would have liked to discuss topics such as educational and vocational choices in a clinic, but did not get the opportunity. Preparation for transition was poor as was training in self-management skills. One third of parents had feelings of anxiety about the upcoming transfer. Results from the survey and evidence-based principles of transitional care were used to develop the clinical transition pathway. The pathway focuses on starting transition early, developing self-management skills, joint consultations and supporting parents in giving young people control of their clinical care. CONCLUSION Care does not currently meet the needs of young people in the process of transition to adult rheumatology services. The clinical transition pathway developed as a result of the study is a tool that may improve this process.
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Affiliation(s)
- Margot Walter
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Johanna Mw Hazes
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Radboud Jem Dolhain
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Philomine van Pelt
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Annette van Dijk
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Sylvia Kamphuis
- Department of Rheumatology, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
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9
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Luque Ramos A, Hoffmann F, Albrecht K, Klotsche J, Zink A, Minden K. Transition to adult rheumatology care is necessary to maintain DMARD therapy in young people with juvenile idiopathic arthritis. Semin Arthritis Rheum 2017; 47:269-275. [PMID: 28583690 DOI: 10.1016/j.semarthrit.2017.05.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 05/08/2017] [Accepted: 05/10/2017] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To evaluate the outpatient health service utilisation of young people (YP) with juvenile idiopathic arthritis (JIA) during transfer from paediatric to adult care in Germany. METHODS Based on claims data of a large German statutory health fund (BARMER GEK) we conducted a cohort study of 2008-2014. Insured YP with diagnosis of JIA (ICD: M08 or M09.0) in two quarters at the age of 16 and continuous insurance until the age of 20 were included. Outpatient health care utilisation, prescribed antirheumatic drugs and diagnosis maintenance were analysed over four consecutive years for all YP with JIA and for the subgroup on disease-modifying antirheumatic drugs (DMARDs) at the age of 16. RESULTS A total of 256 YP with JIA (67% female) were followed during the transfer period, 115 of them received (DMARDs) at the age of 16. At the age of 20, 30% of all 256 YP utilised adult specialty care, 59% still had a JIA diagnosis and 30% were treated with DMARDs. Of those 115 YP, treated with DMARDs at the age of 16 and in need of follow-up, 49% had visited an adult rheumatologist at the age of 20, 75% had a JIA diagnosis and 56% were on DMARDs. Those 49% YP with successful transfer to adult specialty care had a JIA diagnosis in 93% and were treated with DMARDs in 80%. YP, who were only seen by general practitioners, had a JIA diagnosis in 54% and received DMARDs in 27%. CONCLUSIONS One in two YP with JIA and a clear need for ongoing follow-up do not utilise adult rheumatologic care. The maintenance of JIA diagnosis and DMARD therapy depend on the utilisation of specialised care services.
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Affiliation(s)
- Andres Luque Ramos
- Department of Health Services Research, Carl von Ossietzky University, Oldenburg, Ammerländer Heerstrasse 140, 26111, Germany.
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University, Oldenburg, Ammerländer Heerstrasse 140, 26111, Germany
| | - Katinka Albrecht
- Department of Epidemiology, German Rheumatism Research Centre, Berlin, Germany
| | - Jens Klotsche
- Department of Epidemiology, German Rheumatism Research Centre, Berlin, Germany; Charité University Medicine, Berlin, Germany
| | - Angela Zink
- Department of Epidemiology, German Rheumatism Research Centre, Berlin, Germany; Charité University Medicine, Berlin, Germany
| | - Kirsten Minden
- Department of Epidemiology, German Rheumatism Research Centre, Berlin, Germany; Charité University Medicine, Berlin, Germany
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10
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Foster HE, Minden K, Clemente D, Leon L, McDonagh JE, Kamphuis S, Berggren K, van Pelt P, Wouters C, Waite-Jones J, Tattersall R, Wyllie R, Stones SR, Martini A, Constantin T, Schalm S, Fidanci B, Erer B, Demirkaya E, Ozen S, Carmona L. EULAR/PReS standards and recommendations for the transitional care of young people with juvenile-onset rheumatic diseases. Ann Rheum Dis 2016; 76:639-646. [PMID: 27802961 DOI: 10.1136/annrheumdis-2016-210112] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/11/2016] [Accepted: 10/16/2016] [Indexed: 02/06/2023]
Abstract
To develop standards and recommendations for transitional care for young people (YP) with juvenile-onset rheumatic and musculoskeletal diseases (jRMD). The consensus process involved the following: (1) establishing an international expert panel to include patients and representatives from multidisciplinary teams in adult and paediatric rheumatology; (2) a systematic review of published models of transitional care in jRMDs, potential standards and recommendations, strategies for implementation and tools to evaluate services and outcomes; (3) setting the framework, developing the process map and generating a first draft of standards and recommendations; (4) further iteration of recommendations; (5) establishing consensus recommendations with Delphi methodology and (6) establishing standards and quality indicators. The final consensus derived 12 specific recommendations for YP with jRMD focused on transitional care. These included: high-quality, multidisciplinary care starting in early adolescence; the integral role of a transition co-ordinator; transition policies and protocols; efficient communications; transfer documentation; an open electronic-based platform to access resources; appropriate training for paediatric and adult healthcare teams; secure funding to continue treatments and services into adult rheumatology and the need for increased evidence to inform best practice. These consensus-based recommendations inform strategies to reach optimal outcomes in transitional care for YP with jRMD based on available evidence and expert opinion. They need to be implemented in the context of individual countries, healthcare systems and regulatory frameworks.
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Affiliation(s)
- Helen E Foster
- Newcastle University, Institute of Cellular Medicine (Rheumatology), Newcastle, UK
| | - Kirsten Minden
- Children's University hospital Charité, Campus Virchow, SPZ, Berlin, Germany.,Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Daniel Clemente
- Paediatric Rheumatology Unit, Hospital Infantil Universitario "Niño Jesús", Madrid, Spain
| | - Leticia Leon
- Hospital Cí-nico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IDISSC), Madrid, Madrid, Spain.,Health Sciences, Universidad Camilo José Cela, Madrid, Madrid, Spain
| | - Janet E McDonagh
- University of Manchester, Centre for Musculoskeletal Research, Manchester, Manchester, UK
| | - Sylvia Kamphuis
- Immunology and Infectiology, Erasmus MC-Sophia, Rotterdam, The Netherlands
| | | | - Philomine van Pelt
- Department of Paediatrics/Paediatric Rheumatology, Erasmus MC Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands
| | - Carine Wouters
- Pediatric Immunology, University Hospital Gasthuisberg, Leuven, Belgium
| | | | - Rachel Tattersall
- University of Sheffield, School of Health and Related Research, Sheffield, Sheffield, UK
| | - Ruth Wyllie
- Paediatric Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Newcastle upon Tyne, UK
| | | | - Alberto Martini
- Pediatria II, Universita degli Studi di Genova Scuola di Scienze Mediche e Farmaceutiche, Genova, Liguria, Italy
| | | | - Susanne Schalm
- Transitionssprechstunde am Dr. von Haunerschen Kinderspital, Ludwig-Maximilians-Universität München, Munchen, Germany
| | - Berna Fidanci
- Gulhane Military Medical Academy, School of Nursing, Ankara, Turkey, Ankara, Turkey
| | - Burak Erer
- Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Erkan Demirkaya
- Gulhane Military Medical Faculty, Pediatric Rheumatology Unit, FMF Arthritis Vasculitis and Orphan Disease Research in Pediatric Rheumatology (FAVOR), Etlik, Ankara 06018, Turkey, Ankara, Turkey
| | - Seza Ozen
- Pediatric Rheumatology, Hacettepe University Medical Faculty, Ankara, Turkey
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