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Mejía González MA, Quijada Morales P, Escobar MÁ, Juárez Guerrero A, Seoane-Reula ME. Navigating the transition of care in patients with inborn errors of immunity: a single-center's descriptive experience. Front Immunol 2023; 14:1263349. [PMID: 37854610 PMCID: PMC10579936 DOI: 10.3389/fimmu.2023.1263349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/15/2023] [Indexed: 10/20/2023] Open
Abstract
The transition from pediatric to adult care is a critical milestone in managing children, especially in those with complex chronic conditions. It involves ensuring the patient and family adapt correctly to the new phase, maintaining continuity of ongoing treatments, and establishing an appropriate follow-up plan with specialists. Patients with Inborn error of immunity (IEI), formerly known as Primary Immune Disorders (PID) are part of a group of disorders characterized by alterations in the proper functioning of the immune system; as the diagnostic and treatment tools for these entities progress, life expectancy increases, and new needs emerge. These children have special needs during the transition. Particularly important in the group of children with PID and syndromic features, who often present multiple chronic medical conditions. In these cases, transition planning is a significant challenge, involving not only the patients and their families but also a wide range of specialists. To achieve this, a multidisciplinary transition team should be established between the pediatric specialists and the adult consultants, designing a circuit in which communication is essential. As few transition care guidelines in the field of PID are available, and to our knowledge, there is no specific information available regarding patients with PID associated with syndromic features, we share our experience in this issue as a Primary Immunodeficiencies Unit that is a National Reference Center for PID, and propose a guide to achieve an adequate and successful transition to adulthood in these patients, especially in those with associated syndromic features.
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Affiliation(s)
- María Alejandra Mejía González
- Immunology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Primary Immunodeficiencies Unit (National Reference Center for Primary Immunodeficiencies (PID)), Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Patricia Quijada Morales
- Primary Immunodeficiencies Unit (National Reference Center for Primary Immunodeficiencies (PID)), Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Pediatric Immuno-Allergy, Allergy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Ángeles Escobar
- Primary Immunodeficiencies Unit (National Reference Center for Primary Immunodeficiencies (PID)), Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Day-care Hospital of Immunology, Department of Nursing of Day-care Hospital, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Alba Juárez Guerrero
- Primary Immunodeficiencies Unit (National Reference Center for Primary Immunodeficiencies (PID)), Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Pediatric Immuno-Allergy, Allergy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Elena Seoane-Reula
- Primary Immunodeficiencies Unit (National Reference Center for Primary Immunodeficiencies (PID)), Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Pediatric Immuno-Allergy, Allergy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Medical Advisor of the Spanish Association of Primary Immunodeficiencies (AEDIP), Madrid, Spain
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Ouimet F, Fortin J, Bogossian A, Padley N, Chapdelaine H, Racine E. Transitioning from pediatric to adult healthcare with an inborn error of immunity: a qualitative study of the lived experience of youths and their families. Front Immunol 2023; 14:1211524. [PMID: 37600793 PMCID: PMC10432858 DOI: 10.3389/fimmu.2023.1211524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/27/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Transition from pediatric to adult healthcare is a multifaceted and consequential process with important health implications for youth. Although research on transition has grown significantly, research on transition for patients living with an inborn error of immunity (IEI) is scarce. We undertook a qualitative study to better understand the perspectives of youths and parents in an outpatient immunology clinic. Methdos Semi-structured interviews were conducted with 9 youths, 6 parents and 5 clinicians, all recruited from the same clinic. All youths recently transferred to adult care with or without an established diagnosis of IEI. Interviews were transcribed verbatim and thematic analysis was conducted. Two sets of themes were generated. The first set captured the positive and negative aspects experienced during transition, as well as recommendations to facilitate the process. The second set focused on key topics discussed in the interviews that were merged into overarching themes. Results Perspectives of participants were clustered into 6 overarching themes: (1) lack of knowledge about IEIs; (2) scattered transitions; (3) changing healthcare teams; (4) approaching an unknown environment; (5) transitioning to adulthood; (6) assuming responsibility for the management of the condition. Overall, the challenges encountered with respect to these themes had profound clinical and humanistic implications for patients such as generating significant distress. Discussion We discuss the unique challenges of the youths in our study in comparison to common problems reported by youths with chronic illness in the broader transition literature (for example: the change of healthcare team, the lack of information about the transition process and navigating the adult care system, growth towards self-management and the co-occurring developmental transition to adulthood). There is an urgency to attend to the specific problems created by the rarity of IEIs and related lack of knowledge about them as well as the need for multidisciplinary cross-clinic care during transition and beyond.
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Affiliation(s)
- François Ouimet
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - Justine Fortin
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - Aline Bogossian
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
- École de travail social, Faculté des arts et des sciences, Université de Montréal, Montréal, QC, Canada
| | - Nicole Padley
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
| | - Hugo Chapdelaine
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
- Faculté de médecine, Université de Montréal, Montréal, QC, Canada
| | - Eric Racine
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, QC, Canada
- Faculté de médecine, Université de Montréal, Montréal, QC, Canada
- Département de médecine et Département de médecine sociale et préventive, Université de Montréal, Montréal, QC, Canada
- Division of Experimental Medicine, McGill University, Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
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Chan CM, Abdul Latiff AH, Noh LM, Ismail IH, Abd Hamid IJ, Liew WK, Zhong Y, Suratannon N, Nantanee R, Santos-Ocampo FJ, Castor MAR, Nguyen-Ngoc-Quynh L, Van Nguyen AT, Thuc HT, Tuan NM, Muktiarti D, Amalia R, Chean S, Try L, Ali A. Transition practice for primary immunodeficiency diseases in Southeast Asia: a regional survey. Front Immunol 2023; 14:1209315. [PMID: 37529038 PMCID: PMC10390097 DOI: 10.3389/fimmu.2023.1209315] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/23/2023] [Indexed: 08/03/2023] Open
Abstract
Introduction With increased diagnostic capabilities and treatment modalities in the field of primary immunodeficiencies (PID), many pediatric patients survive beyond childhood and experience a change of care to the adult-oriented healthcare system. Unfortunately, the transition pathways for PID are less clearly defined, resulting in deterioration of quality of care in adulthood. Hence, this is the first regional study to address PID clinicians' opinions on practices and challenges of transition care in 7 Southeast Asia (SEA) countries. Methods We adopted a cross-sectional study design through an online survey platform to enquire opinions of transition practices from expert representatives in 7 SEA countries. Results Regionally, 3 out 7 countries reported having no practice of transition care. Among cited challenges were reluctant adaptation by patients and caregivers to unfamiliarized adult healthcare systems, inadequate ratio of adult immunologists to patients and lack of facilities for transfer. Discussion and conclusion Our study provides evidence to advocate policy makers on the importance of standardized integration of transition practice towards betterment of transiting PID patients into adulthood.
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Affiliation(s)
- Chee Mun Chan
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Research Center, Hospital Tunku Ampuan Besar Tuanku Aishah Rohani, Universiti Kebangsaan Malaysia (UKM) Specialist Children’s Hospital, Kuala Lumpur, Malaysia
| | | | - Lokman Mohd Noh
- Malaysian Patient Organization for Primary Immunodeficiencies (MYPOPI), Shah Alam, Selangor, Malaysia
| | - Intan Hakimah Ismail
- Clinical Immunology Unit, Department of Paediatrics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Intan Juliana Abd Hamid
- Primary Immunodeficiency Diseases Group, Department of Clinical Medicine, Institut Perubatan & Pergigian Termaju, Universiti Sains Malaysia, Kepala Batas, Pulau Pinang, Malaysia
| | - Woei Kang Liew
- Rheumatology and Immunology Service, Department of Pediatric Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Youjia Zhong
- Department of Pediatrics, Yong Loo Lin School of Medicine, Kent Ridge, National University of Singapore, Kent Ridge Country, Singapore
| | - Narissara Suratannon
- Center of Excellence for Allergy and Clinical Immunology, Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Rapisa Nantanee
- Center of Excellence for Allergy and Clinical Immunology, Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | | | - Mary Anne R. Castor
- Division of Allergy and Immunology, Department of Pediatrics, College of Medicine - Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | | | - Anh Thi Van Nguyen
- Allergy - Immunology - Rheumatology Department , National Children’s Hospital, Hanoi, Vietnam
| | - Huyen Thanh Thuc
- Allergy and Clinical Immunology Center, Vinmec International Hospital, Hanoi, Vietnam
| | - Nguyen Minh Tuan
- Department of Paediatrics, Children’s Hospital 1, Ho Chi Minh, Vietnam
| | - Dina Muktiarti
- Department of Child Health, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Rizqi Amalia
- Department of Child Health, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Sophâl Chean
- Department of Pediatric Hemato-Immunology, National Pediatric Hospital, Phnom Penh, Cambodia
| | - Lytheang Try
- Department of Pediatric Hemato-Immunology, National Pediatric Hospital, Phnom Penh, Cambodia
| | - Adli Ali
- Department of Pediatric, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Research Center, Hospital Tunku Ampuan Besar Tuanku Aishah Rohani, Universiti Kebangsaan Malaysia (UKM) Specialist Children’s Hospital, Kuala Lumpur, Malaysia
- Institute of IR4.0, Universiti Kebangsaan Malaysia, Bangi, Malaysia
- Infection and Immunology Health and Advanced Medicine Cluster, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Watad A, Bragazzi NL, Shoenfeld Y. Insights from the 11th International Congress on Autoimmunity, Lisbon, Portugal, 2018. Clin Immunol 2018; 199:5-6. [PMID: 30543924 DOI: 10.1016/j.clim.2018.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Abdulla Watad
- Department of Medicine 'B', Tel-Aviv University, Israel; Zabludowicz Center for Autoimmune Diseases, Tel-Aviv University, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel; Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK.
| | - Nicola Luigi Bragazzi
- Postgraduate School of Public Health, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Tel-Aviv University, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Israel
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