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Bailey K, Avolio J, Lo L, Gajaria A, Mooney S, Greer K, Martens H, Tami P, Pidduck J, Cunningham J, Munce S, Toulany A. Social and Structural Drivers of Health and Transition to Adult Care. Pediatrics 2024; 153:e2023062275. [PMID: 38084099 DOI: 10.1542/peds.2023-062275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 01/02/2024] Open
Abstract
CONTEXT Youth with chronic health conditions experience challenges during their transition to adult care. Those with marginalized identities likely experience further disparities in care as they navigate structural barriers throughout transition. OBJECTIVES This scoping review aims to identify the social and structural drivers of health (SSDOH) associated with outcomes for youth transitioning to adult care, particularly those who experience structural marginalization, including Black, Indigenous, and 2-spirit, lesbian, gay, bisexual, transgender, queer or questioning, and others youth. DATA SOURCES Medline, Embase, CINAHL, and PsycINFO were searched from earliest available date to May 2022. STUDY SELECTION Two reviewers screened titles and abstracts, followed by full-text. Disagreements were resolved by a third reviewer. Primary research studying the association between SSDOH and transition outcomes were included. DATA EXTRACTION SSDOH were subcategorized as social drivers, structural drivers, and demographic characteristics. Transition outcomes were classified into themes. Associations between SSDOH and outcomes were assessed according to their statistical significance and were categorized into significant (P < .05), nonsignificant (P > .05), and unclear significance. RESULTS 101 studies were included, identifying 12 social drivers (childhood environment, income, education, employment, health literacy, insurance, geographic location, language, immigration, food security, psychosocial stressors, and stigma) and 5 demographic characteristics (race and ethnicity, gender, illness type, illness severity, and comorbidity). No structural drivers were studied. Gender was significantly associated with communication, quality of life, transfer satisfaction, transfer completion, and transfer timing, and race and ethnicity with appointment keeping and transfer completion. LIMITATIONS Studies were heterogeneous and a meta-analysis was not possible. CONCLUSIONS Gender and race and ethnicity are associated with inequities in transition outcomes. Understanding these associations is crucial in informing transition interventions and mitigating health inequities.
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Affiliation(s)
- Katherine Bailey
- Temerty Faculty of Medicine
- Institute of Health Policy, Management and Evaluation
| | | | - Lisha Lo
- Centre for Quality Improvement and Patient Safety
| | - Amy Gajaria
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Margaret and Wallace McCain Centre for Child, Youth, and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sarah Mooney
- Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta, Canada
- Alberta Strategy for Patient Oriented Research Support Unit
- Faculty of Nursing, Grant MacEwan University, Edmonton, Alberta, Canada
| | - Katelyn Greer
- Alberta Strategy for Patient Oriented Research Support Unit
| | - Heather Martens
- Patient and Community Engagement Research (PaCER) Program, University of Calgary, Calgary, Alberta,Canada
- Alberta Health Services, Edmonton, Alberta, Canada
- KickStand, Mental Health Foundation, Edmonton, Alberta, Canada
| | - Perrine Tami
- Public Health and Preventative Medicine, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Sarah Munce
- Rehabilitation Sciences Institute
- Department of Occupational Science and Occupational Therapy
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Alene Toulany
- Temerty Faculty of Medicine
- Institute of Health Policy, Management and Evaluation
- Department of Pediatrics, Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health and Evaluative Sciences, Sickkids Research Institute, Toronto, Ontario, Canada
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Tadros S, Burns SO. Transition of care in inborn errors of immunity. Curr Opin Allergy Clin Immunol 2023; 23:455-460. [PMID: 37797181 PMCID: PMC10621636 DOI: 10.1097/aci.0000000000000948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
PURPOSE OF REVIEW This review outlines the principles of transition, summarizes current information about transition practices in inborn errors of immunity (IEI) and highlights general and specific considerations for transition of patients with these conditions. RECENT FINDINGS Recent surveys demonstrate the variability in access to and transition practices in IEI. Key challenges of transition in IEI from the perspective of healthcare professionals include lack of adult subspecialists, lack of access to holistic care and fragmentation of adult services. Limited research focused on IEI patient and carer perspectives highlight information gaps, poor coordination and difficulty adapting to adult healthcare structures as important challenges for smooth transition. SUMMARY Local policies and practices for transition in IEI are highly variable with limited assessment of outcomes or patient experience. There is a need for IEI-focused transition research and for development of national and international consensus statements to guide improved transition in IEI.
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Affiliation(s)
- Susan Tadros
- Department of Immunology, Royal Free London NHS Foundation Trust
- University College London Institute of Immunity and Transplantation, London, UK
| | - Siobhan O. Burns
- Department of Immunology, Royal Free London NHS Foundation Trust
- University College London Institute of Immunity and Transplantation, London, UK
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Buie J, McMillan E, Kirby J, Cardenas LA, Eftekhari S, Feldman CH, Gawuga C, Knight AM, Lim SS, McCalla S, McClamb D, Polk B, Williams E, Yelin E, Shah S, Costenbader KH. Disparities in Lupus and the Role of Social Determinants of Health: Current State of Knowledge and Directions for Future Research. ACR Open Rheumatol 2023; 5:454-464. [PMID: 37531095 PMCID: PMC10502817 DOI: 10.1002/acr2.11590] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 06/28/2023] [Accepted: 07/01/2023] [Indexed: 08/03/2023] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease. The complex relationships between race and ethnicity and social determinants of health (SDOH) in influencing SLE and its course are increasingly appreciated. Multiple SDOH have been strongly associated with lupus incidence and outcomes and contribute to health disparities in lupus. Measures of socioeconomic status, including economic instability, poverty, unemployment, and food insecurity, as well as features of the neighborhood and built environment, including lack of safe and affordable housing, crime, stress, racial segregation, and discrimination, are associated with race and ethnicity in the US and are risk factors for poor outcomes in lupus. In this scientific statement, we aimed to summarize current evidence on the role of SDOH in relation to racial and ethnic disparities in SLE and SLE outcomes, primarily as experienced in the U.S. Lupus Foundation of America's Health Disparities Advisory Panel, comprising 10 health disparity experts, including academic researchers and patients, who met 12 times over the course of 18 months in assembling and reviewing the data for this study. Sources included articles published from 2011 to 2023 in PubMed, Centers for Disease Control and Prevention data, and bibliographies and recommendations. Search terms included lupus, race, ethnicity, and SDOH domains. Data were extracted and synthesized into this scientific statement. Poorer neighborhoods correlate with increased damage, reduced care, and stress-induced lupus flares. Large disparities in health care affordability, accessibility, and acceptability exist in the US, varying by region, insurance status, and racial and minority groups. Preliminary interventions targeted social support, depression, and shared-decision-making, but more research and intervention implementation and evaluation are needed. Disparities in lupus across racial and ethnic groups in the US are driven by SDOH, some of which are more easily remediable than others. A multidimensional and multidisciplinary approach involving various stakeholder groups is needed to address these complex challenges, address these diminish disparities, and improve outcomes.
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Affiliation(s)
- Joy Buie
- Lupus Foundation of AmericanWashingtonDC
| | | | | | | | - Sanaz Eftekhari
- Asthma and Allergy Foundation of AmericaGreater LandoverMaryland
| | - Candace H. Feldman
- Harvard Medical School and Brigham and Women's HospitalBostonMassachusetts
| | - Cyrena Gawuga
- Preparedness and Treatment Equity CoalitionNew York CityNew York
| | - Andrea M. Knight
- Hospital for Sick Children and University of TorontoTorontoOntarioCanada
| | - S. Sam Lim
- Emory University and Grady Health SystemAtlantaGeorgia
| | | | | | - Barbara Polk
- John F. Kennedy Center for the Performing Arts and Amplify People AdvisorsWashingtonDC
| | | | - Ed Yelin
- University of California San Francisco
| | - Sanoja Shah
- Charles River AssociatesSan FranciscoCalifornia
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Dhital R, Guma M, Poudel DR, Chambers C, Kalunian K. Infection-related hospitalisation in young adults with systemic lupus erythematosus: data from the National Inpatient Sample. Lupus Sci Med 2023; 10:10/1/e000851. [PMID: 37019477 PMCID: PMC10083864 DOI: 10.1136/lupus-2022-000851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/07/2023] [Indexed: 04/07/2023]
Abstract
INTRODUCTION Care of young adults with SLE (YA-SLE, 18-24 years) is challenging due to major life transitions co-occurring with chronic healthcare needs. Studies have demonstrated poorer outcomes in the post-transition period. Epidemiological studies focused on serious infection-related hospitalisation (SIH) in YA-SLE are lacking. METHODS We used National Inpatient Sample from 2010 to 2019 to study the epidemiology and outcomes of SIH for five common infections in SLE, namely sepsis, pneumonia, urinary tract infections, skin and soft tissue infections, and opportunistic infections. For time trends, we extended the dataset to cover 2000-2019. The primary outcome was the rate of SIH in YA-SLE compared with adults (25-44 years) with SLE and with young adults without SLE (YA-no SLE). RESULTS From 2010 to 2019, we identified 1 720 883 hospital admissions with SLE in patients aged ≥18 years. Rates of SIH were similar in young adults and adults with SLE (15.0% vs 14.5%, p=0.12), but considerably higher than in the YA-no SLE group (4.2%, p<0.001). Among SLE with SIH, sepsis followed by pneumonia was the most common diagnosis. Significantly higher proportions of SIH among young adults than adults with SLE were comprised of non-white patients, belonged to the lowest income quartile and had Medicaid. However, only race/ethnicity was associated with SIH among YA-SLE. There was a higher prevalence of comorbid lupus nephritis and pleuritis among young adults compared with adults with SLE and SIH, and both comorbidities were associated with SIH in YA-SLE. Increasing rates of SIH, driven by sepsis, were seen over time. DISCUSSION YA- SLE had similar rates of SIH to adults with SLE. While hospitalised YA-SLE differed sociodemographically from SLE adults and YA-no SLE, only race/ethnicity was associated with SIH in the YA-SLE group. Lupus nephritis and pleuritis were associated with higher SIH in YA-SLE. Among SLE with SIH, increasing trends of sepsis deserve further study.
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Affiliation(s)
- Rashmi Dhital
- Division of Rheumatology, Department of Medicine, UCSD, La Jolla, California, USA
| | - Monica Guma
- Division of Rheumatology, Department of Medicine, UCSD, La Jolla, California, USA
- Division of Rheumatology, VA San Diego Health Care System, San Diego, California, USA
| | - Dilli R Poudel
- Department of Medicine, Indiana Regional Medical Center, Indiana, Pennsylvania, USA
| | - Christina Chambers
- Division of Environmental Science and Health, Department of Pediatrics, UCSD, La Jolla, California, USA
| | - Kenneth Kalunian
- Division of Rheumatology, Department of Medicine, UCSD, La Jolla, California, USA
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Huckerby L, McDonagh JE, Lee RR. Growing up with chronic pain: a systematic review of the evidence in transitional care for young people with chronic pain. Rheumatol Adv Pract 2023; 7:i19-i25. [PMID: 36968631 PMCID: PMC10036995 DOI: 10.1093/rap/rkad006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/27/2022] [Indexed: 03/26/2023] Open
Abstract
Objective Paediatric chronic pain presents a significant individual and societal burden, with an estimated prevalence of 11–38%. A large proportion of adolescents with chronic pain will have unresolved pain that continues into adulthood and thus requires transitional care. The aim of this review was to investigate the current evidence for the core components of effective transitional care interventions designed for young people with chronic pain. Methods Studies were identified by searching the Embase, MEDLINE, CINAHL and PsycINFO databases. A search strategy using terms such as ‘Adolescent’, ‘Persistent long-term pain’ and ‘Transition’ (or variations of such words) was implemented. Inclusion criteria were sample population age 10–24 years, a confirmed diagnosis of a condition characterized by chronic pain, any healthcare setting, any service provider, published peer reviewed and English language. Results Ninety-eight articles were identified by the search and 14 were selected after abstract screening. Two independent reviewers screened the articles, followed by a senior reviewer. Of the 14 articles, full-text review found that none of the articles looked specifically at evidence with respect to core components of effective transitional care designed for young people with chronic pain. Conclusion Chronic pain is a feature of many long-term health conditions. It remains unknown as to whether there are any pain-specific aspects of transitional care. How pain management is addressed in existing transitional care provision and the relationship of pain to outcomes needs further research. If effective interventions can be provided during these crucial years, the trajectory of these young people can potentially be improved into adulthood.
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Affiliation(s)
- Lauren Huckerby
- Royal Manchester Children’s Hospital, Manchester University Hospitals Trust, Manchester, UK
| | - Janet E McDonagh
- Correspondence to: Janet E. McDonagh, Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Stopford Building, 2 Floor, Room 2.607, Oxford Rd, Manchester M13 9PL, UK. E-mail:
| | - Rebecca Rachael Lee
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- National Institute for Health Research Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester, UK
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Smitherman EA, Chahine RA, Bitencourt N, Rahman AKMF, Lawson EF, Chang JC. Patient-Reported Outcomes Among Transition-Age Young Adults With Juvenile Idiopathic Arthritis in the Childhood Arthritis and Rheumatology Research Alliance Registry. J Rheumatol 2023; 50:98-106. [PMID: 36109074 DOI: 10.3899/jrheum.220514] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To evaluate patient-reported care utilization and outcomes among young adults with juvenile idiopathic arthritis (JIA), including factors associated with complete transfer to adult rheumatology. METHODS We included young adults with JIA enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry from 2015 to 2019 with age ≥ 18 years at their last clinical site visit. We used data from the CARRA Registry Long-term Follow-up program, which follows inactive CARRA Registry patients and collects patient-reported information through phone surveys. We compared the characteristics of respondents with complete and incomplete transfer to adult rheumatology care at their first Long-term Follow-up phone survey. RESULTS We identified 540 young adults with JIA; 187 (35%) responded to the Long-term Follow-up phone survey. The 54% of respondents with complete transfer to adult rheumatology were slightly older and reported more self-assessed disease activity, morning stiffness, and pain compared to those with incomplete transfer. Biologic use was high at both timepoints and did not differ by transfer status. Patients who completed the transfer were more likely to have private insurance and be actively pursuing postsecondary education compared to those with an incomplete transfer. Across the cohort, 65% reported problems with pain or discomfort and 45% with anxiety or depression. CONCLUSION Young adult respondents with JIA in the CARRA Registry commonly report persistent medication use, but still report more problems with pain as compared to population norms. Additional work is needed to understand how best to address comorbid pain around the period of transition to adult care.
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Affiliation(s)
- Emily A Smitherman
- E.A. Smitherman, MD, MS, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama;
| | - Rouba A Chahine
- R.A. Chahine, PhD, Social, Statistical and Environmental Sciences Unit, RTI International, Research Triangle Park, North Carolina
| | - Nicole Bitencourt
- N. Bitencourt, MD, Department of Pediatrics, Loma Linda University Health, Loma Linda, California
| | - A K M Fazlur Rahman
- A.K.M.F. Rahman, PhD, Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Erica F Lawson
- E.F. Lawson, MD, Department of Pediatrics, University of California San Francisco, San Francisco, California
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Ciosek AL, Makris UE, Kramer J, Bermas BL, Solow EB, Wright T, Bitencourt N. Health Literacy and Patient Activation in the Pediatric to Adult Transition in Systemic Lupus Erythematosus: Patient and Health Care Team Perspectives. ACR Open Rheumatol 2022; 4:782-793. [PMID: 35716025 PMCID: PMC9469480 DOI: 10.1002/acr2.11474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 05/01/2022] [Accepted: 05/19/2022] [Indexed: 11/05/2022] Open
Abstract
Objective Methods Results Conclusion
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Affiliation(s)
| | - Una E. Makris
- University of Texas Southwestern Medical Center and Veterans Administration North Texas Health Care System Dallas
| | | | | | | | - Tracey Wright
- University of Texas Southwestern Medical Center, Texas Scottish Rite Hospital for Children, and Children's Health Dallas Dallas Texas
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Appenzeller S, Pereira DR, Julio PR, Reis F, Rittner L, Marini R. Neuropsychiatric manifestations in childhood-onset systemic lupus erythematosus. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:571-581. [PMID: 35841921 DOI: 10.1016/s2352-4642(22)00157-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 05/06/2022] [Accepted: 05/13/2022] [Indexed: 06/15/2023]
Abstract
Neuropsychiatric manifestations occur frequently and are challenging to diagnose in childhood-onset systemic lupus erythematosus (SLE). Most patients with childhood-onset SLE have neuropsychiatric events in the first 2 years of disease. 30-70% of patients present with more than one neuropsychiatric event during their disease course, with an average of 2-3 events per person. These symptoms are associated with disability and mortality. Serum, cerebrospinal fluid, and neuroimaging findings have been described in childhood-onset SLE; however, only a few have been validated as biomarkers for diagnosis, monitoring response to treatment, or prognosis. The aim of this Review is to describe the genetic risk, clinical and neuroimaging characteristics, and current treatment strategies of neuropsychiatric manifestations in childhood-onset SLE.
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Affiliation(s)
- Simone Appenzeller
- Department of Orthopedics, Rheumatology, and Traumatology, University of Campinas, Campinas, Brazil; Rheumatology Laboratory, University of Campinas, Campinas, Brazil.
| | - Danilo Rodrigues Pereira
- Rheumatology Laboratory, University of Campinas, Campinas, Brazil; Medical Physiopathology Graduate Program, University of Campinas, Campinas, Brazil
| | - Paulo Rogério Julio
- Rheumatology Laboratory, University of Campinas, Campinas, Brazil; Child and Adolescent Health Graduate Program, University of Campinas, Campinas, Brazil
| | - Fabiano Reis
- Department of Radiology, University of Campinas, Campinas, Brazil
| | - Leticia Rittner
- School of Medical Science; School of Electrical and Computer Engineering, University of Campinas, Campinas, Brazil
| | - Roberto Marini
- Pediatric Rheumatology Unit, Department of Pediatrics, University of Campinas, Campinas, Brazil
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Ma C, Dushnicky M, Talaat H, Thomas S, Cellucci T, Garner S, Heale L, Matsos M, Beattie K, Batthish M. Self-Reported Transition Readiness of Adolescent Patients with Rheumatic Disease: Do the Parents Agree? J Pediatr 2022; 247:155-159. [PMID: 35561803 DOI: 10.1016/j.jpeds.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/05/2022] [Accepted: 05/06/2022] [Indexed: 11/17/2022]
Abstract
Our objective was to compare transition readiness assessment scores from adolescents with rheumatic disease with their parents and analyze their level of agreement. We found that adolescents and parents generally agree on the level of the transition readiness; however, there is occasional disagreement in specific domains.
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Affiliation(s)
- Christina Ma
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Molly Dushnicky
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Habeba Talaat
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Steffy Thomas
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Tania Cellucci
- Division of Rheumatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Stephanie Garner
- Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Liane Heale
- Division of Rheumatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Mark Matsos
- Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Karen Beattie
- Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Michelle Batthish
- Division of Rheumatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
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Morsa M. The imperative for mental health assessment and support in healthcare transition for adolescents and young adults with chronic conditions and special healthcare needs. J Pediatr Nurs 2022; 64:151-152. [PMID: 35184938 DOI: 10.1016/j.pedn.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 02/08/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Maxime Morsa
- Sorbonne Paris North University, Laboratory of Education and Health Promotion (UR3412), Villetaneuse, France.
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Bitencourt N, Ciosek A, Kramer J, Solow EB, Bermas B, Wright T, Nassi L, Makris U. "You Just Have to Keep Going, You Can't Give Up": Coping mechanisms among young adults with lupus transferring to adult care. Lupus 2021; 30:2221-2229. [PMID: 34874764 DOI: 10.1177/09612033211061057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Coping mechanisms and emotional regulation are important contributors to psychosocial health during stressful life events. We sought to describe the coping and emotional responses of persons with childhood-onset systemic lupus erythematosus during the transfer from pediatric to adult healthcare. METHODS Semi-structured in-depth one-on-one interviews were conducted with 13 young women aged 18-24 of minority background who had transferred to adult care in a public hospital system. Thematic analysis was used to identify themes motifs from the data. RESULTS Participants described the use of (1) problem-focused coping such as the use of clear communication and self-education, (2) adaptive emotion-focused coping such as cognitive reframing and acceptance, (3) social coping including support-seeking, (4) meaning-making coping including positive religious framing and viewing events as learning opportunities for growth, and (5) disengaged coping including denial and social isolation. A range of emotional responses associated with the transfer were described including fear, anger, loss, and feelings of empowerment and excitement. CONCLUSION Effective coping and emotional regulation are modifiable factors that may impact transfer-related outcomes and psychosocial health. Addressing coping mechanisms is relevant to the optimized transfer to adult care.
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Affiliation(s)
- Nicole Bitencourt
- Division of Pediatric Rheumatology, 23335Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Ashley Ciosek
- 25989University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Justin Kramer
- Department of Health and Kinesiology, 14736Texas A&M University, College Station, TX, USA
| | - E Blair Solow
- Division of Rheumatic Diseases, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bonnie Bermas
- Division of Rheumatic Diseases, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Tracey Wright
- Division of Pediatric Rheumatology, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA.,Pediatric Rheumatology, Texas Scottish Rite Hospital for Children, Dallas, TX, USA
| | - Lorien Nassi
- Division of Pediatric Rheumatology, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA.,Pediatric Rheumatology, Texas Scottish Rite Hospital for Children, Dallas, TX, USA
| | - Una Makris
- Division of Rheumatic Diseases, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA.,Medical Service, VA North Texas Health Care System, Dallas, TX, USA
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Overbury RS, Huynh K, Bohnsack J, Frech T, Hersh A. A novel transition clinic structure for adolescent and young adult patients with childhood onset rheumatic disease improves transition outcomes. Pediatr Rheumatol Online J 2021; 19:164. [PMID: 34852832 PMCID: PMC8638174 DOI: 10.1186/s12969-021-00651-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The transition of health care from Pediatric to Adult providers for adolescents and young adults with chronic disease is associated with poor outcomes. Despite the importance of this transition, over 80% of these patients do not receive the services necessary to transition to Adult health care. In 2018, we initiated a transition clinic structure, integrating an Internal Medicine - Pediatrics trained Adult Rheumatologist in a Pediatric Rheumatology clinic to guide this transition. Our goal was to improve transition outcomes. We report the methods of this clinic and its preliminary outcomes. METHODS For patients referred to the transition clinic, the Adult Rheumatologist assumed medical management and implemented a six-part modular transition curriculum. This curriculum included a Transition Policy, Transition Readiness Assessment, medication review and education, diagnosis review and education, and counseling on differences between Pediatric and Adult-oriented care. Eligible patients and their families were enrolled in a prospective observational outcomes research registry. Initial data from this transition clinic is reported including adherence with certain aspects of the transition curriculum and clinic utilization. RESULTS The transition clinic Adult Rheumatologist saw 177 patients in 2 years, and 57 patients were eligible for, approached, and successfully enrolled in the registry. From this registry, all patients reviewed the Transition Policy with the Adult Rheumatologist and 45 (78.9%) completed at least one Transition Readiness Assessment. Of the 22 patients for whom transition was indicated, all were successfully transitioned to an Adult Rheumatologist. 17 (77.3%) continued care post-transition with the transition clinic Adult Rheumatologist, and 5 (22.7%) continued care post-transition with a different Adult Rheumatologist. The median time between the last transition clinic visit and first Adult clinic visit was 5.1 months. CONCLUSIONS Our experience demonstrated the success of our clinic model regarding participation in the transition curriculum and improved clinic utilization data. Our results are an improvement over transition rates reported elsewhere that did not implement our model. We believe that this structure could be applied to other primary care and subspecialty clinics. TRIAL REGISTRATION This research was approved by the University of Utah Institutional Review Board (IRB) in January 2019 (IRB_00115964). Patients were retrospectively registered if involved prior to this date.
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Affiliation(s)
- Rebecca S Overbury
- Division of Pediatric Rheumatology, University of Utah, 30N 1900E 4B200, Salt Lake City, UT, 84132, USA.
- Division of Rheumatology, University of Utah, 30N 1900E 4B200, Salt Lake City, UT, 84132, USA.
| | - Kelly Huynh
- Intermountain Healthcare, Salt Lake City, UT, USA
| | - John Bohnsack
- Division of Pediatric Rheumatology, University of Utah, 30N 1900E 4B200, Salt Lake City, UT, 84132, USA
| | - Tracy Frech
- Division of Rheumatology, University of Utah, 30N 1900E 4B200, Salt Lake City, UT, 84132, USA
| | - Aimee Hersh
- Division of Pediatric Rheumatology, University of Utah, 30N 1900E 4B200, Salt Lake City, UT, 84132, USA
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Abstract
Health and health care disparities in pediatric rheumatology are prevalent among socially disadvantaged and marginalized populations based on race/ethnicity, socioeconomic position, and geographic region. These groups are more likely to experience greater disease severity, morbidity, mortality, decreased quality of life, and poor mental health outcomes, which are in part due to persistent structural and institutional barriers, including decreased access to quality health care. Most of the research on health and health care disparities in pediatric rheumatology focuses on juvenile idiopathic arthritis and childhood-onset systemic lupus erythematosus; there are significant gaps in the literature assessing disparities associated with other pediatric rheumatic diseases. Understanding the underlying causes of health care disparities will ultimately inform the development and implementation of innovative policies and interventions on a federal, local, and individual level.
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Affiliation(s)
- Alisha M Akinsete
- Division of Pediatric Rheumatology, Department of Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, 3415 Bainbridge Avenue, Bronx, NY 10467, USA. https://twitter.com/@akinsetemd
| | - Jennifer M P Woo
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, 111 TW Alexander Drive, Research Triangle Park, NC 27709, USA. https://twitter.com/@jmpwoo
| | - Tamar B Rubinstein
- Division of Pediatric Rheumatology, Department of Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, 3415 Bainbridge Avenue, Bronx, NY 10467, USA.
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14
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Time to First Completed Visit and Health Care Utilization Among Young Adults Transferring From Pediatric to Adult Rheumatologic Care in a Safety‐Net Hospital. Arthritis Care Res (Hoboken) 2021; 73:1730-1738. [DOI: 10.1002/acr.24409] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 08/04/2020] [Indexed: 12/13/2022]
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15
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Case S, Sinnette C, Phillip C, Grosgogeat C, Costenbader KH, Leatherwood C, Feldman CH, Son MB. Patient experiences and strategies for coping with SLE: A qualitative study. Lupus 2021; 30:1405-1414. [PMID: 34013818 DOI: 10.1177/09612033211016097] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE This study explored challenges that patients with systemic lupus erythematosus (SLE) and childhood-onset SLE (cSLE) face to identify modifiable influences and coping strategies in patient experiences. METHODS Participants were recruited from two academic medical centers through a Lupus Registry of individuals ≥18 years old and ≥4 1997 ACR classification criteria for SLE and a centralized data repository of cSLE patients, and participated in three focus groups. Transcripts were coded thematically and adjudicated by two independent reviewers. RESULTS Thirteen adults, 7 (54%) with cSLE, participated in focus groups. Themes were categorized into two domains: (1) challenges with SLE diagnosis and management; and (2) patient coping strategies and modifiable factors of the SLE experience. Participants identified five primary challenges: diagnostic odyssey, public versus private face of SLE, SLE-related stresses, medication adherence, and transitioning from pediatric to adult care. Coping strategies and modifiable factors included social support, open communication about SLE, and strong patient-provider relationships. Several participants highlighted positive lessons learned through their experiences with SLE, including empathy, resilience, and self-care skills. CONCLUSIONS Patients with cSLE and SLE identified common challenges, modifying influences and coping strategies based on personal experiences. A strong patient-provider relationship and trust in the medical team emerged as key modifiable factors. Deriving optimism from experiences with SLE was unique to several patients diagnosed as children or young adults. Leveraging factors that improved the participants' experiences living with SLE may be used in future studies to address vulnerabilities in care.
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Affiliation(s)
- Siobhan Case
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA.,Division of Allergy, Immunology, and Rheumatology, Boston Children's Hospital, Boston, MA, USA
| | - Corine Sinnette
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Courtnie Phillip
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Claire Grosgogeat
- Division of Allergy, Immunology, and Rheumatology, Boston Children's Hospital, Boston, MA, USA
| | - Karen H Costenbader
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Cianna Leatherwood
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Candace H Feldman
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Mary Beth Son
- Division of Allergy, Immunology, and Rheumatology, Boston Children's Hospital, Boston, MA, USA
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Roberts JE, Halyabar O, Petty CR, Son MB. Assessing preparation for care transition among adolescents with rheumatologic disease: a single-center assessment with patient survey. Pediatr Rheumatol Online J 2021; 19:61. [PMID: 33933123 PMCID: PMC8088202 DOI: 10.1186/s12969-021-00544-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the risk for poor outcomes and gaps in care in the transfer from pediatric to adult care, most pediatric rheumatology centers lack formal transition pathways. As a first step in designing a pathway, we evaluated preparation for transition in a single-center cohort of adolescents and young adults (AYA) with rheumatologic conditions using the ADolescent Assessment of Preparation for Transition (ADAPT) survey. FINDINGS AYA most frequently endorsed receiving counseling on taking charge of their health and remembering to take medications. Less than half reported receiving specific counseling about transferring to an adult provider. AYA with lower education attainment compared with those who had attended some college or higher had lower scores in self-management (1.51 vs 2.52, p = 0.0002), prescription medication counseling (1.96 vs 2.41, p = 0.029), and transfer planning (0.27 vs 1.62, p < 0.001). AYA with a diagnosis of MCTD, Sjögren's or SLE had higher self-management scores than those with other diagnoses (2.6 vs 1.9; p = 0.048). Non-white youth indicated receiving more thorough medication counseling than white youth (2.71 vs 2.07, p = 0.027). When adjusting for age, educational attainment remained an independent predictor of transfer planning (p = 0.037). AYA with longer duration of seeing their physician had higher transition preparation scores (p = 0.021). CONCLUSION Few AYA endorsed receiving comprehensive transition counseling, including discussion of transfer planning. Those who were younger and with lower levels of education had lower preparation scores. A long-term relationship with providers was associated with higher scores. Further research, including longitudinal assessment of transition preparation, is needed to evaluate effective processes to assist vulnerable populations.
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Affiliation(s)
- Jordan E. Roberts
- grid.2515.30000 0004 0378 8438Division of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts USA
| | - Olha Halyabar
- grid.2515.30000 0004 0378 8438Division of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts USA
| | - Carter R. Petty
- grid.2515.30000 0004 0378 8438Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, Massachusetts USA
| | - Mary Beth Son
- grid.2515.30000 0004 0378 8438Division of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts USA
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17
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McColl J, Semalulu T, Beattie KA, Alam A, Thomas S, Herrington J, Gorter JW, Cellucci T, Garner S, Heale L, Matsos M, Batthish M. Transition Readiness in Adolescents With Juvenile Idiopathic Arthritis and Childhood-Onset Systemic Lupus Erythematosus. ACR Open Rheumatol 2021; 3:260-265. [PMID: 33711192 PMCID: PMC8063142 DOI: 10.1002/acr2.11237] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/20/2021] [Accepted: 01/27/2021] [Indexed: 11/25/2022] Open
Abstract
Objective The transition from pediatric to adult rheumatology care represents a particularly vulnerable time for patients with juvenile idiopathic arthritis (JIA) and childhood‐onset systemic lupus erythematosus (cSLE). Improving self‐management skills is important in optimizing health care transition. The study’s objectives were to 1) examine variability in transition readiness of adolescents and young adults within and between different ages, sexes, and disease types; 2) determine the association between age and transition readiness; and 3) identify specific challenges to transition readiness for adolescents. Methods Over 1 year, patients 14 to 20 years of age with JIA or cSLE were recruited from pediatric transition and young adult clinics at a single academic institution. Participants completed the 14‐item Transition‐Q at a single time point. Total scores range from 0 to 100; higher scores indicate greater health care self‐management skills as a proxy for transition readiness. Descriptive statistics summarized patient characteristics and Transition‐Q scores for the population. Regression analyses determined the association between age, sex, and disease type and Transition‐Q score. Results Among 70 participants, 61 had JIA and 9 cSLE (mean disease duration 4.6 years). The mean (SD) total Transition‐Q score was 59.8 (14.9). Age was significantly associated with Transition‐Q score (standardized β = 0.372l P = 0.002). The most commonly reported challenges were seeing the physician alone (without parents), making one’s own appointments, picking up prescriptions, and independent transportation for appointments. Conclusion Transition readiness appears to increase with patient age. There is significant variability in Transition‐Q scores between patients of the same age, suggesting that an individualized approach to improving self‐management skills is necessary.
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Affiliation(s)
| | | | | | - Arzoo Alam
- McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | | | - Liane Heale
- McMaster University, Hamilton, Ontario, Canada
| | - Mark Matsos
- McMaster University, Hamilton, Ontario, Canada
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18
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How to close the gap between paediatric and adult care. Nat Rev Rheumatol 2021; 17:9-10. [PMID: 33128019 DOI: 10.1038/s41584-020-00534-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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19
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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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20
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Chang JC, Knight AM, Lawson EF. Patterns of Healthcare Use and Medication Adherence among Youth with Systemic Lupus Erythematosus during Transfer from Pediatric to Adult Care. J Rheumatol 2021; 48:105-113. [PMID: 32007936 DOI: 10.3899/jrheum.191029] [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] [Accepted: 01/10/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Youth with systemic lupus erythematosus (SLE) transferring from pediatric to adult care are at risk for poor outcomes. We describe patterns of rheumatology/nephrology care and changes in healthcare use and medication adherence during transfer. METHODS We identified youth ages 15-25 with SLE using US private insurance claims from Optum's deidentified Clinformatics Data Mart. Rheumatology/nephrology visit patterns were categorized as (1) unilateral transfers to adult care within 12 months, (2) overlapping pediatric and adult visits, (3) lost to followup, or (4) continuing pediatric care. We used negative binomial regression and paired t tests to estimate changes in healthcare use and medication possession ratios (MPR) after the last pediatric (index) visit. We compared MPR between youth who transferred and age-matched peers continuing pediatric care. RESULTS Of the 184 youth transferred out of pediatric care, 41.8% transferred unilaterally, 31.5% had overlapping visits over a median of 12 months before final transfer, and 26.6% were lost to followup. We matched 107 youth continuing pediatric care. Overall, ambulatory care use decreased among those lost to followup. Acute care use decreased across all groups. MPR after the index date were lower in youth lost to followup (mean 0.24) compared to peers in pediatric care (mean 0.57, p < 0.001). CONCLUSION Youth with SLE with continuous private insurance coverage do not use more acute care after transfer to adult care. However, a substantial proportion fail to see adult subspecialists within 12 months and have worse medication adherence, placing them at higher risk for adverse outcomes.
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Affiliation(s)
- Joyce C Chang
- J.C. Chang, MD, MSCE, Division of Rheumatology, and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA;
| | - Andrea M Knight
- A.M. Knight, MD, MSCE, Division of Rheumatology, and SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Erica F Lawson
- E.F. Lawson, MD, Division of Rheumatology, University of California San Francisco Benioff Children's Hospital, San Francisco, California, USA
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21
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Palman J, McDonagh JE. Young Minds: Mental Health and Transitional Care in Adolescent and Young Adult Rheumatology. Open Access Rheumatol 2020; 12:309-321. [PMID: 33324121 PMCID: PMC7732171 DOI: 10.2147/oarrr.s228083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 11/11/2020] [Indexed: 12/27/2022] Open
Abstract
Consideration of the mental health and emotional wellbeing is an important component of health care for all young people, irrespective of setting. Mental health disorders are common during adolescence and young adulthood and young people with rheumatic musculoskeletal diseases (RMD) are not exempt. For such young people, risks of poor outcomes are related to both mental health as well as their RMD. Times of change during adolescence and young adulthood-transitions-are potentially vulnerable life stages for young people with RMD and warrant specific attention in health care provision. Such transitions include those occurring at puberty, during education, training, and employment, socially with moves away from the parental home, as well as from child to adult-centered health services. There is great potential for rheumatology professionals to support young people with RMD at these transitions in view of their frequent encounters and ongoing therapeutic relationships. In this review, we aim to assess the impact of mental health on RMD during adolescence and young adulthood with particular reference to transitional care provision and how rheumatology professionals can be involved in addressing mental health issues during this time of change.
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Affiliation(s)
- Jason Palman
- Department of Paediatric and Adolescent Rheumatology, Royal Manchester Children’s Hospital, Manchester University Hospitals NHS Trust, ManchesterM13 9WL, UK
| | - Janet E McDonagh
- Department of Paediatric and Adolescent Rheumatology, Royal Manchester Children’s Hospital, Manchester University Hospitals NHS Trust, ManchesterM13 9WL, UK
- Versus Arthritis Centre for Epidemiology; Centre for MSK Research, University of Manchester, Manchester, UK
- NIHR Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester, UK
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22
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Barnabe C, Chomistek K, Luca N, Hazlewood G, Barber CEH, Steiman A, Stringer E. National Priorities for High-quality Rheumatology Transition Care for Youth in Canada. J Rheumatol 2020; 48:426-433. [PMID: 33060318 DOI: 10.3899/jrheum.200790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To conduct a needs assessment and environmental scan to support optimal transition from pediatric to adult rheumatology care in Canada. METHODS This initiative involved 3 phases: (1) a survey-based needs assessment of adult and pediatric rheumatologist members of the Canadian Rheumatology Association to identify perceived infrastructure, educational needs, and national resources to support transition care; (2) an environmental scan, through semistructured interviews, of existing rheumatology transition service care models and challenges in care delivery; and (3) a focus group to prioritize national activities. RESULTS The needs assessment survey was completed by 65 members, with 66% agreeing that a national approach to transition care was needed. Semistructured interviews reflecting activities at 9 transition care sites were conducted, and they identified candidate models of care, including direct transfer, progressive transfer, and shared care models. Challenges and needs experienced in these care models reflected resource and infrastructure needs, poor availability of mechanisms to support parents and youth through the transition process, and the need for evaluation to support quality improvement. The focus group and prioritization activity was attended by 26 participants, with each having the ability to cast 3 votes. "Supporting patient education for transition to adult rheumatology health care system" (n = 17 votes) and "advocacy activities to access allied health support, including funding" (n = 10 votes) emerged as the top priorities for national initiatives. CONCLUSION We have identified priorities in education and advocacy for advancing transition care in Canada that require participation of pediatric and adult rheumatology providers, patients, and arthritis stakeholders in the interest of advancing transition care outcomes.
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Affiliation(s)
- Cheryl Barnabe
- C. Barnabe, MD, MSc, Associate Professor, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Past-Chair, Quality Care Committee, Canadian Rheumatology Association;
| | - Kelsey Chomistek
- K. Chomistek, BSc, Masters of Science student, Faculty of Graduate Studies, University of Calgary, Calgary, Alberta
| | - Nadia Luca
- N. Luca, MD, MSc, Clinical Assistant Professor in the Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Executive, Pediatrics Committee, Canadian Rheumatology Association
| | - Glen Hazlewood
- G. Hazlewood, MD, PhD, Assistant Professor, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Member, Quality Care Committee, Canadian Rheumatology Association
| | - Claire E H Barber
- C.E. Barber, MD, PhD, Assistant Professor, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Member, Quality Care Committee, Canadian Rheumatology Association
| | - Amanda Steiman
- A. Steiman, MD, MSc, Assistant Professor, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, and Chair, Quality Care Committee, Canadian Rheumatology Association
| | - Elizabeth Stringer
- E. Stringer, MD, Associate Professor, Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, and Member, Pediatrics Committee, Canadian Rheumatology Association, Canada
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Abstract
Disparities in prevalence, disease severity, physical and mental morbidity, and mortality exist in childhood-onset systemic lupus (cSLE) that lead to worse outcomes in children with systemic lupus erythematosus from socially disadvantaged backgrounds. Important gaps exist in knowledge regarding many individual race/ethnicities across the globe, the interaction between race/ethnicity and poverty, and drivers for identified disparities. Large cSLE registries will facilitate investigating disparities in groups of patients that have yet to be identified. Social-ecological models can inform approaches to investigate, monitor, and address disparities in cSLE.
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24
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Bitencourt N, Kramer J, Bermas BL, Solow EB, Wright T, Makris UE. Clinical Team Perspectives on the Psychosocial Aspects of Transition to Adult Care for Patients With Childhood-Onset Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2020; 73:39-47. [PMID: 32976698 DOI: 10.1002/acr.24463] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/17/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The transition from pediatric to adult care for youth with childhood-onset systemic lupus erythematosus (SLE) is a vulnerable period. Adverse outcomes during this transition include gaps in care, unscheduled health care utilization, loss of insurance, and high disease activity. The objective of this study was to examine the clinical care teams' perspective on the psychosocial factors associated with transition outcomes, which are poorly understood in this population. METHODS We conducted in-depth interviews with clinical care team members who interact with childhood-onset SLE patients during transfer from pediatric to adult rheumatology. A semistructured interview guide was used to prompt participants' perspectives about the psychosocial factors associated with the transition process for patients with childhood-onset SLE. Audio recordings were transcribed and analyzed using the constant comparative method. We stopped conducting interviews once thematic saturation was achieved. RESULTS Thirteen in-depth interviews were conducted. Participants included pediatric rheumatologists (n = 4), adult rheumatologists from both academic and private practice settings (n = 4), nurses (n = 2), a nurse practitioner, a social worker, and a psychologist. We identified several themes deemed by clinical care teams as important during the transition, including the impact of the family, patient resilience and coping mechanisms, the role of mental health and emotional support, and the need for education, peer support, and social connectedness. CONCLUSION We identified several psychosocial themes that clinical team members believe impact the transition of patients with childhood-onset SLE into adult care. The role of parental modeling, youth resilience, mental health and emotional care, improved childhood-onset SLE education, and structured peer support and social connectedness are highlighted, which may be amenable to interventions.
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Affiliation(s)
| | - Justin Kramer
- University of Texas Southwestern Medical Center, Dallas
| | | | - E Blair Solow
- University of Texas Southwestern Medical Center, Dallas
| | - Tracey Wright
- University of Texas Southwestern Medical Center and Texas Scottish Rite Hospital for Children, Dallas
| | - Una E Makris
- University of Texas Southwestern Medical Center and Veterans Administration North Texas Health Care System, Dallas
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25
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Haro SL, Lawson EF, Hersh AO. Disease activity and health-care utilization among young adults with childhood-onset lupus transitioning to adult care: data from the Pediatric Lupus Outcomes Study. Lupus 2020; 29:1206-1215. [DOI: 10.1177/0961203320938868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Individuals with childhood-onset systemic lupus erythematosus (cSLE) must transfer from pediatric to adult care. The goal of this study was to examine disease activity and health-care utilization among young adults with cSLE who are undergoing or have recently completed the transfer to adult care. Methods The Pediatric Lupus Outcomes Study (PLOS) is a prospective longitudinal cohort study of young adults aged 18–30 diagnosed with cSLE. We conducted a cross-sectional analysis comparing 47 participants under the care of pediatric rheumatologists to 38 who had completed transfer to adult care. Demographics, disease manifestations, health- care utilization and transition readiness were compared between groups. Results Those in the post-transfer group had significantly lower medication usage and were less likely to have seen a rheumatologist in the past year. Disease manifestations, flare rates, and hospitalizations were similar between groups. Nearly a quarter of patients who had transferred to adult care reported difficulties with the process. Conclusion Post-transfer patients had lower health-care utilization as evidenced by less medication usage and lack of rheumatology follow-up, in spite of the fact that disease activity was similar in both groups. Future studies will assess longitudinal changes in disease activity and damage in this population.
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Affiliation(s)
- Sara L Haro
- Division of Pediatric Rheumatology, University of California, San Francisco, USA
| | - Erica F Lawson
- Division of Pediatric Rheumatology, University of California, San Francisco, USA
| | - Aimee O Hersh
- Division of Pediatric Rheumatology, University of Utah, Salt Lake City, USA
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27
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Lupus education for physicians and patients in a resource-limited setting. Clin Rheumatol 2019; 39:697-702. [PMID: 31691040 DOI: 10.1007/s10067-019-04795-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 09/19/2019] [Accepted: 09/23/2019] [Indexed: 01/21/2023]
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with a wide range of manifestations and potential to affect several organ systems. Complications arise from both disease and medications especially glucocorticoids, significantly contributing to overall morbidity and mortality. SLE predominantly affects patients during their prime productive years resulting in substantial economic burden on the patient, caregivers, and society due to direct, indirect, and intangible costs. This illness burden is compounded in developing countries with limited resources due to various disparities in healthcare delivery. Physician education and practical referral and endorsement guidelines adapted to the local setting reinforce continuity and coordinated care. Likewise, patient education, self-help programs, and shared decision-making are essential best practice in the clinics. Both physician education and patient education improve overall outcomes in chronic diseases like SLE. As a developing country with very few rheumatologists and/or lupus specialists, efficient healthcare delivery for most Filipino lupus patients remains elusive. We describe our experience in confronting these challenges through development of strategies which focus on physician and patient education. KEY POINTS: • Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with a highly variable course, requiring specialized, individualized, and coordinated care by a healthcare team. • Health disparities and limited resources significantly contribute to illness burden on the patient, family, and society. • Physician education on SLE must commence at undergraduate medical school, be integrated in Internal Medicine and Pediatrics, and reinforced through specialized training in Rheumatology and related specialties. • Patient education and empowerment are integral to improving healthcare outcomes especially in a resource-limited setting.
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28
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Impact of Paediatric Versus Adult Care Setting on Health Care Utilization in Adolescents With Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr 2019; 69:310-316. [PMID: 31124888 DOI: 10.1097/mpg.0000000000002399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Paediatric-onset inflammatory bowel disease (IBD) is different from adult-onset IBD with respect to disease severity and its effect on growth and development. Care of paediatric IBD patients in some countries is dispersed among paediatricians and adult care providers, which may result in different outcomes. This study aims to assess the effect of care setting (paediatric vs adult-oriented) on health care utilization in adolescent IBD patients. METHODS This is a Dutch population-based cohort study based on an insurance claims database covering 4.2 million insurees (approximately 25% of the Dutch population). We identified IBD patients ages 16 to 18 years and followed them until the age of 19 years or transfer to adult care, whichever came first. We categorized patients according to care setting: paediatric versus adult-oriented. We defined outcomes as corticosteroid use, IBD-related hospital admission, IBD-related surgery, and biological use. We estimated Cox proportional hazards regression models to control for confounding by indication. RESULTS Among 626 patients, 380 (61%) were in paediatric and 246 (39%) in adult-oriented care. In paediatric care, patients were less likely to be treated with corticosteroids (hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.52-0.99) or biologicals (HR 0.57, 95% CI 0.34-0.97), and had fewer IBD-related hospital admissions (HR 0.58, 95% CI 0.37-0.92). CONCLUSION In a large and representative community cohort of adolescents with IBD, treatment in paediatric care setting was associated with significantly lower steroid and biological use, without increase in hospital admissions. These results might be used to optimize clinical care for adolescents with IBD.
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Harry O, Crosby LE, Smith AW, Favier L, Aljaberi N, Ting TV, Huggins J, Modi AC. Self-management and adherence in childhood-onset systemic lupus erythematosus: what are we missing? Lupus 2019; 28:642-650. [PMID: 30907294 PMCID: PMC6506349 DOI: 10.1177/0961203319839478] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The aims of this study are (1) to characterize factors influencing self-management behaviors and quality of life in adolescent and young adult (AYA) patients with childhood-onset systemic lupus erythematosus (cSLE) and (2) to identify barriers and facilitators of treatment adherence via focus groups. METHODS AYAs with cSLE ages 12-24 years and primary caregivers of the adolescents participated in this study. Recruitment occurred during pediatric rheumatology clinic visits at a Midwestern children's hospital or the hospital's cSLE active clinic registry. Information about disease severity was obtained from patient health records. Pain and fatigue questionnaires were administered. Descriptive statistics were used to analyze data. RESULTS Thirty-one AYA patients and caregivers participated in six focus groups. Ten major themes emerged from sessions; four were expressed both by the AYA and caregiver groups: knowledge deficits about cSLE, symptoms limiting daily function, specifically mood and cognition/learning, barriers and facilitators of adherence, and worry about the future. Themes unique to AYA participants included symptoms limiting daily functioning-pain/fatigue, self-care and management, impact on personal relationships, and health care provider communication/relationship. For caregiver groups unique themes included need for school advocacy, disruption of family schedule, and sense of normalcy for their adolescent. CONCLUSION AYAs with cSLE face a lifelong disease characterized by pervasive pain, fatigue, organ damage, isolation-social and/or physical-and psycho-socioeducational challenges. This study confirmed that continued psychosocial support, health information education, adherence interventions, and personalized treatment plans are necessary to increase self-management and autonomy in AYAs with cSLE.
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Affiliation(s)
- Onengiya Harry
- Division of Rheumatology, Cincinnati Children’s
Hospital Medical Center, Cincinnati, OH
| | - Lori E Crosby
- Division of Behavior Medicine and Clinical Psychology,
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- College of Medicine, University of Cincinnati, Cincinnati,
OH
| | - Amiee W Smith
- Division of Behavior Medicine and Clinical Psychology,
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Leslie Favier
- Division of Rheumatology, Cincinnati Children’s
Hospital Medical Center, Cincinnati, OH
| | - Najla Aljaberi
- Division of Rheumatology, Cincinnati Children’s
Hospital Medical Center, Cincinnati, OH
| | - Tracy V Ting
- Division of Rheumatology, Cincinnati Children’s
Hospital Medical Center, Cincinnati, OH
- College of Medicine, University of Cincinnati, Cincinnati,
OH
| | - Jennifer Huggins
- Division of Rheumatology, Cincinnati Children’s
Hospital Medical Center, Cincinnati, OH
- College of Medicine, University of Cincinnati, Cincinnati,
OH
| | - Avani C Modi
- Division of Behavior Medicine and Clinical Psychology,
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- College of Medicine, University of Cincinnati, Cincinnati,
OH
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30
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Health Services Use during Transition from Pediatric to Adult Care for Inflammatory Bowel Disease: A Population-Based Study Using Health Administrative Data. J Pediatr 2018; 203:280-287.e4. [PMID: 30266506 DOI: 10.1016/j.jpeds.2018.08.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 07/02/2018] [Accepted: 08/09/2018] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To evaluate the impact of the transfer from pediatric to adult care on health services use for adolescents with inflammatory bowel disease (IBD). STUDY DESIGN A population-based retrospective cohort study identified all children diagnosed with IBD from 1994 to 2008 and treated by pediatric gastroenterologists in Ontario, Canada, using health administrative data. Self-controlled case series analyses compared health service use in the 2 years before and 2 years after transfer with adult gastroenterologists, with a 6-month washout period at transfer. Outcomes evaluated included IBD-specific and IBD-related hospitalizations, emergency department use, outpatient visits, and laboratory use. The relative incidence (RI) in the post-transfer period was compared with pretransfer periods using Poisson regression analysis controlling for transfer starting age. Analyses were stratified by IBD type: Crohn's disease (CD) and ulcerative colitis (UC). RESULTS There were 536 patients included in the study (388 CD, 148 UC). Emergency department use rate was higher after transfer for both CD (RI, 2.12; 95% CI, 1.53-2.93) and UC (RI, 2.34; 95% CI, 1.09-5.03), as were outpatient visits (CD: RI, 1.56; 95% CI, 1.42-1.72; UC: RI, 1.48; 95% CI, 1.24-1.76), and laboratory investigations (CD: RI, 1.43; 95% CI, 1.26-1.63; UC: 1.38; 95% CI, 1.13-1.68). There was no change in the hospitalization rate (CD: RI, 0.70; 95% CI, 0.42-1.18; UC: RI, 2.41; 95% CI, 0.62-9.40). CONCLUSIONS Health services use in Canada increases after transfer from pediatric to adult care for outpatient visits, emergency department use, and laboratory tests, but not hospitalizations. This study has implications for the planning and budgeting of care for adolescents transitioning to adult care.
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31
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Sadun RE, Schanberg LE. Transition and transfer of the patient with paediatric-onset lupus: a practical approach for paediatric and adult rheumatology practices. Lupus Sci Med 2018; 5:e000282. [PMID: 30167316 PMCID: PMC6109813 DOI: 10.1136/lupus-2018-000282] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 06/21/2018] [Indexed: 12/14/2022]
Abstract
The prevalence of paediatric-onset SLE (pSLE) is estimated at 1million people worldwide and accounts for a significant proportion of SLE morbidity, mortality and cost. Patients with pSLE are especially vulnerable during and immediately following transfer from paediatric to adult rheumatology care, when substantial delays in care and increased disease activity are common. Transition is the process through which adolescents and young adults (AYA) develop the skills needed to succeed in the adult healthcare environment, a process that typically takes several years and may span a patient's time in paediatric and adult clinics. Recommendations for improving transition and transfer for AYA with pSLE include setting expectations of the AYA patient and family concerning transition and transfer, developing AYA's self-management skills, preparing an individualised transition plan that identifies a date for transfer, transferring at a time of medical and social stability, coordinating communication between the paediatric and adult rheumatologists (inclusive of both a medical summary and key social factors), and identifying a transition coordinator as a point person for care transfer and to monitor the AYA's arrival and retention in adult rheumatology care. Of paramount importance is empowering the adult rheumatologist with skills that enhance rapport with AYA patients, engage AYA patients and families in adult care models, promote adherence and encourage ongoing development of self-management skills.
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Affiliation(s)
- Rebecca E Sadun
- Department of Pediatrics, Division of Rheumatology, Duke Health, Durham, North Carolina, USA
- Department of Medicine, Division of Rheumatology, Duke Health, Durham, North Carolina, USA
| | - Laura E Schanberg
- Department of Pediatrics, Division of Rheumatology, Duke Health, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
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32
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Tarvin SE, O'Neil KM. Systemic Lupus Erythematosus, Sjögren Syndrome, and Mixed Connective Tissue Disease in Children and Adolescents. Pediatr Clin North Am 2018; 65:711-737. [PMID: 30031495 DOI: 10.1016/j.pcl.2018.04.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Juvenile systemic lupus erythematosus (jSLE), mixed connective tissue disease (jMCTD), and Sjögren syndrome (jSS) are systemic autoimmune and inflammatory disorders with distinct patterns of organ involvement. All are characterized by autoantibody formation, with antinuclear (ANA) and anti-double-stranded DNA common in jSLE, ANA with high-titer ribonucleoprotein antibody in jMCTD, and Sjögren syndrome A and Sjögren syndrome B antibodies + ANA in jSS. Recognition, monitoring, and management for primary care providers are discussed, focusing on the role of primary physicians in recognizing and helping maintain optimal health in children with these potentially life-threatening diseases.
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Affiliation(s)
- Stacey E Tarvin
- Division of Rheumatology, Department of Pediatrics, University of Indiana School of Medicine, Riley Hospital for Children at Indiana University Health, 699 Riley Hospital Drive, Riley Research 307, Indianapolis, IN 46202, USA
| | - Kathleen M O'Neil
- Division of Rheumatology, Department of Pediatrics, University of Indiana School of Medicine, Riley Hospital for Children at Indiana University Health, 699 Riley Hospital Drive, Riley Research 307, Indianapolis, IN 46202, USA.
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33
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Abstract
Although it has been widely acknowledged for more than two decades that transition from pediatric to adult care is a vulnerable time for adolescents and young adults with rheumatic diseases, current primary and subspecialty care transition and transfer processes remain inadequate. Barriers to improving transition include complex health care systems, neurodevelopmental challenges of adolescents and young adults, and insufficient transition-related education and resources for health care providers. Standardized, evidence-based transition interventions are sorely needed to establish best practices. Quality improvement approaches such as the Six Core Elements of Health Care Transition offer opportunities to improve transition care for teens and young adults.
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34
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Sabbagh S, Ronis T, White PH. Pediatric rheumatology: addressing the transition to adult-orientated health care. Open Access Rheumatol 2018; 10:83-95. [PMID: 30013406 PMCID: PMC6037274 DOI: 10.2147/oarrr.s138370] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The transition from pediatric to adult health care is often a challenging process due to multiple interwoven complexities, especially for children with chronic medical conditions. Health care transition (HCT) is a process of moving from a pediatric to an adult model of health care with or without a transfer to a new clinician. This paper focuses on what is known about HCT for youth and young adults (Y/YA) with rheumatic diseases within a larger context of HCT recommendations. HCT barriers for youth, families, and providers and current evidence for a structured HCT processes are reviewed. Practical advice is offered on how to approach transition for Y/YA, what tools are available to assist in a successful transition process, and what are the areas of future research that are needed to improve the HCT evidence base.
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Affiliation(s)
- Sara Sabbagh
- Department of Rheumatology, Children's National Health System, Washington DC, USA
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD USA
| | - Tova Ronis
- Department of Rheumatology, Children's National Health System, Washington DC, USA
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington DC, USA,
| | - Patience H White
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington DC, USA,
- Department of Rheumatology, George Washington University School of Medicine and Health Sciences, Washington DC, USA,
- Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington DC, USA,
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35
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36
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Alunno A, Studenic P, Nikiphorou E, Balážová P, van Nieuwkoop L, Ramiro S, Carubbi F, Richez C, Caeyers N, Gossec L, Kouloumas M. Person-focused care for young people with rheumatic and musculoskeletal diseases: young rheumatologists' and EULAR Young PARE perspectives. RMD Open 2017; 3:e000514. [PMID: 29018568 PMCID: PMC5623325 DOI: 10.1136/rmdopen-2017-000514] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/03/2017] [Accepted: 08/20/2017] [Indexed: 12/15/2022] Open
Abstract
In recent years, the evolution of healthcare challenged the management of people with rheumatic and musculoskeletal diseases (RMDs). From disease-centred care to person-focused care, a holistic approach along with patient empowerment about their disease, improved the physician-patient relationship and allowed to achieve better outcomes with lower healthcare costs. Nevertheless, RMDs may occur from childhood to the old age and to date very few studies have addressed the needs and priorities of young people with RMDs. However, the image of RMDs is still associated with the elderly population. In this regard, the group of young people with arthritis and rheumatism in Europe (PARE) was recently developed within European League Against Rheumatism to represent the voice of the young affected and to carry out projects aiming for a better understanding of these specific aspects. This viewpoint discusses the needs and priorities of young people compared with adult people with RMDs, based on the available literature and on the results of the PARE Youth research project, aiming to identify the next steps of actions that need to be taken to improve the current situation.
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Affiliation(s)
- Alessia Alunno
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Paul Studenic
- Division of Rheumatology, Department of Internal Medicine 3, Medical University Vienna, Vienna, Austria
| | - Elena Nikiphorou
- Department of Academic Rheumatology, King's College London, London, UK.,Department of Rheumatology, Whittington Hospital, London, UK
| | - Petra Balážová
- Patient, EULAR Young PARE, Zurich, Switzerland.,Slovak League Against Rheumatism, Piestany, Slovakia
| | | | - Sofia Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Francesco Carubbi
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.,Department of Medicine, ASL1 Avezzano-Sulmona-L'Aquila, L'Aquila, Italy
| | - Christophe Richez
- Department of Rheumatology, FHU ACRONIM, Pellegrin Hospital and UMR CNRS 5164, Bordeaux University, Bordeaux, France
| | | | - Laure Gossec
- Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique (UMRS 1136), Paris, France.,Department of Rheumatology, Hôpital Pitié Salpêtrière, AP-HP, Paris, France
| | - Marios Kouloumas
- Patient, EULAR Young PARE, Zurich, Switzerland.,Cyprus Legue Against Rheumatism, Aglantzia, Cyprus
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37
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Thong B, Olsen NJ. Systemic lupus erythematosus diagnosis and management. Rheumatology (Oxford) 2017; 56:i3-i13. [PMID: 28013206 DOI: 10.1093/rheumatology/kew401] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Indexed: 01/07/2023] Open
Abstract
SLE presents many challenges for clinicians. The onset of disease may be insidious, with many different symptoms and signs, making early and accurate diagnosis challenging. Tests for SLE in the early stages lack specificity; those that are useful later often appear only after organ damage is manifest. Disease patterns are highly variable; flares are not predictable and not always associated with biomarkers. Children with SLE may have severe disease and present special management issues. Older SLE patients have complicating co-morbid conditions. Therapeutic interventions have improved over recent decades, but available drugs do not adequately control disease in many patients, and successful outcomes are limited by off-target effects; some of these become manifest with longer duration of treatment, now in part revealed by improved rates of survival. Despite all of these challenges, advances in understanding the biological basis of SLE have translated into more effective approaches to patient care. This review considers the current state of SLE diagnosis and management, with a focus on new approaches and anticipated advances.
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Affiliation(s)
- Bernard Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Republic of Singapore
| | - Nancy J Olsen
- Division of Rheumatology, Department of Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
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38
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Clemente D, Leon L, Foster H, Carmona L, Minden K. Transitional care for rheumatic conditions in Europe: current clinical practice and available resources. Pediatr Rheumatol Online J 2017; 15:49. [PMID: 28599656 PMCID: PMC5466791 DOI: 10.1186/s12969-017-0179-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 06/05/2017] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To assess European pediatric rheumatology providers' current clinical practices and resources used in the transition from child-centered to adult-oriented care. METHODS European pediatric rheumatologists were invited to complete a 17-item anonymized e-survey assessing current transition practices, transition policy awareness, and needs in advance of the publication of EULAR/PReS recommendations on transition. RESULTS The response rate was 121/276 (44%), including responses from 115 centers in 22 European Union countries. Although 32/121 (26%) responded that their centers did not offer transition services, the majority (99%) agreed that a formalized process in transitioning patients to adult care is necessary. A minority (<30%) of respondents stated that they have a written transition policy although 46% have an informal transition process. Designated staff to support transitional care were available in a minority of centers: nurse (35%), physiotherapist (15%), psychologist (15%), social worker (8%), and occupational therapist (2%). The existence of a designated team member to coordinate transition was acknowledged in many centers (64% of respondents) although just 36% use a checklist for young people as part of individualized transitional care. CONCLUSION This survey of European pediatric rheumatology providers regarding transitional care practices demonstrates agreement that transitional care is important, and wide variation in current provision of transition services exists.
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Affiliation(s)
- Daniel Clemente
- 0000 0004 1767 5442grid.411107.2Paediatric Rheumatology Unit, Hospital Infantil Universitario “Niño Jesús”, Madrid, Spain
| | - Leticia Leon
- grid.449750.bIDISSC, Hospital Clínico San Carlos; Health Sciences, Universidad Camilo José Cela, Madrid, Spain
| | - Helen Foster
- Musculoskeletal Research Group, Institute Cellular Medicine, Newcastle University, and Great North Children’s Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Kirsten Minden
- Department of Rheumatology and Clinical Immunology, and German Rheumatism Research Centre, Charité University Medicine Berlin, a Leibniz Institute, Berlin, Germany.
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39
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Lawson EF, Mellins ED. Paediatric rheumatic diseases: Navigating the transition from paediatric to adult care. Nat Rev Rheumatol 2017; 13:138-139. [PMID: 28202918 DOI: 10.1038/nrrheum.2017.16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Erica F Lawson
- Division of Rheumatology, University of California San Francisco Department of Pediatrics, 550 16th Street, San Francisco, California 94143, USA
| | - Elizabeth D Mellins
- Department of Pediatrics and the Stanford Program in Immunology, Stanford University, 300 Pasteur Drive, Stanford, California 94305, USA
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40
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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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41
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Thakral A, Klein-Gitelman MS. An Update on Treatment and Management of Pediatric Systemic Lupus Erythematosus. Rheumatol Ther 2016; 3:209-219. [PMID: 27747587 PMCID: PMC5127968 DOI: 10.1007/s40744-016-0044-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Indexed: 12/17/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disorder in which 20 % of patients are diagnosed in childhood. Childhood-onset SLE is associated with higher morbidity and mortality than adult-onset SLE. The aims of disease management with early immunosuppression are to decrease disease activity and improve quality of life. A multidisciplinary approach is necessary due to the complexity of lupus in pediatric patients. It is important to provide patients with high quality of care and to instill ownership of their disease process from a young age to prepare them to manage this life-long illness. This article reviews current management of SLE in children.
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Affiliation(s)
- Amit Thakral
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, USA.
| | - Marisa S Klein-Gitelman
- Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, USA
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