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McDonagh JE, Tattersall R, Clinch J, Swan J, Foster HE, McCann L. Developmentally appropriate transitional care during the Covid-19 pandemic for young people with juvenile-onset rheumatic and musculoskeletal diseases: the rationale for a position statement. Pediatr Rheumatol Online J 2021; 19:136. [PMID: 34433477 PMCID: PMC8386148 DOI: 10.1186/s12969-021-00609-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The importance of developmentally appropriate transitional care in young people with juvenile-onset rheumatic and musculoskeletal disease is well recognised. The Paediatric Rheumatology European Society (PReS) / European League Against Rheumatism (EULAR) Taskforce has developed international recommendations and standards for transitional care and a growing evidence base supports the positive benefits of such care. However, there is also evidence that universal implementation has yet to be realised. In 2020, against this background the COVID-19 pandemic arrived with significant impact on all our lives, young and old, patient, public and professional alike. The unfortunate reality of the pandemic with potential for unfavourable outcomes on healthcare provision during transition was acknowledged by the PReS working groups in a position statement to support healthcare professionals, young people and their caregivers. AIM The aim of this review is to present the literature which provides the rationale for the recommendations in the PReS Position Statement. The following areas are specifically addressed: the prime importance of care coordination; the impact of the pandemic on the various aspects of the transition process; the importance of ensuring continuity of medication supply; the pros and cons of telemedicine with young people; ensuring meaningful involvement of young people in service development and the importance of core adolescent health practices such as routine developmental assessment psychosocial screening and appropriate parental involvement during transitional care.
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Affiliation(s)
- Janet E. McDonagh
- Versus Arthritis Centre for Epidemiology; Centre for MSK Research, University of Manchester, Stopford Building, 2nd floor, Oxford Rd, Manchester, M13 9PT UK
- NIHR Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester, UK
- Department of Paediatric and Adolescent Rheumatology, Royal Manchester Children’s Hospital, Manchester University Hospitals NHS Trust, Manchester, UK
| | - Rachel Tattersall
- Sheffield Children’s Hospital and Sheffield Teaching Hospitals, Manchester, UK
| | - Jacqui Clinch
- Bristol Royal Hospital for Children and Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Joanne Swan
- Public Health Family Nurse, Family Nurse Partnership, Wallacetown Health Centre, NHS Tayside, Dundee, UK
- Paediatric Rheumatology European Society (PReS) Juvenile Dermatomyositis Working Party, Manchester, UK
| | - Helen E. Foster
- Paediatric Rheumatology, Newcastle University, Newcastle upon Tyne, UK
- Honorary Consultant Great North Children’s Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Chair Paediatric Global Musculoskeletal Task Force, Manchester, UK
| | - Liza McCann
- Paediatric Rheumatology European Society (PReS) Juvenile Dermatomyositis Working Party, Manchester, UK
- Consultant Paediatric Rheumatologist, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
- Honorary Clinical Senior Lecturer, University of Liverpool, Liverpool, UK
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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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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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Willis E, McDonagh JE. Shifting the mindset-adolescent and young adult rheumatology in transition. THE LANCET. RHEUMATOLOGY 2020; 2:e236-e244. [PMID: 38268158 DOI: 10.1016/s2665-9913(19)30163-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/12/2019] [Accepted: 12/20/2019] [Indexed: 01/26/2024]
Abstract
Almost 30 years have passed since publication of the first reports acknowledging the crucial importance of transitional care for adolescents and young adults with chronic disease, but universal implementation has yet to be achieved. Progress has undoubtedly been made, with increasing evidence for best practice in transitional care. However, translation of research and guidance into clinical practice continues to be challenging. Neuroscience advances in understanding the changes occurring in the adolescent brain demand that the third phase of transition (ie, post-transfer to adult services) is given further attention, with recognition that transfer itself is not the end of the transition process. The complex, often unwieldy health systems delivering care must also be considered. Paediatric and adult rheumatology practitioners need to collaborate not only with each other, but also with practitioners in other disciplines, specialties, and agencies, to plan and commission rheumatology services that are responsive to adolescents and young adults. A shift in approach from focusing on health transition towards developmentally appropriate health care has the potential to improve the care provided during this vulnerable life stage, increasing the likelihood of continuing engagement of patients in their own health care into adulthood and thereby improving health outcomes.
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Affiliation(s)
- Emily Willis
- Department of Paediatric and Adolescent Rheumatology, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Trust, Manchester, UK
| | - Janet E McDonagh
- Department of Paediatric and Adolescent Rheumatology, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Trust, Manchester, UK; Versus Arthritis Centre for Epidemiology, and Centre for Musculoskeletal Research, University of Manchester, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester, UK.
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Abstract
PURPOSE OF REVIEW Effective transitional care for adolescents and young adults (AYA) with rheumatic musculoskeletal disease (RMD) is fundamental to rheumatology care provision. Here we review the recent evidence from the literature on transition in rheumatology and debate why universal implementation has yet to be recognised. RECENT FINDINGS Evidence of need for transitional care continues to be reported. The triphasic nature of transitional care remains poorly recognised, and the third phase following transfer to adult rheumatology is particularly under-researched in spite of the recognition of the age-related trajectories of transition skill development during young adulthood. Several rheumatology-specific transitional care interventions have now been evaluated but the search for valid measures including outcome continues. Finally, the need to study transition at a health system level is increasingly recognised. Future research in this area should consider the developmental trajectories of AYA as well as the social-ecological model of transition readiness, which focuses on the interactions between AYA, caregivers and providers (and the systems they are part of) as these are the likely targets of any intervention to improve health transitions.
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Affiliation(s)
- Janet E McDonagh
- Versus Arthritis Centre for Epidemiology, Centre for MSK Research, University of Manchester and NIHR Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester, UK.
| | - Albert Farre
- School of Nursing and Health Sciences, University of Dundee, Dundee, UK
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