Clinicians: Mind the Gap
Transition is defined as “a purposeful, planned process that addresses the medical, psychosocial, educational, and vocational needs of adolescents and young adults with chronic medical conditions, as they advance from a pediatric and family-centered to an adult, individual focused health care provider”1. The need of a planned, dynamic, multidisciplinary well-organized transition service is important to ensure patients safety and autonomy. Inappropriate transition can be a risky process, as it may create a care gap2. Current models of clinical care recommend a well-designed and available transition services. For example non-structured transition of children with diabetes was associated in one study with increased risk of hospitalization3. Therefore we conducted this audit to assess the need and the current available transition services in Ireland. The challenges that affect transition services from clinicians’ point of view have been examined.
A questionnaire-based survey was designed and sent by post to paediatric consultants in five hospitals in Ireland including Our lady’s children hospital, Children’s university Hospital, National children’s hospital, University hospital of Limerick and Cork University Hospital. In total, feedback reports from 49 paediatric consultants were received. Transition services are currently provided by 22 of 49 (52.4%) paediatric consultants, of whom 42 of 49 (85.7%) indicated the need for transition services. Of 49 consultants, 42 (85.7%) suggested that transition should be considered at average of 17 years of age (range 16-18 years), however 7 (14.3%) did not respond to the same question. Among 22 consultants who provide transition services, the average number of annual clinics held ranges between three and four. Nevertheless, 14 of these 22 (63.3%) consultants recommended that number of clinics should be increased. Currently available transition services include inflammatory bowel diseases; diabetes mellitus, metabolic disorders, cystic fibrosis and post-transplant conditions. Challenges, which were reported, include lack of structural services, difficulties or unavailability of adult services such as cerebral palsy and neurodisability. Some conditions are transitioned via letter transfer only without clinical attendance. Participating paediatricians reported that the common challenges encountered are the need for personnel (30 of 49 (61.2%), availability of clinic slots (21 (42.9%), extra resources (22 (44.9%), lack of coordination (30 (61.2%) and workload (22 (44.9%). Notably, transition can be a challenge in neurodisability and metabolic disorders. It was highlighted by one of the established model in one of the CF department that transition services start at 12 years of age and finishes by 16-17 years. Our survey identified clearly that transition services are a real challenge. Current services should be supported and expanded. Deficits should be identified and efforts to remove obstacles need to be removed. More resources and guidance are needed for effective transition services. A national wide-based survey is on progress and we hope that will help in setting a clear clinical standards and recommendation to improve care of adolescents with chronic conditions.
A Mohammed 1, M Nadeem 2, T Yousif 2
1St Michael’s Hospital, Dublin, Ireland
2National Children’s Hospital, Dublin, Ireland
Amani Mohammed, Medical Registrar St Michael’s Hospital, Dublin, Ireland
1. Carrizosa J, An I, Appleton R, Camfield P, Von Moers A. Models of transition clinics. Epilepsia 2014; 55:46- 51
2. White PH , Ardoin S. Transitioning Wisely: Improving the connection from pediatric to adult health care. Arthritis Rheumatol 2016; 68(4):789-794.
3. Nakhla M, Daneman D, To T, Paradis G, Guttmann A. Transition to Adult Care for Youths With Diabetes Mellitus: Findings From a Universal Health Care System. Pediatrics 2009; 124:e1134-e1141.