Background Transition is a multifaceted process involving medical, psychosocial, educational needs of the teenager who must move from a pediatric care to adult care system.
The pediatric paradigm focuses on the family, it focuses on aspects of growth and development, often neglecting, to acknowledge the increasing independence and autonomy of the patient as an individual.
The culture of adult medicine implies to have as a partner a patient independent and autonomous in the management of the disease, including aspects of playing, ignoring the issues related to the growth, development and relations with the family.
Objectives to drive the patient along the transition, getting him finding the new treating as a continued assistance, more mature and personalized in sharing issues related to the disease; to create a best practice of transition service.
Methods promoted by AMaR Piemonte - regional expression of ANMAR - and thanks to the availability and sensitivity of the doctors of the Pediatric Rheumatology Service (responsible Prof. Silvana Martino) and the UOA Rheumatology (director dr. Enrico Fusaro), located in two different buildings of the same “Città della Salute e della Scienza di Torino” hospital, it was possible to organize a transition pathway for teenagers since eighteen, structured as follows:
first telephone contact between Pediatrician Rheumatologist and Rheumatologist
sharing of clinical and personal information about the young patient
introduction to the new care giver: during the routine consultation Pediatrician Rheumatologist presents his colleague, anticipating the different types of examinations and departmental activities and highlighting the peculiarities and sensitivity of his colleague
meeting with parents: on the fringes the two specialists meet parents, preparing them for their future role and announcing that in the next visit they will be excluded
transition examination: directly scheduled, it is a joint examination by the two rheumatologists to the young patient, who is directly involved discussing his health state and the decisions to be taken to continue therapies or monitoring the disease (if in remission). A second one may be scheduled if the young patient shows severe psychological problems.
A collegial meeting between patient, rheumatologists and physiatrist/rehabilitator will be programmed if a special rehabilitation is needed
taking care: the new rheumatologist takes care of the young patient
All the pathway takes end in a period of time not exceeding one month, with a maximum of three consultations.
Results 52 patients (79% female, 21% male) taken in care by “adult” rheumatology since 2012 to 2016. No patient reports he lived the transition as a trauma and 10%, even saying to have found in the new rheumatologist a sure and affordable referral, stay in contact with the pediatric rheumatologist “because of emotional issues”. 58% remains under treatment with DMARDs and biologics; in 32% of patients an extra-articular manifestation occurs even in the absence of clinical parameters indicative of medium-high disease activity. The remaining 10%, in remission, continues the control.
Conclusions Transition is an educational and therapeutic process, not an event; it requires collaboration between the teenager, family and caregivers.
Disclosure of Interest None declared