This means that during the patient’s transition to adult care, the adult rheumatologist should have a conversation with the pediatric rheumatologist to understand why certain doses of medication were used. This will also demonstrate to the patient that the adult rheumatologist values the opinion of their pediatric counterpart, a physician with whom the patient has a strong relationship.
Dr. Sadun presented two mnemonics to help adult rheumatologists remember key topics in the transition for patients. The first is TRANSFER: 1) understand the Treatment history; 2) be aware of Recent complications or Recent medication changes; 3) think about Adherence challenges and root causes for these issues; 4) consider Needs (e.g., referrals to other specialists); 5) be cognizant of their Social history, including transportation needs; 6) consider Financial challenges; 7) be aware of Emotional and intellectual challenges that patients may face; and 8) take into account Reasons that this is a good—or not a good—time for transfer to adult care.
The second mnemonic is WELCOME: 1) Welcome the patient and congratulate them on the transfer; 2) Explain similarities and differences in adult care (e.g., adult clinics may have a stricter policy if a patient is late for appointments); 3) Let patients and parents know respective roles; 4) keep the Channel of communication open with the pediatric rheumatologist; 5) provide an Opportunity for questions from patients and parents; 6) conduct a thorough Medical visit and Minimize medication changes at the first visit; and 7) End the visit by supportively communicating expectations. It is also important to include sexual and psychological history taking in the visit, and parents should be asked to leave during the interview to ensure the patient can be open and honest.
Jason Liebowitz, MD, is an assistant professor of medicine in the Division of Rheumatology at Columbia University Vagelos College of Physicians and Surgeons, New York.
References
- Hazel E, Zhang X, Duffy CM, Campillo S. High rates of unsuccessful transfer to adult care among young adults with juvenile idiopathic arthritis. Pediatr Rheumatol Online J. 2010 Jan 11;8:2. doi: 10.1186/1546-0096-8-2. PMID: 20148143; PMCID: PMC2820032.
- Packham JC, Hall MA. Long-term follow-up of 246 adults with juvenile idiopathic arthritis: functional outcome. Rheumatology (Oxford). 2002;41(12):1428–1435.
