Post on 11-Jan-2016
Stacee Lerret PhD, RN, CPNP, CCTCMedical College of WisconsinChildren’s Hospital of WisconsinWI ITNS Annual ConferenceOctober 13, 2012
MOVING ON UP: PEDIATRIC TO ADULT TRANSITION
FINANCIAL DISCLOSURE
None to report
Review current state of transition in solid organ transplant and other chronic illness populations.
Identify obstacles to a successful transition process for solid organ transplant recipients.
Identify transition practices and resources currently used at transplant centers.
OBJECTIVES
Growing number of chi ldren with complex health condit ions
Transfer from pediatric to adult faci l i ty is another milestone
MILESTONES
Definition“Purposeful, planned movement of adolescents and young adults with chronic physical and medical conditions from child-centered to adult-oriented health care systems”.
Blum et al., 1993
INTRODUCTION
Transition• Active process that addresses needs of
adolescents as they prepare to move from child to adult centered health care• Medical• Psychosocial• Educational/Vocational
Transfer• Physical change in location where care is
provided
DEFINITIONS
Blum et al., 1993; Sawyer et al., 1997
LiteratureSolid organ transplant Human immunodeficiency virus
Cystic fibrosisDiabetesOther chronic illness populations
National practice and research priority
TRANSITION LITERATURE
TRANSITION LITERATURE: CONSENSUS STATEMENTS
Formal framework for enabling the seamless transition of transplant patients for all healthcare providers to follow.
Age of transfer is individualized and transfer takes place during the transition process age range 14-24 years.
Every patient should be offered the opportunity of participating in a young adult clinic.
Pediatric and adult centers should identify a clinical lead.
Process of consultation with patients and families to ensure all needs are met.
During transfer patients should have access to support service tailored to their specific needs in the adult center.
Performance standards are defined and monitored to ensure all patients receive similar service.
TRANSITION LITERATURE:CONSENSUS STATEMENTS
35 pediatric and 24 adult liver transplant coordinatorsResults highlight important role of communication
and partnership between pediatric and adult programs
TRANSITION: COORDINATOR PERSPECTIVE
Despite literature and momentum to improve transition process limitations exist Overall lack of
consistency in healthcare and support services provided to young adults and their families
Insuffi ciencies may be related to adverse outcomes Acute rejection Graft loss
TRANSITION LITERATURE CONT.
Patient
Family
Pediatric Team
Adult Team
Hospital Systems
OBSTACLES TO SUCCESSFUL TRANSITION
•Education at an early age•Foster responsibility and autonomy•Individualized to development and acuity
•Address fear and anxiety
Patient
•Encourage inclusion of child at an early age•Provide suggestions for enhancing independence•Include in process of choosing adult provider
Family
OVERCOMING TRANSITION OBSTACLES
•Promote age appropriate responsibilities•Coordinate and communicate with adult center
Pediatric Team
•Coordinate and communicate with adult center•Increase frequency of clinic appointments after transfer•Encourage adult primary care provider
Adult Team
•Transition policy•Support for dedicated individuals focusing on transition•Utilize experts for financial and insurance issues•Timing of transfer (age)
Systems
OVERCOMING TRANSITION OBSTACLES
NOW WHAT?
One visit
• Adult MD or RN meeting family at pediatric facility
Alternating visits
• Pediatric and adult facility
TRANSITION CLINICS
TRANSITION RESOURCES
American Society of Transplantation
National Health Care Transition Center http://www.gottransition.org/ Got Transition Partnership
National Alliance to Advance Adolescent Health American Academy of Pediatrics
Target Health care professionals Families Youth Health policy makers
Content Transition tools and tips
RESOURCES: GOT TRANSITION
RESOURCES: GOT TRANSITION CONT.
TRANSITION RESOURCES
The Hospital for Sick Children, Torontohttp://www.sickkids.ca/Good2Go/
TRANSITION RESOURCES“GOOD 2 GO”
http://www.sickkids.ca/Good2Go/
TRANSITION RESOURCES“GOOD 2 GO”
http://www.sickkids.ca/Good2Go/
TRANSITION RESOURCES“GOOD 2 GO”
http://www.sickkids.ca/Good2Go/
TRANSITION RESOURCES“GOOD 2 GO”
http://www.sickkids.ca/Good2Go/
TRANSITION RESOURCES: READINESS CHECKLIST
Sawicki, 2011
TRANSITION RESOURCES: READINESS SURVEY
Fredericks et al., 2010
Important transplant and chronic illness issue Goal to maximize health and
quality of life Live as independent and self
suffi cient adultsLiterature regarding
transition Currently have single center
experiences published in literature
More rigorous research Limitations remain
Guide or framework Checklists built into electronic
medical record
National eff orts Consensus group Transiti on workgroups
CONCLUSION
Discussion and
Questions