M E Bauman1, S Kuhle2, A A K Bruce3, L Bolster4, M P Massicotte5. 1. Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada; University Hospital, University of Alberta, Edmonton, AB, Canada. Electronic address: mary.bauman@albertahealthservices.ca. 2. Dept. of Pediatrics, Dalhousie University, Halifax, NS, Canada; Dept. of Obstetrics & Gynaecology, Dalhousie University, Halifax, NS, Canada. 3. Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada; University Hospital, University of Alberta, Edmonton, AB, Canada. 4. University Hospital, University of Alberta, Edmonton, AB, Canada. 5. Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada.
Abstract
UNLABELLED: Health transition of youth from a child-centered care model to the adult model has been recognized to be of critical importance due to the increasing numbers of children now surviving chronic conditions. A formalized transition process is required adequately assess the AYA's readiness for transition and to move towards adult care. Indefinite warfarin therapy poses challenges as warfarin is a narrow therapeutic index drug that requires frequent monitoring and attentiveness to warfarin interactions and affects. OBJECTIVE: The objective of this study was to evaluate transition to adult care for AYAs requiring indefinite warfarin therapy within a structured self-management program. OUTCOME MEASURES: Results were compared between Phase 1 (enrollment to patient self-management) and Phase 2 (independent warfarin management) 6months following confirmation of transition to adult care. There was no statistical difference between outcome measures except INR testing frequency, and no adverse events. CONCLUSIONS: This transition process resulted in successful transition as measured by TTR and other clinical end-points from pediatric to adult care. Implementing a formal transition process for young adults with chronic health conditions that considers patient preferences motivates and empowers them over time to develop autonomy with warfarin self-management, results in successful transition and warfarin management.
UNLABELLED: Health transition of youth from a child-centered care model to the adult model has been recognized to be of critical importance due to the increasing numbers of children now surviving chronic conditions. A formalized transition process is required adequately assess the AYA's readiness for transition and to move towards adult care. Indefinite warfarin therapy poses challenges as warfarin is a narrow therapeutic index drug that requires frequent monitoring and attentiveness to warfarin interactions and affects. OBJECTIVE: The objective of this study was to evaluate transition to adult care for AYAs requiring indefinite warfarin therapy within a structured self-management program. OUTCOME MEASURES: Results were compared between Phase 1 (enrollment to patient self-management) and Phase 2 (independent warfarin management) 6months following confirmation of transition to adult care. There was no statistical difference between outcome measures except INR testing frequency, and no adverse events. CONCLUSIONS: This transition process resulted in successful transition as measured by TTR and other clinical end-points from pediatric to adult care. Implementing a formal transition process for young adults with chronic health conditions that considers patient preferences motivates and empowers them over time to develop autonomy with warfarin self-management, results in successful transition and warfarin management.
Keywords:
Adolescent; Coumadin; Pediatrics; Point of care monitoring; Quality of life; Transition; Vitamin K antagonist; Warfarin; Warfarin self-management; Warfarin self-testing; Young adult
Authors: Antoine Rachas; Philippe Tuppin; Laurence Meyer; Bruno Falissard; Albert Faye; Nizar Mahlaoui; Elise de La Rochebrochard; Marie Frank; Pierre Durieux; Josiane Warszawski Journal: PLoS One Date: 2018-03-13 Impact factor: 3.240