Wendy F Bower1, Deborah Christie2, Mario DeGennaro3, Pallavi Latthe4, Ann Raes5, Rodrigo L P Romao6, Arash Taghizadeh7, Dan Wood8, Christopher R J Woodhouse9, Stuart B Bauer10. 1. SubAcute Services, Royal Park Campus, The Royal Melbourne Hospital, Melbourne, Australia. 2. Consultant Clinical Psychologist, University College London Hospitals NHS Trust. 3. Department of Nephrology Urology, Head, Division of Urology and Urodynamics, Bambino Gesù Children Hospital, Roma, Italy. 4. Consultant Obstetrician and Gynaecologist, Birmingham Women's NHS Foundation Trust, Birmingham, United Kingdom. 5. Professor and Pediatric Nephrologist, Ghent University Hospital and Ghent University, Belgium, Europe. 6. Assistant Professor of Surgery and Urology, IWK Health Centre, Dalhousie University Halifax, Nova Scotia, Canada. 7. Consultant Pediatric Urologist, Evelina London Children's Hospital and Guy's Hospital, London, United Kingdom. 8. Consultant in Adolescent and Reconstructive Urology, University College London Hospitals. 9. Emeritus Professor of Adolescent Urology, University College, London. 10. Department of Urology, Harvard Medical School and Senior Associate, Boston Children's Hospital.
Abstract
INTRODUCTION: Children with urinary tract disorders managed by teams, or individual pediatricians, urologists, nephrologists, gastroenterologists, neurologists, psychologists, and nurses at some point move from child-centered to adult-centered health systems. The actual physical change is referred to as the transfer whilst the process preceding this move constitutes transition of care. Our aims are twofold: to identify management and health-service problems related to children with congenital or acquired urological conditions who advance into adulthood and the clinical implications this has for long-term health and specialist care; and, to understand the issues facing both pediatric and adult-care clinicians and to develop a systems-approach model that meets the needs of young adults, their families and the clinicians working within adult services. METHODS: Information was gleaned from presentations at an International Children's Continence Society meeting with collaboration from the International Continence Society, that discussed problems of transfer and transitioning such children. Several specialists attending this conference finalized this document identifying issues and highlighting ways to ease this transition and transfer of care for both patients and practitioners. RESULTS: The consensus was, urological patients with congenital or other lifelong care needs, are now entering adulthood in larger numbers than previously, necessitating new planning processes for tailored transfer of management. Adult teams must become familiar with new clinical problems in multiple organ systems and anticipate issues provoked by adolescence and physical growth. During this period of transitional care the clinician or team assists young patients to build attitudes, skills and understanding of processes needed to maximize function of their urinary tract-thus taking responsibility for their own healthcare needs. Preparation must also address, negotiating adult health care systems, psychosocial, educational or vocational issues, and mental wellbeing. CONCLUSIONS: Transitioning and transfer of children with major congenital anomalies to clinicians potentially unfamiliar with their conditions requires improved education both for receiving doctors and children's families. Early initiation of the transition process should allow the transference to take place at appropriate times based on the child's development, and environmental and financial factors. Neurourol. Urodynam. 36:811-819, 2017.
INTRODUCTION:Children with urinary tract disorders managed by teams, or individual pediatricians, urologists, nephrologists, gastroenterologists, neurologists, psychologists, and nurses at some point move from child-centered to adult-centered health systems. The actual physical change is referred to as the transfer whilst the process preceding this move constitutes transition of care. Our aims are twofold: to identify management and health-service problems related to children with congenital or acquired urological conditions who advance into adulthood and the clinical implications this has for long-term health and specialist care; and, to understand the issues facing both pediatric and adult-care clinicians and to develop a systems-approach model that meets the needs of young adults, their families and the clinicians working within adult services. METHODS: Information was gleaned from presentations at an International Children's Continence Society meeting with collaboration from the International Continence Society, that discussed problems of transfer and transitioning such children. Several specialists attending this conference finalized this document identifying issues and highlighting ways to ease this transition and transfer of care for both patients and practitioners. RESULTS: The consensus was, urological patients with congenital or other lifelong care needs, are now entering adulthood in larger numbers than previously, necessitating new planning processes for tailored transfer of management. Adult teams must become familiar with new clinical problems in multiple organ systems and anticipate issues provoked by adolescence and physical growth. During this period of transitional care the clinician or team assists young patients to build attitudes, skills and understanding of processes needed to maximize function of their urinary tract-thus taking responsibility for their own healthcare needs. Preparation must also address, negotiating adult health care systems, psychosocial, educational or vocational issues, and mental wellbeing. CONCLUSIONS: Transitioning and transfer of children with major congenital anomalies to clinicians potentially unfamiliar with their conditions requires improved education both for receiving doctors and children's families. Early initiation of the transition process should allow the transference to take place at appropriate times based on the child's development, and environmental and financial factors. Neurourol. Urodynam. 36:811-819, 2017.
Authors: Jay G Berry; James C Gay; Karen Joynt Maddox; Eric A Coleman; Emily M Bucholz; Margaret R O'Neill; Kevin Blaine; Matthew Hall Journal: BMJ Date: 2018-02-27