Lut Berben1,2, Nora Sigg3, Mary Louise Daly1,2,3, Stefan Bachmann4, Walter Baer4, Gérald Berthet5, Isabel Bolt6, Diana Dan7, Susanna Enderlin Steiger8, Johannes Fröhlich9, Paul Hasler10, Michaël Hofer11,12, Christian Huemer13, Daniela Kaiser14, Natalie Marcoli15, Seraina Palmer Sarott16, Yella Rottländer17, Gernot Schmid18, Christa Soennichsen19, Laura Strahm Furler9, Federica Vanoni20, Lukas Wildi21, Thomas Daikeler2, Andreas Woerner3. 1. Department of Nursing Development, University Children's Hospital Basel, Switzerland 2. Department of Rheumatology, University Hospital Basel, Switzerland 3. Department of Paediatric Rheumatology, University Children's Hospital Basel, Switzerland 4. Department of Pediatric Rheumatology, Cantonal Hospital Graubünden, Switzerland 5. Department of Paediatric Rheumatology, Cantonal Hospital Aarau, Switzerland 6. Department of Paediatric Rheumatology, University Children's Hospital Bern, Switzerland 7. Department of Rheumatology, Lausanne University Hospital and Lausanne University, Switzerland 8. Department of Rheumatology, University Hospital Zurich, Switzerland 9. Department of Rheumatology, University Hospital Bern, Switzerland 10. Department of Rheumatology, Cantonal Hospital Aarau, Switzerland 11. Department of Paediatric Rheumatology of Suisse Romande, Lausanne University Hospital, Switzerland 12. Department of Paediatric Rheumatology Geneva University Hospital, Switzerland 13. Department of Paediatric Rheumatology, Children's Hospital of Eastern Switzerland, Switzerland 14. Department of Paediatric Rheumatology, Cantonal Hospital Lucerne, Switzerland 15. Department of Rheumatology, Regional Hospital Lugano, Switzerland 16. Department of Paediatric Rheumatology, University Children's Hospital Zürich, Switzerland 17. Department of Rheumatology, Cantonal Hospital St Gallen, Switzerland 18. Department of Rheumatology, Cantonal Hospital Lucerne, Switzerland 19. Department of Paediatric Rheumatology, Cantonal Hospital Winterthur, Switzerland 20. Instituto Pediatrico della Svizzera Italiana, Bellinzona, Switzerland 21. Department of Rheumatology, Cantonal Hospital Winterthur, Switzerland
Abstract
BACKGROUND: About half of all children with rheumatic diseases need continuous medical care during adolescence and adulthood. A good transition into adult rheumatology is essential. Guidelines for a structured transition process have therefore been recommended by the European League Against Rheumatism (EULAR) and the Paediatric Rheumatology European Society (PReS). However, implementation of these guidelines requires resources often not available in a busy clinical practice. AIMS: To assess the current practice of transitional care in Switzerland in relation to EULAR/PReS recommendations and to describe gaps and challenges in following the recommendations. METHODS: All paediatric Swiss rheumatology centres and their collaborating adult centres offering a transition service to adult care were invited to participate in this survey. The responsible paediatric and adult rheumatologist of each centre was interviewed separately using a structured manual addressing the EULAR/PReS transitional care recommendations. RESULTS: All 10 paediatric and 9 out of 10 adult rheumatologists agreed to participate. Centres varied in the number of patients in transition, from n = 0 to n = 111. The following EULAR/PReS recommendations were implemented and applied in most centres: continuity in the healthcare team, consultations focused on adolescents and young adults, joint consultations between the paediatric and adult rheumatologist, and access to the EULAR website. Only rarely did a centre have a written transition policy or evaluate their transitional care programme. The vast majority of the interviewees had no specific training in adolescent health. Most centres rated their transitional care performance as very good. CONCLUSION: Transition in Switzerland is not uniform and consequently the implementation of the EULAR/PReS recommendations is variable in Swiss rheumatology centres. Skills of healthcare professionals, continuity between clinical settings, size of the centres, and hospital focus on the needs of adolescents and young adults may represent key predictors of successful transitional care for patients with chronic rheumatic diseases. Future studies should examine these variables.
BACKGROUND: About half of all children with rheumatic diseases need continuous medical care during adolescence and adulthood. A good transition into adult rheumatology is essential. Guidelines for a structured transition process have therefore been recommended by the European League Against Rheumatism (EULAR) and the Paediatric Rheumatology European Society (PReS). However, implementation of these guidelines requires resources often not available in a busy clinical practice. AIMS: To assess the current practice of transitional care in Switzerland in relation to EULAR/PReS recommendations and to describe gaps and challenges in following the recommendations. METHODS: All paediatric Swiss rheumatology centres and their collaborating adult centres offering a transition service to adult care were invited to participate in this survey. The responsible paediatric and adult rheumatologist of each centre was interviewed separately using a structured manual addressing the EULAR/PReS transitional care recommendations. RESULTS: All 10 paediatric and 9 out of 10 adult rheumatologists agreed to participate. Centres varied in the number of patients in transition, from n = 0 to n = 111. The following EULAR/PReS recommendations were implemented and applied in most centres: continuity in the healthcare team, consultations focused on adolescents and young adults, joint consultations between the paediatric and adult rheumatologist, and access to the EULAR website. Only rarely did a centre have a written transition policy or evaluate their transitional care programme. The vast majority of the interviewees had no specific training in adolescent health. Most centres rated their transitional care performance as very good. CONCLUSION: Transition in Switzerland is not uniform and consequently the implementation of the EULAR/PReS recommendations is variable in Swiss rheumatology centres. Skills of healthcare professionals, continuity between clinical settings, size of the centres, and hospital focus on the needs of adolescents and young adults may represent key predictors of successful transitional care for patients with chronic rheumatic diseases. Future studies should examine these variables.