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      Implementing transition: Ready Steady Go

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          Abstract

          There is good evidence that morbidity and mortality increase for young persons (YP) following the move from paediatric to adult services. Studies show that effective transition between paediatric and adult care improves long-term outcomes. Many of the issues faced by young people across subspecialties with a long-term condition are generic. This article sets out some of the obstacles that have delayed the implementation of effective transition. It reports on a successful generic transition programme ‘Ready Steady Go’ that has been implemented within a large National Health Service teaching hospital in the UK, with secondary and tertiary paediatric services, where it is now established as part of routine care.

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          Transition from child-centered to adult health-care systems for adolescents with chronic conditions. A position paper of the Society for Adolescent Medicine.

          D Orr, N Okinow, R R Blum … (1993)
          Article 0 comments Cited 195 times – based on 0 reviews     Review now
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            Poor prognosis of young adults with type 1 diabetes: a longitudinal study.

            Desley Neil, K Bryden, David Dunger … (2003)
            To determine the role of early behavioral and psychological factors on later outcomes in young adults with childhood- or adolescent-onset type 1 diabetes. We conducted a longitudinal cohort study of patients recruited from the register of the young adult outpatient diabetes clinic, Oxford, U.K. A total of 113 individuals (51 male subjects) aged 17-25 years completed assessments, and 87 (77%) were reinterviewed as older adults (aged 28-37 years). Longitudinal assessments were made of glycemic control (HbA(1c)) and complications. Psychological state at baseline was assessed using the Present State Examination and self-report Symptom Checklist, with corresponding interview schedules administered at follow-up. There was no significant improvement between baseline and follow-up in mean HbA(1c) levels (8.5 vs. 8.6% in men, 9.3 vs. 8.7% in women). The proportion of individuals with serious complications (preproliferative or laser-treated retinopathy, proteinuria or more severe renal disease, peripheral neuropathy, and autonomic neuropathy) increased from 3-37% during the 11-year period. Women were more likely than men to have multiple complications (23 vs. 6%, difference 17%, 95% CI 4-29%, P = 0.02). Psychiatric disorders increased from 16 to 28% (20% in men, 36% in women at follow-up, difference NS), and 8% had psychiatric disorders at both assessments. Baseline psychiatric symptom scores predicted follow-up scores (beta = 0.32, SE [beta] 0.12, P = 0.008, 95% CI 0.09-0.56) and recurrent admissions with diabetic ketoacidosis (odds ratio 9.1, 95% CI 2.9-28.6, P < 0.0001). The clinical and psychiatric outcome in this cohort was poor. Psychiatric symptoms in later adolescence and young adulthood appeared to predict later psychiatric problems.
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              Non-compliance and transfer from paediatric to adult transplant unit.

              Ronald W G Watson (2000)
              Adolescents and young adults appear to be a particularly high-risk group for problems of non-compliance and associated graft loss. We reviewed the progress of 20 young adults (9 female) who had been transferred to three different adult centres at a mean age of 17.9 years (range 15.7-20.9 years) having been transplanted at a mean age of 14.3 years (range 9.6-18.1 years) in the paediatric unit. Eight transplants failed within 36 months of transfer, and in 7 of 20 (35%) the transplant failure was unexpected (3 < 12 months, 3 12-24 months, 1 31 months post transfer). Although many of the patients had recognised problems in family dynamics, only 1 had had a major rejection episode prior to transfer due to admitted non-compliance. In 3 others low cyclosporin levels had been noted. Two young men had been transplanted preemptively in the paediatric unit at 15.3 and 16.7 years, and 3 patients had been transferred to the adult unit via the recently established transition clinic. The results suggest that close attention needs to be paid to this group of patients who require ongoing education and support. Improved dialogue between staff of the paediatric and adult units about transition issues is also essential.
              Article 0 comments Cited 83 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Arch Dis Child Educ Pract Ed
                Journal ID (iso-abbrev): Arch Dis Child Educ Pract Ed
                Journal ID (hwp): edpract
                Journal ID (publisher-id): eap
                Title: Archives of Disease in Childhood. Education and Practice Edition
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Print): 1743-0585
                ISSN (Electronic): 1743-0593
                Publication date (Print): December 2015
                Publication date (Electronic): 10 June 2015
                Volume: 100
                Issue: 6
                Pages: 313-320
                Affiliations
                [l ]Department of Paediatric Nephro-Urology, Southampton Children's Hospital , Southampton, UK
                [2 ]Department of Paediatric Respiratory Medicine, Southampton Children's Hospital , Southampton, UK
                [3 ]Department of Paediatric Endocrinology and Diabetes, Southampton Children's Hospital , Southampton, UK
                [4 ]Department of Adult Congenital Heart Medicine, University Hospitals Southampton , Southampton, UK
                Author notes
                [Correspondence to ] Dr Arvind Nagra, Department of Paediatric Nephro-Urology, Southampton Children's Hospital, Tremona Road, Southampton SO16 6YD, UK; arvind.nagra@ 123456uhs.nhs.uk
                Article
                Publisher ID: edpract-2014-307423
                DOI: 10.1136/archdischild-2014-307423
                PMC ID: 4680199
                PubMed ID: 26063244
                SO-VID: 5a51e368-10c6-4e9a-8419-361364bb38a3
                Copyright © Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
                License:

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                Date received : 27 August 2014
                Date revision received : 23 April 2015
                Date accepted : 6 May 2015
                Related
                Categories
                Subject: 1506
                Subject: E&P: Quality improvement
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                Keywords: adolescent health,cardiology,cystic fibrosis,diabetes,nephrology,patient empowerment
                Data availability:
                Keywords: adolescent health, cardiology, cystic fibrosis, diabetes, nephrology, patient empowerment

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