Authors (including presenting author) :
Chan DTH (1), Leung CY (2), Ho LY (3), Chiang GPK (2)
Affiliation :
(1) Department of Medicine, Alice Ho Miu Ling Nethersole Hospital
(2) Department of Paediatrics and Adolescent Medicine, Alice Ho Miu Ling Nethersole Hospital
(3) Department of Medicine and Geriatrics, Tai Po Hospital
Introduction :
Transition from paediatric to adult care is a challenging phase for paediatric patients with chronic illnesses, often leading to care disruption and worsening disease status. This is particular problematic for rheumatology patients, as their conditions are more difficult to manage. A smooth transition is essential for maintaining treatment adherence and promoting psychological well-being. To address these challenges, we established the first paediatric transition clinic in our cluster.
Objectives :
1) To shorten the transition period and simplify the referral process from paediatrics to adult rheumatology care; 2) To promote quality and continuation of specialist care.
Methodology :
The study was conducted in two parts. First, a retrospective review was performed using the Clinical Data Analysis and Reporting System to analyse patients referred from paediatric to adult rheumatology services between January 1, 2016, and December 31, 2020. Data collected included the number of referrals, patient age, time from referral to first adult rheumatology assessment, and dropout rates.
Second, patients awaiting their first adult medical appointment or recently turning 18 were recruited into the transition clinic. Prospective data, including patient age and time from referral to first adult rheumatology assessment, were collected. They were also required to fill in a questionnaire to assess their readiness for transition.
Result & Outcome :
In the retrospective review, 35 patients were referred to adult medical care, with 24 seen in adult rheumatology clinics and three lost to follow-up. The mean age at attendance in adult rheumatology clinic was 20.2 years, with a median of 20.3 years). The mean waiting time for the clinic was 20.3 months, with a median of 20.7 months (IQR: 15.3; 11.9–27.2).
Since the transition clinic’s establishment, nine patients were seen across two clinic sessions. The mean age at attendance was 19.3 years, with a median of 19.4 years. The mean transition time from paediatric to adult care was 9.9 months, with a median of 11.9 months (IQR: 6.4; 6.65–13.05). This represents a reduction in the mean waiting time by 10.4 months. The questionnaire responses demonstrate that patients value the importance of the transition clinic.
Conclusions:
The establishment of a paediatric transition clinic has significantly improved the transition process from paediatric to adult rheumatology care. It reduced transition time and streamlined referrals. These improvements highlight the effectiveness of a structured transition program in minimizing care disruption, and ensuring continuity of care, serving as a model for managing transitions in rheumatology and other chronic conditions.
