An introduction to transitional care
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This document discusses transitional care from pediatric to adult care for patients with chronic kidney disease. It notes the increasing numbers of young patients graduating from pediatric to adult care due to improved treatment. The challenges of transition include relative immaturity, stressful life events, risk-taking behavior and learning self-management. Poor outcomes are seen if transition is not well-managed, with some studies showing high rates of transplant loss and mortality. An ideal transition involves individual planning and preparation starting in early adolescence along with involvement of pediatric and adult care teams, family and patients. Transition plans aim to improve competencies in disease management and healthcare navigation. Barriers to transition are noted to be greater in Egypt due to extended family support pressures, lack of multi-
An introduction to transitional care
- 1. An introduction to transitional care Ihab Shaheen Consultant Paediatric nephrologist Royal Hospital for Children Glasgow-UK
- 2. Objectives • What is an adolescence? • Facts • Challenges • Bad figures that need attention... • Solutions.......
- 3. Adolescent is a time of increasing independence, experimentation, rebellious behaviour and peer pressure What this will lead to????
- 4. Depression, lack of secure feeling, unknown future & Anger, indestructible
- 5. Facts...number The number of young patients graduating from paediatric to adult renal care has progressively increased due to improved management ( antenatal diagnosis, dialysis in young children, general awareness,....)resulting in patient survival rates of 85–90%
- 6. Fact..... Growth and development A comprehensive, multi professional team of clinicians, nurses, dietitians, social workers, play therapists, psychologists and educators is the most effective way to minimise disabilities and maximise the potential of each child
- 7. Fact....support Support for children and families from a more diverse multi professional team is one of the major differences between paediatric and adult care
- 8. Facts....different CKD aetiology Adult nephrologists may be less familiar with the commonest cause of CKD in young children ( Genetic diseases)
- 9. Fact........it is a process Transfer is an event that takes place at the end of a transition process designed to prepare the young person with a chronic condition to accept responsibility for his/her disease management
- 10. What are the challenges?
- 11. Increasing numbers Special needs Relative immaturity Stressful life events Risk taking behaviour Learn self management Transfer to new team Reduced compliance Poor outcomes
- 12. UK RR. NDT 2018. 33(2):356-364 Almost 1 in 10 young adults died by 5 years from start of RRT
- 13. A Paediatric UK study has shown that 35% of young renal renal recipients had lost their transplants by 36 months after transfer to adult real care..... Watson et al, ped neph 2000
- 14. Ideal transition..... Transition from paediatric to adult renal services: a consensus statement by the International Society of Nephrology (ISN) and the International Paediatric Nephrology Association (IPNA)
- 15. Be individualised for each patient after he/she has completed a transition plan; this will depend upon completion of physical growth and, where possible, educational, social and psychological attainment
- 16. Be agreed upon jointly by the patient and his/her family/ in conjunction with the paediatric and adult renal care teams
- 17. • Take place during a period without crises, especially if there is unstable social support • Take place after completing school education
- 18. • Introduced to the concept of transition in early adolescence (12–14 years) • Given information about transition in a gradual manner appropriate to his/her developmental stage and intellectual ability
- 19. • Include parents, other family members and even boyfriends/girlfriends (if the young person agrees), as more information lessens anxiety • Be offered the opportunity of an informal visit to the nominated adult service before transfer occurs
- 20. • Be given the opportunity to participate in group sessions with other young people who are about to transition for peer- support experience, peer support can be complemented by establishing a local e-mail and social networking group
- 21. • Be able to receive tools to aid in the acquisition of disease self-management skills, such as the transition medical passport
- 22. • Provided with a generic transition plan that then can be individualised for each patient, most transition plans have certain competencies to be achieved at a certain age. Examples....
- 23. • I understand my condition and can describe it to others • I know my medications and what they are for • I can make decisions for myself about my treatment • I know what the adult clinic arrangements are and who will be reviewing me in clinic • I know how to make my appointments
- 24. • I can make my own transport arrangements to get to the hospital for appointments • I know who to call in a medical emergency • I am able to talk about my worries concerning blood tests and other treatments
- 25. • I know the dietary advice that I have to follow and the importance of activity • I have appropriate knowledge about sexual health matters • I have discussed smoking and drug issues..
- 26. We are different....Egypt • Extended care and support provided by parents....self management/immaturity ....more family burden More challenging here • Lack/no specialised nurses,dietatians....Dr’s job to arrange all aspects.. • Psychosocial issues versus financial load.. • Private sector.....even worse