ACR 2011: Transitioning the Pediatric Rheumatology Patient

Transitioning an adolescent or teenager from a pediatric rheumatologist to an adult rheumatologist can be a very delicate and complicated process. With so many pitfalls along the way, it’s easy to see why this problem has been occurring more and more. The good news? It’s a very “fixable” problem.

Fortunately for ACR attendees who sat in on this morning’s session: “Preparing for Transition from Day One of Diagnosis to Adult Care,” the process should be easier thanks to a three-pronged, highly informational presentation. Presenters Katherine Marzan, Children’s Hospital Los Angeles; Elizabeth C. Ortiz, University of Southern California; and Sandra J. Watcher, Children's Hospital of Los Angeles took turns covering all of the variables and people involved in this process.

Any transition involving patient care can be difficult; when all the parts of the process were outlined in the presentation it looked overwhelming and daunting for any health care provider. But the simple fact is that this is an issue that must be handled appropriately in order to ensure the safety of the patient. If the transition of care is not thorough or handled carelessly, the patient might not be properly educated to handle their chronic condition, or, worse they might become at risk for medication-associated morbidity. That is because medications associated with rheumatic conditions that are applied in youth (corticosteroids, for instance) must be monitored closely for long-term effects. Making things even more complicated, said Watcher, is this patient population is at high risk for emotional and social dysfunction. If all parties involved in this process are not helpful and positive, it could cause serious problems for the patient. The panel mentioned that they have seen, on many occasions, an overprotective pediatric rheumatologist who won’t “let go” of the patient and that, when transition occurs, the physician is very negative and in some cases even tells the patient that it will “not be the same.” This in turn leaves the patient feeling very unsettling about the change and can result in poor adherence or a reluctance to trust the new physician.

The coordination of care in a transition such as this requires several parties to work together. Parents must be supportive, and physicians must be positive. “As soon as a chronic rheumatic diagnosis is made, transition begins,” said Watcher. “That isn’t to say that physicians should be fixated on a transition that is years down the line, but if they are diagnosed with a chronic disease that is going to impact the rest of their life, then that itself is a transition,” she added. But even though a transition to a new medical provider might be in the distant future, it is still up to the pediatric rheumatologist to do their part in maintaining good documentation about the patient. If this is not done, there can be serious consequences, such as increased ER trips or even organ damage.

There’s no question that transitioning a patient can be difficult, espcially considering that the proces will vary depending on the many variables involved; but if handled properly and with the patient in mind, it can make a world of difference.

This activity is not sanctioned by, nor a part of, the American College of Rheumatology.