Skip to main content

Comment on: a novel transition clinic structure for adolescent and young adult patients with childhood onset rheumatic disease improves transition outcomes

Dear Editor,

The article in Pediatric Rheumatology by Overbury et al. [1] proposing a transition clinic named ACCORD (Adult Center for Childhood Onset Rheumatic Disease) that integrates internal medicine - pediatrics trained adult rheumatologist in a pediatric rheumatology clinic is a very interesting novel concept. Successful transition of all indicated adolescents and young adults (AYA) with childhood onset rheumatic disease (CORD) to adult rheumatologist with a median time between last transition clinic visit and first adult clinic visit of just 5.1 months ensured continuity of medical care [1] and could potentially increase the likelihood of positive outcomes. Although European and American societies have recognized the importance of health care transition (HCT) and have developed international recommendations and standards for transitional care, universal implementation is still not realized. There is growing evidence of benefits of HCT [1,2,3,4], however there is no consensus on the optimal model since there is no systematic approach to evaluating and reporting the effectiveness of implemented programs across the globe. Creating appropriate questionnaires and their validation in order to monitor the activity and severity of the disease would significantly improve the quality of transition clinics.

Hence, a question: Has the time come for all relevant societies, like the efforts of Assessment of Spondyloarthritis International Society (ASAS)/European League Against Rheumatism (EULAR) in axial spondyloarthritis [5], to join together to develop recommendations for the care of this vulnerable group of patients?

The ACCORD clinic bridges the gap between pediatric and adult rheumatology, and it might be the right way forward in the care of AYA patients. Furthermore, ACCORD clinic is a step toward a life course management approach in rheumatology enabling trained rheumatologist in this field to manage transitional clinic. Multidisciplinary treatment (MDT) approach to the treatment of AYA patients with CORD involves a pediatric and adult rheumatologist requiring coordination of availability of experts. Another very valid question in MDT approach is: with whom lies the final responsibility and choice of treatment. Ultimately, this should be standardized in the same way as treatment recommendations. Furthermore, structured HCT process for youth with special health care needs has showed improvements in adherence to care, disease-specific measures, quality of life, self-care skills, satisfaction with care, health care utilization, and HCT process of care [6]. We have witnessed recent advances in rheumatology research and approval of wide range of disease-modifying anti-rheumatic drugs (DMARDs), biologic (bDMARDs) and targeted synthetic (tsDMARDs). However, not all bDMARDs/tsDMARDs are approved for adolescents limiting their treatment options. The ACCORD clinic has the possibility to take this aspect into consideration as well and improve access to appropriate therapy. Finally, HCT process could be a determining factor to prevent hospital admission rates, surgeries needed and adult clinic attendance rates [7].

References

  1. Overbury RS, Huynh K, Bohnsack J, Frech T, Hersh A. A novel transition clinic structure for adolescent and young adult patients with childhood onset rheumatic disease improves transition outcomes. Pediatr Rheumatol Online J. 2021;19(1):164. https://doi.org/10.1186/s12969-021-00651-w.

    Article  PubMed  PubMed Central  Google Scholar 

  2. McDonagh JE, Farre A. Transitional care in rheumatology: a review of the Literature from the Past 5 Years. Curr Rheumatol Rep. 2019;21(10):57. https://doi.org/10.1007/s11926-019-0855-4.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Martins P, Barreira SC, Melo AT, Campanilho-Marques R, Costa-Reis P, Fonseca JE, Oliveira-Ramos F. Transition in a paediatric rheumatology unit - experience from a tertiary unit. Acta Reumatol Port. 2019;44(4):320–1.

    PubMed  Google Scholar 

  4. Berben L, Sigg N, Daly ML, Bachmann S, Baer W, Berthet G, Bolt I, Dan D, Enderlin Steiger S, Fröhlich J, Hasler P, Hofer M, Huemer C, Kaiser D, Marcoli N, Palmer Sarott S, Rottländer Y, Schmid G, Soennichsen C, Strahm Furler L, Vanoni F, Wildi L, Daikeler T, Woerner A. Current practice of transitional care for adolescents and young adults in Swiss paediatric and adult rheumatology centres. Swiss Med Wkly. 2021;12:w30046. https://doi.org/10.4414/smw.2021.w30046.

    Article  Google Scholar 

  5. van der Heijde D, Ramiro S, Landewé R, Baraliakos X, Van den Bosch F, Sepriano A, Regel A, Ciurea A, Dagfinrud H, Dougados M, van Gaalen F, Géher P, van der Horst-Bruinsma I, Inman RD, Jongkees M, Kiltz U, Kvien TK, Machado PM, Marzo-Ortega H, Molto A, Navarro-Compàn V, Ozgocmen S, Pimentel-Santos FM, Reveille J, Rudwaleit M, Sieper J, Sampaio-Barros P, Wiek D, Braun J. 2016 update of the ASAS-EULAR management recommendations for axial spondyloarthritis. Ann Rheum Dis. 2017;76(6):978–91. https://doi.org/10.1136/annrheumdis-2016-210770.

    Article  PubMed  Google Scholar 

  6. Schmidt A, Ilango SM, McManus MA, Rogers KK, White PH. Outcomes of Pediatric to Adult Health Care Transition Interventions: An Updated Systematic Review. J Pediatr Nurs. 2020;51:92–107. https://doi.org/10.1016/j.pedn.2020.01.002.

    Article  PubMed  Google Scholar 

  7. García-Rodríguez F, Raygoza-Cortez K, Moreno-Hernandez L, et al. Outcomes of transitional care programs on adolescent chronic inflammatory systemic diseases: systematic review and meta-analyses. Pediatr Rheumatol Online J. 2022;20(1):15. https://doi.org/10.1186/s12969-022-00670-1 Published 2022 Feb 17.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

Not applicable.

Funding

Not applicable.

Author information

Authors and Affiliations

Authors

Contributions

MR wrote the manuscript and searched the literature. The author(s) read and approved the final manuscript.

Corresponding author

Correspondence to Mislav Radić.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The author declares no conflicts of interest

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Radić, M. Comment on: a novel transition clinic structure for adolescent and young adult patients with childhood onset rheumatic disease improves transition outcomes. Pediatr Rheumatol 20, 62 (2022). https://doi.org/10.1186/s12969-022-00718-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12969-022-00718-2