1. The Transition of Juvenile Rheumatoid Arthritis Patients from Pediatric to Adult Services
Irena Haghighi
DePaul University , School of Nursing
Background
Juvenile Idiopathic Arthritis, JIA, is an autoimmune disease characterized by chronic inflammation and swelling in one or more joints. The average age of onset is between one to three years old, which complicates diagnosis and incidence reporting.
The American College of Rheumatology(ACR) estimates 300,000 cases in children in the US alone (ACR, 2017), of these about a third of patients do not attain remission and transition into adult care.
Current transitional services from adult to pediatric care are dependent on insurance regulations as well as providers.
The transition from pediatric to adult care in the JIA population is in need of refinement so that adolescent undergoing the transition may be more successful in their adult care programs.
Research Questions
Purpose
Methods
An Integrative literature review was conducted to synthesize the current research conducted on the transitional period of JIA, including if this was successful or not and establish recommendations for future interventions and further research.
Search was done using
Peer reviewed articles from
Pudmed, Cumulative Index to Nursing and Health Literature (CINHAL), and PsychINFO databases.
How is successful transition from pediatric to adult services in the JIA population currently described and defined?
What are the essential elements to be included in the interventions that create a successful transition of services?
The purpose of this integrative literature review as to describe the current body of research regarding the facilitation of transition of care from pediatric to adult services in the adolescent population with JIA.
Conceptual Framework
Erikson’s theory for psychosocial development
Stresses the individuals development as influenced by culture, society and personality.
The individual is constantly evolving throughout the lifespan, and this development occurs in eight stages.
Stage five was applied to this research, encompassing ages 1-20, the adolescent stage.
Developmental tasks involved included transition from childhood to early adulthood and formation of identity for role confidence.
Within the framework of transitional care, self-management was seen as a key factor for the feeling of success.
Results
Among the research regarding successful transition from pediatric to adult care, several common themes arose for those that were considered most successful by both patients, care teams and parents,. These included,
Gradual phasing of transition
Flexibility of transition
Role certainty
Joint care/collaboration
Education for the establishment of self-management skills
Research based interventions to help with the transition period from pediatric to adult care were found to be varied and widely undistributed. Based on the interventions four elements common to the different projects were compiled. These included
Web based interventions
Development of skills to effectively communicate with the provider
Education focused on future milestones and ongoing self-management
Support of autonomy
References:
American College of Rheumatology (ACR). (2017). Juvenile Arthritis. Retrieved from
American Academy of Pediatrics (AAP). (July 2011). Supporting the Health Care Transition
from Adolescence to Adulthood in the Medical Home. Pediatrics, 128(1) Doi: /peds
Limitations
Conclusion
Major limitations to this study included regional implications of the research available. A majority of the research on implementation projects has been done in countries outside of the US.
The study found a that successful transition programs provided patients with a holistic approach to their care, including starting preparation for transition early and using collaboration as a bridge for care. Further suggestions for better transitional programs may be made based on the results to help future transitional programs to have the best outcomes.
Suggestions
Further research particularly surveying the JIA population in the US would be helpful to establish a better understanding of what is available to patients.
As well as to establish what barriers are perceived by providers in both peds and adult care to establish better guidelines.