Preparation for transition may be considered from early
adolescence (11-13 years) in accordance with the patient’s developmental
stage (D, IV-V) |
HCP may want to consider the following when deciding
when to start the transition process: mental and physical development,
disease activity, health literacy, adherence to treatment, autonomy in
disease management, family’s socioeconomic circumstances and school
format. |
Foster13; Elli16;
CAPHC19; Vajro17;
NICE18; Brooks15; Ludvigsson
201614
|
For a transition model to be effective, the following may be
considered for inclusion: |
For a transition model to be
effective, the following may be considered for inclusion: |
|
- the use of a structured, multidisciplinary transition
programme within the clinic/healthcare unit (D, I-V)
|
Shared regional protocol agreed with HCP, AYA, parents/careers, HCP and
regularly updated at least every 5 years. This could include
age-appropriate written information and structured transition
communication/reports between all paediatric and adult HCP. It may be
helpful to have a lead person to coordinate the transition process and
be a contact person for HCP, AYA and parents/carers.
|
Calvo, 201512; Foster, 201613;
Brooks15; CAPHC19;
NICE18, Vajro17
|
- informing AYA and parents/caregivers about allergy and/or
asthma as well as the transition processes and the support available in
a form that is appropriate for their developmental stage (D, I-V)
|
HCP may want to consider including the following information: purpose of
transfer to an adult setting and what to expect when they come there;
location of available adult centres, disease characteristics, treatments
(including side effects), how to recognize alarm symptom, how to assist
AYAs to take on their own care and support available. Ideas for formats:
leaflets, web-page, audio for AYA with disabilities. It may be helpful
for AYA to have their own personal transition
plan17,19.
|
Brooks15; Calvo12;
Elli16; CAPHC19;
NICE18
|
- a checklist of skills and knowledge to assess AYA readiness
for transition (D, I-V)
|
Tools can be used several times throughout the transition process in
order to identify which areas of AYA self-management and well-being need
to be addressed and improved. There are no specific allergy and asthma
tools but generic ones are available: Transition Readiness Assessment
Questionnaire20, “Ready, Steady,
Go”21 and TR(x)ANSITION Scale
22.
|
CAPHC19; Vajro17;
Brooks15; Foster13
|
- active monitoring of adherence to treatment through the
transition process (D, I-V)
|
Adherence may benefit from targeted specific educational and
organisational interventions, e.g. more frequent
appointments15 , repeated education. A good open
dialogue and communication is important. AYA with ”new onset” of a
disease will have minimal prior experience and so need more input.
|
Calvo12; Brooks15;
Vajro17; Ludvigsson14;
Elli16
|
-a period of overlap between paediatric and adult care providers
before AYA is transferred, then feedback from the adult to the
paediatric clinic about their attendance and any changes in management
(D, I-V)
|
Where AYA care needs to be moved to another service clinic, AYA medical
information (ideally in the form of a transition report) should be
transferred to the adult medical service. Where possible, AYA should be
seen in a joint paediatric-adult clinic, AYA should ideally see the same
HCP in adults’ services for at least the first 2 attended appointments
after transfer 18.
|
Calvo12; Foster, 201613;
Elli16; CAPHC19;
NICE18; Ludvigsson14;
Brooks15; Vajro17
|
- regular meetings between paediatric and adult care providers
(D, I-V)
|
Particular focus should be placed on more complex patients. Meetings
could be virtual. Process could be informed by areas of the assessment
tools e.g. adherence, disease activity outcomes,
HEADSS26.
|
Elli16;Vajro17
|
Other options for effective communication between HCP and AYA
can be recommended (eg web-based, mobile technologies) (B, I-V) |
Options may include web-based communication boards and digital
communication tools such as text. |
Vajro17;Brooks15;
NICE18
|
Discussion of self-management of AYA allergy and/or asthma
within current and potential future college, university, work or social
environments may be considered (D, I-V) |
Areas that HCP may want to
consider discussing lifestyle, future health concerns, educational and
employment goals, independent living and housing options, financial
needs, psychosocial, mental health, sexuality and reproduction.
Particular attention is required while taking exams, especially in AYA
with allergic rhinitis. Additional help may be needed from other
professionals, eg psychologist, social and youth worker. |
Calvo12; CAPHC19;
NICE18; Brooks15
|
Specific training in transitional and AYA care may be
recommended for all HCP involved in transition process (C, II-V) |
Training in generic transition process, disease-specific and
developmentally-appropriate care (e.g. clinical experience, e-learning,
workshops) as part of the continuing professional development.
Developmentally-appropriate healthcare should be practiced. |
Calvo12; Foster13;
CAPHC19
|
Regular audit of a transition service may be recommended to
assess key performance indicators and improve service provision (C,
I-V) |
Audit should involve AYA and families, policy and decision
makers, administrators, researchers, HCP and government agencies. |
Brooks15; CAPHC19;
NICE18
|