The challenges of transferring chronic illness patients to adult care: reflections from pediatric and adult rheumatology at a US academic center

Abstract

Background: Little is known about the transfer of care process from pediatric to adult rheumatology for patients with chronic rheumatic disease. The purpose of this study is to examine changes in disease status, treatment and health care utilization among adolescents transferring to adult care at the University of California San Francisco (UCSF).

Methods: We identified 31 eligible subjects who transferred from pediatric to adult rheumatology care at UCSF between 1995-2005. Subject demographics, disease characteristics, disease activity and health care utilization were compared between the year prior to and the year following transfer of care.

Results: The mean age at the last pediatric rheumatology visit was 19.5 years (17.4-22.0). Subject diagnoses included systemic lupus erythematosus (52%), mixed connective tissue disease (16%), juvenile idiopathic arthritis (16%), antiphospholipid antibody syndrome (13%) and vasculitis (3%). Nearly 30% of subjects were hospitalized for disease treatment or management of flares in the year prior to transfer, and 58% had active disease at the time of transfer. In the post-transfer period, almost 30% of subjects had an increase in disease activity. One patient died in the post-transfer period. The median transfer time between the last pediatric and first adult rheumatology visit was 7.1 months (range 0.7-33.6 months). Missed appointments were common in the both the pre and post transfer period.

Conclusion: A significant percentage of patients who transfer from pediatric to adult rheumatology care at our center are likely to have active disease at the time of transfer, and disease flares are common during the transfer period. These findings highlight the importance of a seamless transfer of care between rheumatology providers.

Figure 1

Differences in disease activity between the Pre and Post Transfer Period (n = 31).