Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Are They Ready for Adult Care? An Assessment of Variables Affecting Patient Autonomy When Transitioning from Pediatric to Adult Rheumatology.

Banks3,  Sharon E., Bingham1,  Catherine A., Groh2,  Brandt P.

Hershey Medical Center, Zionsville, PA
Hershey Medical Center, Hershey, PA
Hershey Medical Center

Background:

Transition from a pediatric to adult provider is often difficult for pediatric rheumatology patients and their families. Currently there are no criteria used to determine whom or when to transition. Physicians expect the adolescent to become motivated to be medically independent in caring for his/her own disease without parental influence. However, many adolescents are not ready to assume this role causing a lapse in medical care. We sought to identify factors which, when present, might lead to increased autonomy. Identification of these factors could be used in the clinic to determine which patients would make a more successful transition.

Methods:

69 pediatric and young adult rheumatology patients between the ages of 14 and 21 were surveyed independently without parental input. Information was collected by questionnaire that consisted of two types of questions. Independence questions included whom the patient would contact in case of worsening disease, medication refills, medical emergencies, missed appointments, and to make an appointment. Life skills questions included whether the patient ever had a summer job, a drivers license, current grades, scholastic level achieved, and family income. Data was analyzed to see if there was any correlation between an individual's response to independence questions and his/her response to life skills questions. Significance was determined using Chi-square statistics and Fishers exact test where applicable. Statistically significant or near significant correlations are shown in the table below.

Results:

Conclusions:

Higher scores in school, college enrollment, having a summer job, and a drivers license all contributed to independence in medical care. Higher family income, taking medications which require lab monitoring, and taking medications daily were associated with less independence. Physicians could assess this information to determine which patients may need more preparation for transition to adult rheumatology versus those ready to transition.

Life skill questionIndependence questionP-value
Higher scores in schoolTake meds without a reminder from parentsP = 0.01
Take meds which require laboratory monitoringParents give the medsP = 0.07
Male genderLikely to call doctor, not parent, if feel sickP = 0.02
Take meds dailyParent (not adolescent) phones doctor for emergencyP = 0.07
Increased household incomeParent makes doctor appointmentP = 0.09
Increased household incomeParent calls doctor for disease flareP = 0.03
Increased household incomeParent cancels doctor appointmentP = 0.02
College levelCancel own doctor appointmentP = 0.02
Have summer jobGive self medsP = 0.04
Have summer jobCall doctor (not parent) if disease flaresP = 0.01
Have a drivers licenseCall doctor (not parent) if run out of medsP = 0.001
Have drivers licenseMake own doctor appointmentP = 0.01
Have drivers licenseGive self medsP = 0.09

To cite this abstract, please use the following information:
Banks, Sharon E., Bingham, Catherine A., Groh, Brandt P.; Are They Ready for Adult Care? An Assessment of Variables Affecting Patient Autonomy When Transitioning from Pediatric to Adult Rheumatology. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :211
DOI: 10.1002/art.27980

Abstract Supplement

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