title: Evaluation of a Rheumatology Transition Clinic.
abstract: BACKGROUND
  An adolescent with a chronic condition must prepare for transition from the pediatric to the adult health care system. Ideally, transition is a purposeful and coordinated process between the two systems. We sought to evaluate a pediatric rheumatology transition clinic from the perspective of the young adults who attended the clinic.
  
  
  METHODS
  Young adults who attended the IWK Health Centre Pediatric Rheumatology Transition Clinic in Halifax, Nova Scotia, Canada were asked to complete a mail questionnaire. In this clinic an adult rheumatologist joins the pediatric team for the patient's visit. Subjects rated satisfaction with the clinic and how completely a number of items were addressed (e.g. knowledge about disease, self-management, adolescent issues) on a 10 cm visual analog scale (higher scores reflecting more favourable assessment). Compliance with follow-up post-transfer to adult care was assessed by self-report and a chart review. Data were summarized descriptively.
  
  
  RESULTS
  The response rate was 34% (51/151). The mean age of respondents was 22 years with the majority diagnosed with juvenile idiopathic arthritis. Most patients were transferred to adult care between the ages of 17 and 20 years. The mean overall satisfaction score with the transition clinic was 7.3 ± 2.6. There was significant variability regarding how well individual transition-related items were perceived to have been addressed, with an overall mean of 6.1 ± 3.2. Items which received a majority of scores of > 7 included learning about side effects of medications, learning to live with their disease, confidence in disease management, and control of disease at transfer. Items rated as <5 by a third of respondents included addressing teen issues (smoking, alcohol, sexual health) and learning about new developments related to their condition. 74% of patients reported regular appointments with adult rheumatology.
  
  
  CONCLUSIONS
  Most young adults reported overall satisfaction with the transition clinic, however their perception of how adequately various transition issues were addressed was quite variable. It appears that there were some perceived deficits in the care that was provided in all areas, but possibly more so in counselling around general adolescent issues. There was a high rate of follow-up after transfer to the local adult clinic.
authors.affiliation: Division of Pediatric Rheumatology, IWK Health Centre, Halifax, NS, B3K 6R8, Canada. Elizabeth.stringer@iwk.nshealth.ca.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Stringer
authors.affiliation: Pediatric Endocrinology Service, CHU Sainte-Justine, 3175, chemin de la Cote-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada. Rachel.scott.hsj@ssss.gouv.qc.ca.
authors.forename: Rachel
authors.initials: R
authors.lastname: Scott
authors.affiliation: Division of Rheumatology, University of Calgary, 3280 Hospital Drive NW, 3aa18 HRIC, T2N 4Z6, Calgary, AB, Canada. dpmosher@ucalgary.ca.
authors.forename: Dianne
authors.initials: D
authors.lastname: Mosher
authors.affiliation: Division of Pediatric Rheumatology, IWK Health Centre, Halifax, NS, B3K 6R8, Canada. Inezmacneill@hotmail.com.
authors.forename: Inez
authors.initials: I
authors.lastname: MacNeill
authors.affiliation: Division of Pediatric Rheumatology, IWK Health Centre, Halifax, NS, B3K 6R8, Canada. Adam.huber@iwk.nshealth.ca.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Huber
authors.affiliation: Division of Pediatric Rheumatology, IWK Health Centre, Halifax, NS, B3K 6R8, Canada. Suzanne.ramsey@iwk.nshealth.ca.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Ramsey
authors.affiliation: Division of Pediatric Rheumatology, IWK Health Centre, Halifax, NS, B3K 6R8, Canada. Bianca.lang@iwk.nshealth.ca.
authors.forename: Bianca
authors.initials: B
authors.lastname: Lang
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009674:Nova Scotia; D017060:Patient Satisfaction; D012216:Rheumatic Diseases / Q000628:therapy*; D012219:Rheumatology; D057566:Self Report; D011795:Surveys and Questionnaires; D060305:Transition to Adult Care / Q000592:standards*; D016896:Treatment Outcome; D055815:Young Adult