title: The journey for adolescents and young adults with chronic conditions transitioning to adult care with successful warfarin management.
abstract: Health transition of youth from a child-centered care model to the adult model has been recognized to be of critical importance due to the increasing numbers of children now surviving chronic conditions. A formalized transition process is required adequately assess the AYA's readiness for transition and to move towards adult care. Indefinite warfarin therapy poses challenges as warfarin is a narrow therapeutic index drug that requires frequent monitoring and attentiveness to warfarin interactions and affects.
  
  
  OBJECTIVE
  The objective of this study was to evaluate transition to adult care for AYAs requiring indefinite warfarin therapy within a structured self-management program.
  
  
  METHODS
  Results were compared between Phase 1 (enrollment to patient self-management) and Phase 2 (independent warfarin management) 6months following confirmation of transition to adult care. There was no statistical difference between outcome measures except INR testing frequency, and no adverse events.
  
  
  CONCLUSIONS
  This transition process resulted in successful transition as measured by TTR and other clinical end-points from pediatric to adult care. Implementing a formal transition process for young adults with chronic health conditions that considers patient preferences motivates and empowers them over time to develop autonomy with warfarin self-management, results in successful transition and warfarin management.
authors.affiliation: Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada; University Hospital, University of Alberta, Edmonton, AB, Canada. Electronic address: mary.bauman@albertahealthservices.ca.
authors.forename: M E
authors.initials: ME
authors.lastname: Bauman
authors.affiliation: Dept. of Pediatrics, Dalhousie University, Halifax, NS, Canada; Dept. of Obstetrics & Gynaecology, Dalhousie University, Halifax, NS, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Kuhle
authors.affiliation: Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada; University Hospital, University of Alberta, Edmonton, AB, Canada.
authors.forename: A A K
authors.initials: AA
authors.lastname: Bruce
authors.affiliation: University Hospital, University of Alberta, Edmonton, AB, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Bolster
authors.affiliation: Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada.
authors.forename: M P
authors.initials: MP
authors.lastname: Massicotte
mesh_terms: D000293:Adolescent; D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D002648:Child; D019468:Disease Management; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D000067716:Point-of-Care Testing; D011788:Quality of Life; D012646:Self Administration; D060305:Transition to Adult Care; D014859:Warfarin / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: Adolescent; Coumadin; Pediatrics; Point of care monitoring; Quality of life; Transition; Vitamin K antagonist; Warfarin; Warfarin self-management; Warfarin self-testing; Young adult