Date post: | 03-Jun-2015 |
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Health & Medicine |
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Young Adult Rheumatology clinic(from 16-25 years old)
Dr Alison Kinder FRCPRheumatology consultant
Why?
• Unmet need in Leicester
• Young adults with chronic diseases have additional challenges in negotiating the complexities of their adolescence by virtue of their medical needs
Differences between adult centred and paediatric care
Adult care Paediatric care
Individual consultations Family consultations
Limited multidisciplinary team(often less access to psychosocial support)
More likely multidisciplinary team and psychosocial support
Payment for medication Usually free medication
Larger patient number Smaller numbers of patients
Consultation less likely to include vocational aspects
Educational and vocational aspects key to consultation
Shorter consultation time Longer consultation time
Procedural pain relief – less sedation or ga use
More sedation or ga use
Less tolerance of immaturity Greater tolerance of immaturity
Less chasing of patients who DNA Greater chasing of famillies who DNA
Less direct supervision of trainees Greater direct supervision of trainees
Less likely to see same dr at consecutive consultations
More likely to see same dr at consecutive visits
• “ emerging adulthood ” is a time of exploration, a crucial part of growing up and as such remains a time of continued vulnerability (Arnett 2000)
Several policies
• Royal college of nursing 2004• Department of health 2006• Department of Children, Schools and Famillies 2007• Royal college of physicians of Edinburgh 2008• Chief medical Officer 2008
• Review the evidence of benefit of good quality transitional care and setting out best practice models
Core set of principles
• Transition starts early and is a future focussed active process
• Young person centred and inclusive of family, carers and kinship groups
• Multidisciplinary involving paediatric and adult services with GP
For young adult
• Age appropriate• Developmentally appropriate• Culturally appropriate• Flexible process equipping him/her with skills
in communication, decision making, assertiveness, self care and self management
• Ultimate aim of transitional care is to enable adolescents to take control of their healthcare needs and emerge into adulthood with maximal function and potential
Young adult clinic
• Set up Jan 2011 in adult setting • Leicester Royal Infirmary• Only for 16 to 25 years old• Consists of – Consultant Dr Alison Kinder– Specialist nurse Toni Dorman
– May be SpRs present for training
• Accepting transfers of young adults with long term rheumatology conditions that live in Leicestershire from– Nottingham– Birmingham– Leicester– Transfers from other paediatric units for Leicester
university students
• I attend rheumatology paediatric clinic 1x/month in Leicester
• Try and meet patients prior to transfer from other centres
Current case load
• Mainly JIA • SLE• Sarcoid• Ankylosing spondylitis – If on methotrexate injections or biological therapy
requires transfer of prescription to adult service
New referrals
• Young adults with new presentations of rheumatological diseases
• Needs to be as named referral • Not on choose and book
• Clinic from Jan 2012 1x/month
Needs to be a service the young adults want
• Currently developing a questionnaire asking patients what they want from the service
• Informal feed back – Like to come to young adult clinic only– Meet other young adults– Get to see the same dr and nurse
Any questions?