October 28, 2021

From pediatrician to rheumatologist: facilitated path for young people


For adolescents suffering from chronic rheumatic diseases, and therefore in need of ongoing assistance, the transition from pediatric care to that of the adult rheumatologist particularly delicate. As some studies show, the risk that they do not follow the therapies correctly or even abandon the treatments and periodic checks. To facilitate the transition, the Italian Society of Rheumatology (Sir) and the Italian Society of Pediatrics (Sip) have promoted the Transition project. In practice, they have defined a specific path dedicated to rheumatological transition, practical and certified, with visits to the clinic by a team of pediatricians, rheumatologists, psychologists and nurses.

The problem

It is estimated that about 50 percent of young adults with rheumatological disease who do not make a proper transition from pediatric to adult specialist care are exposed to risk of developing organ damage or potentially serious long-term complications – he pressed Alberto Villani, president of Sip -. Being able to ensure continuous and adequate assistance in the post-adolescent phase, which is decisive for the clinical history of patients, their quality of life and well-being in adulthood Adds the rheumatologist Luigi Sinigaglia, president of the Italian Society of Rheumatology: The transition is not an automatic path but must be regulated considering various aspects, clinical, welfare, related to adherence to therapies, but also psychological and organizational. Usually the pediatrician who advises or contacts the rheumatologist directly on the basis of a knowledge relationship. The project intends to define a minimal but effective path, throughout the national territory, to allow young patients to pass into adulthood by reducing psychological trauma and possible difficulties in managing the disease.

The project

What does “Transition” consist of? It is a shared protocol that provides for a specific diagnostic-therapeutic assistance path (Pdta) to accompany the adolescent in the transition phase – says the pediatrician Angelo Ravelli, project coordinator for the Sip -. The child has a confidential relationship with the pediatrician, who takes care of him from the first years of life, so he feels protected when he becomes a teenager. must manage all aspects of the disease independently and, if the rheumatologist’s management of the adult is not effective, the risk that the patient will not take the prescribed therapies or abandon the treatments. Who activates the PDTA and how? It is up to the Regions to implement the Pdta, which can be declined in the health and hospital Trusts – explains the rheumatologist Florenzo Iannone, project coordinator for SIR -. a minimum practical model was shared, validated by a recognized certification body, which allows the transition with few resources e a computerized medical record. One or two team visits are planned, then the adolescent meets a pediatrician, rheumatologist, psychologist, nurse. If it is not possible to visit in person, in times of pandemic or because the center is distant, it is used the teleconsultation for the collegiate visit.

The comment

The PDTA for the rheumatological transition has the applause of the patient associations. We hope that the PTOs will be rapidly adopted and disseminated in all the Regions – he comments Silvia Tonolo, president of Anmar, National Association of Rheumatic Patients -. A shared and consolidated operating model, in fact, would guarantee health and quality of life for young patients with chronic inflammatory rheumatism. He adds Antonella Celano, president of Apmarr, National Association of people with rheumatological and rare diseases: We have always been waiting for the possibility of having a dedicated shared path, especially people like me are waiting for it, suffering from a rheumatological disease from the age of 4 without ever having met a pediatrician who took care of it, let alone be accompanied in the transition phase to the adult rheumatologist.

October 26, 2020 (change October 26, 2020 | 19:35)

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