Shifting the Mindset – Adolescent and Young Adult Rheumatology in Transition

Almost 30 years after the first reports acknowledging the crucial importance of transitional care for adolescents and young adults (AYA) with chronic disease, universal implementation has yet to be achieved. Progress has undoubtedly been made, with an increasing evidence base for best practice in transitional care. However, translation of research and guidance into clinical practice continues to be challenging.

Neuroscience advances in understanding the changes occurring in the adolescent brain demand that the third phase of transition (i.e. post transfer) is given further attention and recognition that the event of transfer itself is not the end of the transition process. The complex, often unwieldy health systems in which care is delivered must also be considered. Paediatric and adult rheumatology practitioners need to collaborate not only with each other, but also with practitioners in other disciplines, specialties and agencies, to plan and commission AYA-responsive rheumatology services.

A shift in approach from focussing on health transition towards developmentally appropriate healthcare (DAH) has the potential to improve the care provided to AYA during this vulnerable life-stage, increasing the likelihood of successful, continuing engagement in their own health care into adulthood and thereby improving health outcomes.