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Rheumatol Int. 2015 Oct;35(10):1615-24. doi: 10.1007/s00296-015-3273-6. Epub 2015 Apr 28.

Consensus of the Spanish society of pediatric rheumatology for transition management from pediatric to adult care in rheumatic patients with childhood onset.

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Servicio de Pediatría, H La Fe, Valencia, Spain.
Hospital Universitari i Politècnic La Fe, Avinguda de Fernando Abril Martorell, nº 106, 46026, Valencia, Spain.
Servicio de Pediatría, H Sant Joan de Deu, Esplugues de Llobregat, Spain.
Servicio de Reumatología, HU de Canarias, Santa Cruz de Tenerife, Spain.
Servicio de Pediatría, HU Virgen del Rocío, Seville, Spain.
Unidad de Reumatología Pediátrica, H 12 de Octubre, Madrid, Spain.
Servicio de Reumatología, H Ramón y Cajal, Madrid, Spain.
Servicio de Reumatología, EOXI CHU A Coruña, A Coruña, Spain.
Servicio de Pediatría, H Universitari Son Dureta, Mallorca, Spain.
Servicio de Pediatría, H del Niño Jesús, Madrid, Spain.
Servicio de Reumatología, H Miguel Servet, Saragossa, Spain.
Unidad de Reumatología Pediátrica, H La Paz, Madrid, Spain.
Servicio de Reumatología, H Vall d'Hebron, Barcelona, Spain.
UGC de Pediatría, H Materno Infantil, H Regional Universitario de Málaga, Málaga, Spain.
Servicio de Pediatría, HU Cruces, Barakaldo, Bizkaia, Spain.
Servicio de Reumatología, H General Hospitalet-Moisès Broggi, Sant Joan Despí, Spain.
Servicio de Reumatología, HU Virgen Macarena, Seville, Spain.
Instituto de Salud Musculoesquelética, Madrid, Spain.


To develop recommendations on the transition from pediatric care to adult care in patients with chronic inflammatory rheumatic diseases with childhood onset based. Recommendations were generated following nominal group methodology and Delphi technique. A panel of 16 experts was established. A systematic literature review (on transitional care) and a narrative review were performed and presented to the panel in the first panel meeting to be discussed. A first draft of recommendations was generated and circulated. Focal groups with adolescents, young adults and parents were organized. In a second meeting, the focus group results along with the input from invited psychologist were used to establish definitive recommendations. Then, a Delphi process (two rounds) was carried out. A group of 72 pediatric and adult rheumatologists took part. Recommendations were voted from 1 (total disagreement) to 10 (total agreement). We defined agreement if at least 70 % voted ≥7. The level of evidence and grade or recommendation was assessed using the Oxford center for evidence-based medicine levels of evidence. Transition care was defined as a purposeful, planned process that addresses the medical, psychosocial and educational/vocational needs of adolescents and young adults with chronic inflammatory rheumatic diseases with childhood onset as they move from child-centered to adult-oriented healthcare systems. The consensus covers: transition needs, barriers and facilitators, transitional issues (objectives, participants, content, phases, timing, plans, documentation and responsibilities), physicians' and other health professionals' knowledge and skill requirements, models/programs, and strategies and guideline for implementation. Preliminary recommendations and agreement grade are shown in the Table (first Delphi round). These recommendations are intended to provide health professionals, patients, families and other stakeholders with a consensus on the transition process from pediatric to adult care.


Adolescent; Pediatric rheumatology; Transitional care

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