Calvo Inmaculada, Antón Jordi, Bustabad Sagrario, Camacho Marisol, de Inocencio Jaime, Gamir M Luz, Graña Jenaro, La Cruz Lucía, Robledillo Juan Carlos López, Medrano Marta, Merino Rosa, Modesto Consuelo, Nuñez Esmeralda, Rua M Jesús, Torrente-Segarra Vicenç, Vargas Carmen, Carmona Loreto, Loza Estíbaliz
Servicio de Pediatría, H La Fe, Valencia, Spain.
Hospital Universitari i Politècnic La Fe, Avinguda de Fernando Abril Martorell, nº 106, 46026, Valencia, Spain.
Rheumatol Int. 2015 Oct;35(10):1615-24. doi: 10.1007/s00296-015-3273-6. Epub 2015 Apr 28.
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.
为基于儿童期起病的慢性炎症性风湿性疾病患者从儿科护理过渡到成人护理制定建议。建议是按照名义群体法和德尔菲技术生成的。成立了一个由16名专家组成的小组。进行了一项关于过渡护理的系统文献综述和一项叙述性综述，并在第一次小组会议上提交给小组进行讨论。生成了建议初稿并进行了传阅。组织了青少年、青年及其父母的焦点小组。在第二次会议上，焦点小组的结果以及受邀心理学家的意见被用于确定最终建议。然后，开展了一个德尔菲过程（两轮）。72名儿科和成人风湿病学家参与其中。建议的投票从1分（完全不同意）到10分（完全同意）。如果至少70%的人投票≥7分，我们就定义为达成共识。使用牛津循证医学中心的证据水平评估证据水平和推荐等级。过渡护理被定义为一个有目的、有计划的过程，该过程满足儿童期起病的慢性炎症性风湿性疾病的青少年和青年在从以儿童为中心的医疗保健系统转向以成人为导向的医疗保健系统时在医疗、心理社会和教育/职业方面的需求。共识涵盖：过渡需求、障碍和促进因素、过渡问题（目标、参与者、内容、阶段、时间、计划、记录和责任）、医生和其他卫生专业人员的知识和技能要求、模式/项目以及实施策略和指南。初步建议和共识等级见表（第一次德尔菲轮）。这些建议旨在为卫生专业人员、患者、家庭和其他利益相关者就从儿科护理向成人护理的过渡过程达成共识。
