Abstract
BackgroundTo investigate the utilization of health care services before and after transfer from pediatric to adult rheumatology care in clinical practice.MethodsUsing US commercial claims data from January 2005 through August 2012, we identified individuals with a JIA diagnosis code from a pediatric rheumatologist followed by any diagnosis code from an adult rheumatologist. Individuals had 6 months observable time before the last pediatric visit and 6 months after the first adult visit. Medication, emergency room, physical therapy use, and diagnosis codes were compared between the pediatric and adult interval using McNemar’s test. The proportion of days covered (PDC) of TNFi for the time between last pediatric and first adult visit was calculated.ResultsWe identified 58 individuals with JIA who transferred from pediatric to adult rheumatology care after the age of 14. The median age at the last pediatric rheumatology visit was 18.1 years old and the median transfer interval was 195 days. 29 % of patients received NSAIDs in the adult interval compared to 43 % in the pediatric interval (p = 0.06). In the pediatric interval, 71 % received a JRA and 0 % received an RA physician diagnosis code compared to 28 and 45 %, respectively, in the adult interval. The median PDC for patients receiving a TNFi was 0.75 during the transfer interval.ConclusionIndividuals with JIA who transferred to adult care were more likely receive a diagnosis of RA instead of JRA and were less likely to receive NSAIDs, but had no significant immediate changes to other medication use.
Highlights
To investigate the utilization of health care services before and after transfer from pediatric to adult rheumatology care in clinical practice
The providers who met the taxonomy criteria for pediatric rheumatologist were reviewed by MLM with >90 % of individuals identified by name as practicing pediatric rheumatologists by training or board certification
Understanding the current patterns of transition and transfer for individuals with Juvenile idiopathic arthritis (JIA) will contribute to the evaluation of barriers that limit patients from continuing rheumatologic care
Summary
To investigate the utilization of health care services before and after transfer from pediatric to adult rheumatology care in clinical practice. As with all chronic diseases that begin in childhood, patients who are seen by a pediatric specialist in childhood must transition to an adult specialist at the age of adulthood, usually near the end of adolescence. The process of transition begins in early adolescence to educate and prepare individuals for the adult experiences of disease and healthcare and culminates in the transfer from a pediatric specialist to adult specialist [10]. Since the time of transition, both the age of adolescence and transfer of care, can be a high risk period for disease flares or complications, improving the transition process for young adults with special health care needs, including those with a rheumatologic diagnosis, has become a focus of multiple organizations [11].
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