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Transitional care of young people with juvenile idiopathic arthritis in Italy: results of a Delphi consensus survey

Angelo Ravelli1, Luigi Sinigaglia2, Rolando Cimaz3

  • 1Dip. di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Univ. di Genova; Clinica Pediatrica e Reumatologia, IRCCS Ist. G.Gaslini, Genoa, Italy; and Sechenov First Moscow State Medical Univ., Russian Federation.

Clinical and Experimental Rheumatology
|August 4, 2019
PubMed

Insights

Italian rheumatologists found EULAR/PReS transitional care (TC) recommendations for juvenile idiopathic arthritis (JIA) had limited applicability. A Delphi consensus survey highlighted needs for country-specific statements to improve TC for young people with JIA in Italy.

Area of Science:

  • Rheumatology
  • Pediatrics
  • Healthcare Systems

Background:

  • Transitional care (TC) is crucial for young people (YP) with juvenile idiopathic arthritis (JIA) moving from pediatric to adult healthcare.
  • Existing European League Against Rheumatism/Pediatric Rheumatology European Society (EULAR/PReS) recommendations require evaluation for Italian healthcare practices.
  • A Delphi consensus survey was conducted among Italian rheumatologists to assess TC applicability and develop country-specific statements.

Purpose of the Study:

  • To evaluate the applicability of 2016 EULAR/PReS TC recommendations for YP with JIA in Italy.
  • To formulate country-specific statements to enhance TC suitability within the Italian context.
  • To achieve consensus among Italian pediatric and adult rheumatologists on optimal TC strategies.

Main Methods:

  • A taskforce of 27 Italian pediatric and adult rheumatologists participated in a two-round Delphi consensus survey.
  • Applicability of EULAR/PReS recommendations and agreement with new statements were voted on a 0-10 scale.
  • A mean agreement score of ≥8 was considered acceptable for consensus.

Main Results:

  • Consensus was reached on only 4 out of 12 EULAR/PReS recommendations.
  • Agreement was achieved on 25 out of 27 newly proposed country-specific statements.
  • Barriers included a lack of centers with both pediatric and adult rheumatologists, differing views on transition timing and coordinators, varied assessment tools, and insufficient support.

Conclusions:

  • The consensus initiative is a significant step towards establishing a nationwide TC network for YP with JIA in Italy.
  • Future goals include identifying adult rheumatology centers for TC, educating adult teams on childhood-onset rheumatic diseases, and raising awareness among healthcare authorities.
  • Improved TC quality requires collaboration and targeted educational and administrative support.
Abstract

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