Outcomes of transitional care programs on adolescent chronic inflammatory systemic diseases: systematic review and meta-analyses

Abstract

Background Patients with juvenile chronic inflammatory systemic diseases (jCID) are vulnerable to many circumstances when transitioning to adult-centered healthcare; this increases the burden of disease and worsen their quality of life. Methods MEDLINE, Embase, Web of Science and Scopus were searched from inception to March 16th, 2021. We included observational, randomized controlled trials and quasi-experimental studies that evaluated a transitional care program for adolescents and young adults with jCIDs. We extracted information regarding health-related quality of life, disease activity, drop-out rates, clinical attendance rates, hospital admission rates, disease-related knowledge, surgeries performed, drug toxicity and satisfaction rates. Results Fifteen studies met our inclusion criteria. The implementation of transition programs showed a reduction on hospital admission rates for those with transition program (OR 0.28; 95% CI 0.13 to 0.61; I 2 = 0%; p = 0.97), rates of surgeries performed (OR 0.26; 95% CI 0.12 to 0.59; I 2 = 0%; p = 0.50) and drop-out rates from the adult clinic (OR 0.23; 95% CI 0.12 to 0.46; I 2 = 0%; p = 0.88). No differences were found in other outcomes. Conclusion The available body of evidence supports the implementation of transition programs as it could be a determining factor to prevent hospital admission rates, surgeries needed and adult clinic attendance rates.

Transition From Pediatric to Adult Rheumatology Care

“…19 In addition, there is sufficient body of evidence that the implementation of transition programs is a determining factor for continuity of care. 20 Some of the results obtained from our survey, although not sufficiently representative, showed that the average age at the beginning of the transition process was between 15 and 17 years for the majority of the respondents, and >18 years in 5% and 30% of the respondents from Brazil and other countries from LATAM, respectively. This demonstrates that we should start the process earlier, if we compare our results, for example, with the NICE guidelines.…”

“…These health care transition processes are (1) preparation, (2) transfer of care, and (3) integration into adult health care 19 . In addition, there is sufficient body of evidence that the implementation of transition programs is a determining factor for continuity of care 20 …”

Effects of transition programs to adulthood for adolescents and young adults with congenital heart disease: a systematic review with meta-analysis

“…However, in this study, the addition of one more study to the effect size pooling conducted by Moons et al 1 yielded a significant effect on loss to follow-up. Furthermore, a meta-analysis by García-Rodríguez et al, 50 which included various chronic disease populations, also found a significant effect size for clinic drop-out. By combining the results of the previous meta-analysis with the findings of this study, it can be deduced that transition programs may help reduce loss to follow-up.…”

Pediatric Inflammatory Bowel Disease

“…In a metaanalysis that included adolescents with chronic inflammatory systemic diseases, the use of these programs resulted in significantly fewer hospital admissions during the first 2 years after transition and reduced surgery rates. 76 Finally, it deserves mention that the therapeutic arsenal for pediatric gastroenterologists is more restricted when compared with adult-care providers. Novel drugs undergo testing in the adult patient population, which often gives rise to long lag times between a drug's first approval for adults and the pediatric population.…”