[Transition medicine-structural solutions]. / Transitionsmedizin ­ strukturelle Lösungsansätze.

Young adults suffering from chronic diseases represent a critical subgroup of patients that after reaching legal age have to be transferred to the colleagues from adult medicine. Thus in this patient group two evident problems come together: first, the adolescence phase that presents a challenge for any young adult and second, the transition to the novel structure and environment of adult medicine. It has been recognized for Germany that there are significant deficits for this transition phase. These deficits have already been addressed by other countries through the introduction of so-called transition clinics. In this article, we will summarize the challenges of this transition phase and the resulting points and needs that will have to be addressed by a structured program for transition. As an example, the Berliner TransitionsProgramm (BTP) will be presented where a framework structure is provided that allows for the transition of various chronic diseases. The BTP accompanies the transition process for a two-year time period by providing a framework structure consisting of transition consultations, a transition booklet, a structured summary of the previous disease course as well as a case manager who assures that the included patients stay within the program and do not get lost to assure treatment continuity. In addition, the program succeeded, at least from some insurance companies, in obtaining financial reimbursement for this time-consuming effort. Thus in our view, the BTP functions as role model for transition medicine in Germany.

Different models of transition to adult care after pediatric kidney transplantation: a comparative study.

Transition from pediatric to adult care is a critical and difficult step for young people with transplants and for the multidisciplinary team involved. In our retrospective study, we investigated the clinical course in a two-yr period of transition. Data from 66 teenagers were collected one yr before and after their transfer to three different adult care settings: (i) a specialized transition clinic, (ii) a general transplantation clinic, and (iii) a nephrologist. Patient survival rate was 100%. Three patients developed graft loss. GFR development was comparable in the three settings (ΔGFR 1.4 ± 8.7 vs. 3.1 ± 10.6 vs. 0.8 ± 4.4 mL/min/1.73 m2 , p = ns). Immunosuppressive therapy was stable in setting 1, whereas the number of changes increased in setting 2 and even more in setting 3. The percentage of patients with steroids increased from 36% to 38% and 52% in settings 1-3. Patient satisfaction was highest in setting 1 (100% vs. 64% and 78%, p < 0.05). Setting 1 was associated with fewer changes in therapy (13% vs. 91% and 45%, p < 0.05). The use of a specialized transition clinic is associated with fewer changes in medication and care and a higher level of patient satisfaction. This was not associated with a lower increase in GFR one yr after transition. Long-term results are awaited.

[Concept to improve adherence in adolescents following renal transplantation: vision or reality?]. / Konzept zur Verbesserung der Adhärenz bei jugendlichen Erwachsenen nach Nierentransplantation : Vision oder Realität?

Transition to adult care is a generic issue for subspecialties dealing with chronic illness and has received little attention to date. The transition from pediatric to adult care for renal transplant recipients is recognized as a high-risk period for poor graft outcome associated with more than 20% graft loss. Non-adherence to immunosuppressive medications is one of the most important factors contributing to graft loss during this period. Transition is, therefore, a concern of both pediatric and adult providers, and medical improvements in this area will require more effective collaboration at this interface. This report explores medical and psychological risk factors and barriers during the transition process. In addition, a specially developed coaching concept for young adults is presented intended to assist adolescents with early childhood end-stage renal disease in the transition from pediatric to adult care.