Differences in Health Care Transition Views, Practices, and Barriers Amongst North American Pediatric Rheumatology Clinicians from 2010 to 2018.

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Since 2010, the rheumatology community has developed guidelines and tools to improve healthcare transition . In this study we aimed to compare current transition practices and beliefs among Childhood Arthritis and Rheumatology Research Alliance (CARRA) rheumatology providers with transition practices from a 2010 provider survey published by Chira et al. METHODS: In 2018, CARRA members completed a 25-item online survey about healthcare transition. Got Transition's™ Current Assessment of Health Care Transition Activities was used to measure clinical transition processes on a scale of 1 (basic) to 4 (comprehensive). Bivariate analyses were used to compare 2010 and 2018 survey findings.Over half of CARRA members completed the survey (217/396), including pediatric rheumatologists, adult- and pediatric-trained rheumatologists, pediatric rheumatology fellows, and advanced practice providers. The most common target age to begin transition planning was 15-17 (49%). Most providers transferred patients prior to age 21 or older (75%). Few providers used the American College of Rheumatology transition tools (31%) or have a dedicated transition clinic (23%). Only 17% had a transition policy in place, and 63% did not consistently address healthcare transition with patients. When compared to the 2010 survey, improvement was noted in three of twelve transition barriers: availability of adult primary care providers, availability of adult rheumatologists, and pediatric staff transition knowledge and skills (p<0.001 for each). Nevertheless, the mean Current Assessment score was less than 2 for each measurement.This study demonstrates improvement in certain transition barriers and practices since 2010, although implementation of structured transition processes remains inconsistent.

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