AB1622-HPR ESTABLISHING A SUCCESSFUL TRANSITION SERVICE FOR JUVENILE IDIOPATHIC ARTHRITIS (JIA) USING AN ADVANCE CLINICAL PRACTITIONER
Authors: H. Bickerdike
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Advanced clinical practitioners (ACPs) level of practice is characterised by a high degree of autonomy and complex decision making. This is underpinned by a master's level award that encompasses the four pillars of clinical practice, leadership and management, education and research. <i>It</i> embodies the ability to manage clinical care in partnership with individuals, families and carers. It includes the analysis and synthesis of complex problems across a range of settings, enabling innovative solutions to enhance people's experience and improve outcomes. The demands on clinics capacity and clinician availability in adult care does not reflect the support and nurturing from the paediatric service. There are well documented challenges for patients with chronic diseases transitioning from paediatric to adult care, which include delayed treatments, missed appointments, substandard care and psychological issues. <h3>Objectives:</h3> Our aim was to utilise the appointment of a new ACP, to develop a transition service for patients with JIA as a means of extending the preparation period for adult services and allow time for maturation into adult care. <h3>Methods:</h3> The ACP and rheumatologist attend the rheumatology paediatric clinic to meet patients at the beginning of transitional age range for as many appointments as necessary to meet patients and families aiming for introduction and familiarisation. When patients and families are ready and when the MDT agree it is clinically appropriate, patients between the ages of 16 and 18 transfer to an ACP run monthly clinic, supervised by the consultant rheumatologist, with 30-minute appointments. No specialist nursing or consultant appointments were used. There is opportunity to discuss all aspects of life and encouraged to make strides into adulthood by taking on responsibility for treatment. There is no measurable criteria to achieve before transition to full adult care, other than agreement between clinician and patient. 'Readiness' includes maturity and completion of education either university or further education and in employment. <h3>Results:</h3> Clinic successfully implemented. 13 patients have transferred since initiation in March 2022. 100% of patients were either completely satisfied or satisfied by their support. 100% of patients have knowledge of how to contact ACP. There have been no missed transfers of homecare supply and biological DMARDs reintroduced swiftly as required. Patients regularly move appointments and have appeared in consultant clinic in error. 3 patents have not attended appointments, but were reappointed immediately by the ACP and since reviewed. <h3>Conclusion:</h3> This new clinic has received excellent patient feedback and fulfilled the aims of providing continuity and improved quality of care during the transfer to adult care. Patients particularly felt reassured in the knowledge that they were meeting the same professionals in the new clinical environment. It demonstrates transfer can be organised and systematic. Developing effective therapeutic relationships and consistency is essential for success, particularly given the continuing active disease and morbidity seen in young adulthood. The next stage will be to begin the full immersion to the adult team of those young adults who are deemed 'ready'. We will then audit the impact on patient and services and longer term review the effects on the patient's health. Transitional care is well recognised and documented, however this new concept of extending transition beyond transferred has improved the quality of care for young adults; particularly the most vulnerable with JIA. Using an ACP to facilitate this clinic frees up consultant colleagues for more challenging cases and maintains a relationship with patients not possible with junior doctors. ACPs are more and more becoming a focus for the NHS as an impetus to meet the workforce shortfall. It has evolved to become a profession in its own right, and an option for career progression for staff when a clinical pathway is preferred to that of management. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> York rheumatology department patients and collegues. <h3>Disclosure of Interests:</h3> <b>None declared.</b>