Audit of Endocrine Adolescent Transition Clinic, RHSC Glasgow, 20082010
Avril Mason1, S F Ahmed1, M D Donaldson1, E McNeill1, V Campbell1, C Perry2 & M G Shaikh1
Introduction: A multi-disciplinary endocrine Adolescent Transition Clinic (ATC), with key professionals from paediatric and adult services, was instituted at the Royal Hospital for Sick Children, Glasgow, in October 2008 serving young people in the West of Scotland. A good transition should improve clinic attendance, health outcomes and quality of life into adulthood.
Aim: To systematically review the success of ATC in engaging young people following their transfer to an adult endocrine service.
Methods: Three-monthly ATC lists were reviewed to identify patients who were no longer being reviewed in a paediatric setting. Confirmation of transfer was obtained by reviewing the last available ATC letter. A combination of a Glasgow-wide electronic patient record and telephone contact with medical secretaries was used to determine clinic attendance and DNA rates between final ATC and June 2011. Results are expressed as median (range).
Results: Fourteen young people (8 males), with median age at last ATC visit of 18.7 years (16.5, 23) were transferred to six adult endocrine services in the West of Scotland after 2 (1, 3) ATC attendances. The diagnoses (number of patients) included: panhypopituitarism (9) (acquired secondary to craniopharyngioma (4); cranial irradiation (2); infiltration in iron overload (2); and traumatic brain injury (1)); congenital adrenal hyperplasia (2); Klinefelter syndrome (1); congenital hypothyroidism (1) hypogonadotrophic hypogonadism (1). The frequency of adult endocrine clinic attendance was 4 (1, 5) clinics/year. The interval between last ATC to adult clinic was 0.45 (0.09, 1.14) yrs. All patients attended the first adult clinic appointment offered. The subsequent DNA rate was only 9% with no young person lost to follow-up. Of 14, 11 had complex care needs requiring input from more than one adult subspecialty team.
Conclusion: The endocrine ATC is successful in engaging young people in adult endocrine care. A dedicated young-adult endocrine clinic, in the adult hospital, may help retain young people in an adult clinic setting long-term. Coordination between specialist teams at transition may be required to provide a more seamless transfer of patient care.