This transcript has been edited for clarity.
Hope L. O’Brien, MD, MBA, FAHS: Welcome to today’s discussion. This discussion will discuss issues related to transitioning migraine patients from pediatric to adult care. My name is Hope O’Brien. He is the founder, CEO and medical director of the Headache Center of Hope in Cincinnati, Ohio. I am a headache specialist neurologist, trained in managing both pediatric and adult populations, with a particular interest in late adolescents and young adults. I am delighted to have my friend and colleague, Dr. Sharonda Slater, join us.
Dr. Sharonda K. Slater: My name is Sharonda Slater. He is a pediatric psychologist and professor in the Department of Behavioral Medicine and Clinical Psychology at Cincinnati Children’s Hospital Medical Center. My specialty is treating chronic pain, especially headaches, in children, adolescents and young adults.
O’Brien: I thought I’d start the conversation by sharing my encounter with a mother who was diagnosed with migraines at age 5 and her 17-year-old daughter. to discuss plans for her continued care when she becomes an adult. They were worried about when she would be discharged from pediatrics, as she would be 18 in a few days, and were questioning what would happen at that point. Will she leave the hospital soon? where is she going Who does she see as a neurologist? And how will she find adult health care providers?
As most people know, migraine is a chronic disease. It affects children and may persist into adulthood. Also note that migraines can worsen and become chronic if not properly managed throughout adulthood. Aggressive and successful management is important, and proper management can lead to remission.
There are studies examining patients with other chronic diseases that show that organized programs focused on transitioning patients into adult care can significantly improve outcomes. However, the successful transition of care from pediatrics to adult neurology remains a challenge because no systematic approach exists.
Dr. Slater, could you describe some of the challenges that exist with respect to transitioning care for chronic migraine patients who require ongoing behavioral or psychological interventions? Also, the comorbidities present in this population? Could you please explain?
Developmental Disorders and Comorbidities: What to Look for
Slater: The transition from adolescence to adulthood is a critical time for migraine sufferers. There are various considerations for this population. Late adolescents may suffer from a variety of psychiatric comorbidities, such as anxiety and depression, which may influence treatment options and create opportunities to manage multiple conditions with less medication. There is. Cognitive-behavioral therapy (CBT) for pain is an empirically supported treatment for children, adolescents, and adults with chronic headache, including migraine.
As such, continued involvement of behavioral medicine is critical for adolescents with migraine who have functional and psychiatric comorbidities. Psychologists who specialize in treating chronic pain and chronic medical conditions can be placed in hospitals, universities, or private clinics.
O’Brien: Adolescents and young adults face unique challenges related to development. For adolescent individuals, the onset of sexual activity, the development of gynecological disorders, and the presence of irregular or painful menstruation may raise questions about the use of oral contraceptives to treat migraine. There is also the problem of use, smoking and illegal drug use.
These should be topics covered in conversations and counseling. As a provider, I find it important to have these discussions with my patients, and I find it helpful to do this when my adolescent patients are not in the presence of their parents. We ask that you please leave. It is very important to document these discussions as they arise.
As mentioned before, in neurology there is no formal process that exists for the transition of care from pediatrics to adulthood. Each facility should determine when patients will be ready to transition, if they will be ready for transition, and the amount of guidance patients will receive during the process.
A consensus statement that may be helpful to clinicians is neurology Describe the three phases of planning a transition of care. There are three phases: transition planning, patient education, and transition readiness.
Slater: That is correct. Each phase has a clear goal. The goal during transition planning is to expand personal knowledge of the patient’s condition and introduce self-advocacy skills. It’s time to understand the important things that accepting providers should know before transferring. This applies to both patients and providers.
Patients should be introduced to the concept of self-management. what do you mean? See if patients understand their type of headache disorder and know how to abort and prevent headaches. Prevention includes lifestyle modifications, biobehavioral approaches such as CBT, biofeedback, medication You should know that it consists of healthy habits such as physical management. Patients begin to take responsibility for self-care and gain confidence in their ability to make informed decisions.
The patient should be spoken to directly and clearly, rather than focusing on speaking to the caregiver. In doing so, clinicians can understand their patient’s knowledge base and directly communicate their expectations of taking greater responsibility for their own health.
Tips to ease the transition to migraine care
O’Brien: Dr. Slater, you make a great point. I would like to return to your point regarding pharmacological management, because many options open up to patients once they reach the age of 18. As you know, most migraine drugs are approved for adults in that age group. It has been.
Now, before transitioning, it’s important to identify an adult provider. Patients and caregivers can do their own research or ask others, including pediatric health care providers, for recommendations. It is important to identify who he is a year or two in advance of the transition, especially if you want a provider that specializes in headache medicine.
Given the lack of on-site providers, this may not be practical. Through the expansion of telemedicine and partnering with colleagues who are happy to help care for patients with recurrent headaches, we hope that all patients will have access to the very best in migraine management.
Dr. Slater, do you have any other tips for transfer providers to look out for?
Slater: Leaving to attend college can pose challenges. Patients may need assistance in finding a provider for their commute. College students may choose to have their doctor and medical team located in their hometown rather than where they attend college.
O’Brien: Patients should also be educated about the basics of the health care system, including how health coverage works, especially in the event of changes in coverage that may interfere with the process of staying healthy. . You should also know that modern health insurance may limit the requirements of the providers you can choose from. Patients should receive an age-appropriate reading level summary of their health history in electronic format.
So, are there ways to assess a patient’s readiness to transition care? neurology, This introduced the Transition Readiness Assessment Questionnaire (TRAQ). It is considered the best validated migration readiness tool.
It is widely used to help healthcare providers identify areas where patients may not feel ready to transition. The questionnaire focuses on five categories, including managing medications, maintaining appointments, tracking health issues, talking to providers, and managing daily activities. Patients will have to fill out a form individually to know where they are ready to transition.
Dr. Slater, what would you recommend to help patients be better prepared and ready to transition to adult care providers?
Slater: Patients should be comfortable calling their healthcare provider on their behalf to schedule and discuss their medical condition. An advance visit by an adult health care provider can ease the stress and anxiety associated with the transition. Unprepared patients have poor outcomes, including increased morbidity.
Factors that have hampered the transition include the lack of resources for late adolescents and the fact that many young adults feel unprepared to enter the adult healthcare setting. This is a big challenge for the migration process.
Therefore, annual assessments should include knowledge of the patient’s medical condition and medications, understanding of side effects of various treatments, identification of key signs and symptoms of potential mood disorders, and assessment of overall psychological health. there is.
O’Brien: Are there other factors that contribute to a successful migration?
Slater: yes. A successful transition was defined as being older at the time of the last visit to the pediatric center, having no comorbidities, having no history of drug use, adhering to prophylactic treatment and preventative procedures, attending appointments without parents or siblings, and Relevant for patients living near medical facilities. The recommendations were documented in the patient’s chart.
I have a question for Dr. O’Brien. As an adult migraine specialist, what can you do as a recipient?
O’Brien: A brief summary of patient information, also called a transport packet, is helpful. A history of headaches should be included. diagnosis; treatment regimens, including failed medications; length of medication trials; comorbidities such as anxiety and depression; non-pharmacologic headache treatments. You should also include an emergency plan in the form of an emergency department protocol letter, for example, in case the patient needs to seek emergency care at an outside facility while away from the university.
You should also include a backup plan. A list of preferred medications should be summarized with details of dosage and frequency. It’s also helpful to have a list of medications to avoid. This packet can also be used for care coordination and communication between providers. It should be updated periodically based on patient input regarding goals and preferences.
What is the right age to start this transition process? Research shows that this process should start as early as age 13. This helps everyone understand everything they need to know about transitioning care. At age 14, you should work with your patient, caregiver, and medical team to create a transition packet.
Dr. Slater, nice to meet you. We are pleased to take this opportunity to share information on how to successfully transition care for patients who continue to manage migraine into adulthood.
Slater: Thank you Dr. O’Brien. It was a really great discussion.
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