1. Young Adult Rheumatology clinic
(from 16-25 years old)
Dr Alison Kinder FRCP
Rheumatology consultant

3. Why?
• Unmet need in Leicester
• Young adults with chronic diseases have
additional challenges in negotiating the
complexities of their adolescence by virtue of
their medical needs

4. Differences between adult centred and
paediatric care
Adult care Paediatric care
Individual consultations Family consultations
Limited multidisciplinary team(often less More likely multidisciplinary team and
access to psychosocial support) psychosocial support
Payment for medication Usually free medication
Larger patient number Smaller numbers of patients
Consultation less likely to include Educational and vocational aspects key to
vocational aspects consultation
Shorter consultation time Longer consultation time
Procedural pain relief – less sedation or ga More sedation or ga use
use
Less tolerance of immaturity Greater tolerance of immaturity
Less chasing of patients who DNA Greater chasing of famillies who DNA
Less direct supervision of trainees Greater direct supervision of trainees
Less likely to see same dr at consecutive More likely to see same dr at consecutive
consultations visits

5. • “ emerging adulthood ” is a time of
exploration, a crucial part of growing up and
as such remains a time of continued
vulnerability (Arnett 2000)

7. Several policies
• Royal college of nursing 2004
• Department of health 2006
• Department of Children, Schools and Famillies
2007
• Royal college of physicians of Edinburgh 2008
• Chief medical Officer 2008
• Review the evidence of benefit of good quality
transitional care and setting out best practice
models

8. Core set of principles
• Transition starts early and is a future focussed
active process
• Young person centred and inclusive of family,
carers and kinship groups
• Multidisciplinary involving paediatric and
adult services with GP

9. For young adult
• Age appropriate
• Developmentally appropriate
• Culturally appropriate
• Flexible process equipping him/her with skills
in communication, decision making,
assertiveness, self care and self management

10. • Ultimate aim of transitional care is to enable
adolescents to take control of their healthcare
needs and emerge into adulthood with
maximal function and potential

11. Young adult clinic
• Set up Jan 2011 in adult setting
• Leicester Royal Infirmary
• Only for 16 to 25 years old
• Consists of
– Consultant Dr Alison Kinder
– Specialist nurse Toni Dorman
– May be SpRs present for training

12. • Accepting transfers of young adults with long
term rheumatology conditions that live in
Leicestershire from
– Nottingham
– Birmingham
– Leicester
– Transfers from other paediatric units for Leicester
university students

13. • I attend rheumatology paediatric clinic
1x/month in Leicester
• Try and meet patients prior to transfer from
other centres

14. Current case load
• Mainly JIA
• SLE
• Sarcoid
• Ankylosing spondylitis
– If on methotrexate injections or biological therapy
requires transfer of prescription to adult service

15. New referrals
• Young adults with new presentations of
rheumatological diseases
• Needs to be as named referral
• Not on choose and book
• Clinic from Jan 2012 1x/month

16. Needs to be a service the young adults
want
• Currently developing a questionnaire asking
patients what they want from the service
• Informal feed back
– Like to come to young adult clinic only
– Meet other young adults
– Get to see the same dr and nurse

17. Any questions?