Table 2.

Strategies for improving transition and transfer outcomes

Problem/Obstacle	Paediatrics clinic strategies	Adult clinic strategies
AYA does not schedule with adult provider or misses the first adult rheumatology appointment.	Frame transfer as ‘graduating to adult care’; express confidence in adult provider.	Communicate with paediatric provider when transferred AYA misses the first appointment.
Transition coordinator/registry.
AYA drops out of care after the first adult rheumatology clinic visit.	Prepare AYA for what to expect from adult clinic and provider, highlighting: Process differences. Differences in clinic culture. Medical practice differences. Communicate with receiving adult provider before the first visit, using the TRANSFER mnemonic.	Use the WELCOME mnemonic: Use the first visit to develop rapport with AYA and parent(s). Align with paediatrics provider the WELCOME mnemonic. Minimise medical changes during the first visit. Communicate back to paediatric clinic after AYA’s first visit.
Transition coordinator/registry.
AYA lost to follow-up due to poorly timed transfer.	Avoid transfer during medical flare, pregnancy, other major life events. Consider adult comanagement rather than full transfer of care.
AYA lost to follow-up due to scheduling policies.	Prepare AYA/family regarding scheduling expectations and rules of adult clinic.	Delineate expectations to AYA/family. Encourage AYA to save office phone number in cell phone. Advise AYA not to cancel without rescheduling.
AYA struggle in adult clinic due to lack of self-management skills.	Use readiness assessments (eg, TRAQ or Got Transition) to guide transition preparation and help determine transfer time.	Use readiness assessments (eg, TRAQ or Got Transition) to guide ongoing development of self-management skills.
Adolescent medicine aspects of health not explicitly addressed in the adult clinic.	Ask parent to leave room for all AYAs>16 years (or >12 years). Encourage AYA to ask and answer questions independently. Connect AYA with community resources prior to transfer.	Establish expectation that AYA answers questions first. Perform social history with parent(s) out of the room; use HEADSS or other adolescent-focused approach to the history. Assess potential barriers to care (health literacy, transportation, adherence, contraception and others). Use available social work and community resources.
Poor medication adherence.	Consolidate medications (eg, number, dosing frequency). Provide pillbox or consider prescribing blister packs. Encourage free medication reminder apps like Mango Health. Help patient overcome financial barriers by using a drug company patient assistance programme, applying for other medication support (www.needymeds.org) and identifying the least expensive pharmacy (www.goodrx.com, www.lowestmed.com).

AYA, adolescents and young adults; HEADSS, Home, Education/employment, Activities, Drugs, Sex/Sexuality, Suicide/depressio; TRAQ, Transition Readiness Assessment Questionnaire.