目的:评估一个多学科专家小组对青少年重度哮喘从儿童护理向成人护理转变的共识水平。
方法:一项61项调查是根据其他慢性病变指南制定的,涵盖过渡规划,准备,有效转让,和后续行动。两轮德尔菲过程评估了98名专家(49名儿科医生,24名过敏症专家和25名肺科医生)。达成共识,协议≥70%。
结果:42项(70%)达成共识。小组成员没有商定开始过渡的年龄范围。专家确定的过渡期间要实现的主要目标是青少年获得自主权来管理其严重的哮喘和处方治疗。小组成员同意制定个性化计划的重要性,促进患者的自主性,并确定家庭环境因素。他们一致认为,成人医疗团队应该具备严重哮喘的专业知识,生物制剂和青少年患者的管理。儿科和成人医疗团队应共享临床信息,就维持生物治疗的标准达成一致,并在有效转移前与患者进行现场联合访问。成人医疗保健专业人员应在有效转移后密切关注患者,以确保正确的吸入器技术,治疗依从性和参加医疗保健预约。
结论:该共识文件为西班牙儿科和成人团队提供了第一个路线图,以确保涵盖严重哮喘过渡过程的关键方面。这些建议的实施将提高为患者提供的护理质量。
OBJECTIVE: To assess the degree of
consensus among a multidisciplinary expert panel on the transition of adolescents with severe asthma from pediatric to adult care.
METHODS: A 61-item survey was developed based on
guidelines for other chronic diseases, covering transition planning, preparation, effective transfer, and follow-up. A 2-round Delphi process assessed the degree of consensus among 98 experts (49 pediatricians, 24 allergists, and 25 pulmonologists).
Consensus was established with ≥70% agreement.
RESULTS: Consensus was reached for 42 items (70%). Panelists were unable to agree on an age range for initiation of transition. The main goal during the transition identified by the experts is for adolescents to gain autonomy in managing severe asthma and prescribed treatments. The panelists agreed on the importance of developing an individualized plan, promoting patient autonomy, and identifying factors associated with the home environment. They agreed that the adult health care team should have expertise in severe asthma, biologics, and management of adolescent patients. Pediatric and adult health care teams should share clinical information, agree on the criteria for maintaining biological therapy, and have an on-site joint visit with the patient before the effective transfer. Adult health care professionals should closely follow the patient after the effective transfer to ensure correct inhaler technique, adherence, and attendance at health care appointments.
CONCLUSIONS: This
consensus document provides the first roadmap for Spanish pediatric and adult teams to ensure that key aspects of the transition process in severe asthma are covered. The implementation of these recommendations will improve the quality of care offered to the patient.