The journey for adolescents and young adults with chronic conditions transitioning to adult care with successful warfarin management

- Pediatric survivors of previously fatal illnesses require long-term warfarin therapy and are transitioning to adult care.
- A warfarin education program and patient self-management of warfarin have been validated in children.
- A modified process for transitioning adolescents requiring warfarin to adult care is successful.
- A collaborative transition process equips the adolescent / young adult for safe and effective transition to adult care.

Health transition of youth from a child-centered care model to the adult model has been recognized to be of critical importance due to the increasing numbers of children now surviving chronic conditions. A formalized transition process is required adequately assess the AYA's readiness for transition and to move towards adult care. Indefinite warfarin therapy poses challenges as warfarin is a narrow therapeutic index drug that requires frequent monitoring and attentiveness to warfarin interactions and affects.ObjectiveThe objective of this study was to evaluate transition to adult care for AYAs requiring indefinite warfarin therapy within a structured self-management program.Outcome measuresResults were compared between Phase 1 (enrollment to patient self-management) and Phase 2 (independent warfarin management) 6 months following confirmation of transition to adult care. There was no statistical difference between outcome measures except INR testing frequency, and no adverse events.ConclusionsThis transition process resulted in successful transition as measured by TTR and other clinical end-points from pediatric to adult care. Implementing a formal transition process for young adults with chronic health conditions that considers patient preferences motivates and empowers them over time to develop autonomy with warfarin self-management, results in successful transition and warfarin management.