TRAQ score predicts readiness to transition from pediatric to adult rheumatology care
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Key takeaways:
- Scoring above 4 on the Transition Readiness Assessment Questionnaire (TRAQ) was linked to successful transition to adult rheumatology care.
- Medication adherence monitoring after transition is critical.
Pediatric rheumatology patients could be considered ready to transfer to adult care if they score greater than 4 on the Transition Readiness Assessment Questionnaire, according to data published in Rheumatology.
“The most appropriate age for starting [transitional care] remains undetermined,” Ezgi Deniz Batu, MD, MSc, of Hacettepe University, in Ankara, Turkey, and colleagues wrote. “Familial and cultural features also have an impact on the ideal age for transition. A standard tool for evaluating the transition/transfer readiness with a predetermined cut-off value is lacking. Moreover, most centers are still struggling with problems in [transitional care], such as inadequate financial resources and paucity/lack of medical staff dedicated to [transitional care].”
To analyze transition readiness in rheumatology care, as well as the factors that impact success, Batu and colleagues conducted a prospective study of patients aged older than 12 years in the Hacettepe University pediatric rheumatology unit. Patients completed the Transition Readiness Assessment Questionnaire 5.0 (TRAQ) during visits between February 2021 and December 2022 and were transferred to adult-oriented care at some point during that period. According to the researchers, a higher TRAQ score — which ranges from 1 to 5 — represents an increased transition readiness.
After the transfer, patients were surveyed over the phone about the success of the process. They reported their drug adherence before and after transitioning to adult care using the four-item Morisky Medication Adherence Scale (MMAS-4) and rated the overall process using a zero-to-10 visual analog scale. The researchers defined a successful transition as having at least one adult-oriented outpatient visit in the first 6 months from pediatric discharge, and no missed appointments.
A total of 406 patients completed 504 TRAQ questionnaires. The scores were positively correlated with age and were higher among girls vs. boys (median 4.2 vs. 4, respectively; P = .005).
Among the 93 patients transferred to adult care, 78 (83.9%) demonstrated a successful transition, according to the researchers. Among patients whose transition was not successful, visual analog scale for the process was lower compared with those who successfully transitioned (median 8 vs. 9, respectively; P = .03). Their reported drug adherence was also worse, with a median MMAS-4 score of 3 vs. a median score of 4 among those with a successful transition (P = .02).
Additionally, a receiver operating characteristics curve analysis showed that the best-performing cut-off value to predict transfer readiness was a TRAQ score of 4, yielding 71% sensitivity and 48% specificity, the researchers wrote.
“This study is one of the largest prospective cohort studies evaluating transitional care in rheumatology,” Batu and colleagues wrote. “Having a good [transitional care] experience contributes to the success of the transition. However, medication adherence should be monitored closely, not only in patients whose transition is not successful but also in the successfully transitioned patients.”
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