Table 1

Common differences between paediatric and adult clinic settings

Paediatric healthcareAdult healthcare
Care orientation
  • Family-centred (triadic).

  • Patient-centred (dyadic).

Team approach
  • Multidisciplinary.

  • Reliant on referrals to other services.

Social work involvement
  • Social worker often onsite.

  • Social worker less available.

Appointment length
  • Follow-up typically 30 min.

  • Follow-up often 20 min or less.

Insurance
  • Parental private insurance (until age 26 in the US).

  • Medicaid (US governmental insurance assistance) available as a safety net untilage 19.

  • Not eligible for parental insurance past a certain age (27 in the US).

  • Medicaid available only after burden of proof met demonstrating disability.

Educational/vocational needs
  • Addressed and actively supported during clinic visits.

  • Less commonly addressed or actively supported in clinic.

Late/no-show policy
  • Patients typically accommodated despite tardiness or missed appointments.

  • Patients often not seen if late; patients may be released from clinic for repeated missed appointments.

Trainee supervision
  • Patients staffed in real time.

  • Less direct supervision.

Medical care of SLE
  • Vaccines often provided during specialty clinic visit.

  • Patients’ primary care needs often addressed during specialty clinic visit.

  • Aggressive steroid and cyclophosphamide dosing.

  • Annual screening echo and PFTs common.

  • Emphasis on minimising radiation during imaging studies.

  • Unlikely to provide vaccines during specialty clinic visit.

  • Patients usually required to see PCP for comorbidities and health maintenance.

  • Less intravenous steroid pulsing; often lower doses of cyclophosphamide.

  • Rarely screened with echo or PFTs unless indicated by history or suggestive symptoms.

  • More likely to use CT.

Medication non-adherence
  • Teams often ‘work around’ non-adherence by using intravenous medications.

  • Physicians likely to hold patient accountable for non-adherence.

Follow-up interval
  • Typically every 2-3 months.

  • Typically every 3-6 months.

  • Adapted from Eleftheriou et al 22and from Tattersall and McDonagh.29

  • PCP, primary care physician.