1. Boston University School of Medicine asks all individuals involved in the development and presentation of Continuing Medical Education (CME) activities to disclose all relationships with commercial interests. This information is disclosed to CME activity participants. Boston University School of Medicine has procedures to resolve apparent conflicts of interest. In addition, presenters are asked to disclose when any discussion of unapproved use of pharmaceuticals and devices is being discussed. I, Alain Joffe, have no commercial relationships to disclose. I will not be discussing any unapproved uses of pharmaceuticals or devices

2. Transitioning to college An 18 year old female freshman from Idaho presents mid-October to the Student Health and Wellness Center (SHWC) with a 2-3 week history of cough and increasing dyspnea. Her baseline medical regimen included inhaled steroids and albuterol MDI as needed. 3 days before being seen at SHWC, she called her primary care physician who started her on azithromycin for presumed pneumonia (500 mg day one, 250 mg days 2-5)

3. Transitioning to college PMH (no records available) Born at 28 weeks; complicated NICU stay Discharged with moderate BPD Followed by pulmonologist at home Exam in SHWC Pulse ox 92%, tachypneic, diffuse wheezes and rales (crackles) – “I always have them” CXR Chronic changes; possible new infiltrate in RML

4. Transitioning to college Telephone consult with pediatric pulmonology that day; seen in clinic next day Switched antibiotics, oral steroids – did not improve Recommendation for hospitalization Student elected to go home for treatment Went on LOA for fall semester

5. Transitioning to college Could this have been prevented??

6. Transitioning to college CHALLENGES FOR STUDENTS WITH CHRONIC ILLNESS Navigating a new health system (providers, insurance, labs, prior authorization) Managing medication regimen alone Can no longer rely on parents to interpret symptoms or make appointments Knowledge of pertinent PMH Changes in established daily routine (IDDM, ADHD)

7. Transitioning to college CHALLENGES FOR STUDENTS WITH CHRONIC ILLNESS Wanting a fresh start Redefining oneself without the illness “Maybe I don’t really need these meds” Importance of health versus getting into desired classes, desired dorm room placement, making friends, extracurricular activities, athletics

8. Transitioning to college PROPOSED STRATEGIES – SYSTEMS ISSUES Collaboration among PCP, college health center, home and college- located subspecialists – WHO WILL DO WHAT? Eating disorders ADHD, other psychiatric medications Knowledge of insurance issues (preferred labs, radiology, prior authorization, need for PCP at school, HMO/Kaiser, state Medicaid and state exchange issues). Bring card!! Bring or send recent (within 3-6 months) summary: pertinent PMH, current medication regimen What to do in case of emergency? (e.g., seizure disorder) Immunizations UTD (?? flu shot before going off/back to school)

9. Transitioning to college PROPOSED STRATEGIES – SYSTEMS ISSUES Make an appointment at health center before or shortly after orientation (or least a telephone consult) Identify a subspecialist (if needed) months before start of school ADHD/psychiatric medications – who will prescribe?

10. Transitioning to college PERSONAL ISSUES Whom will you tell (roommate, RA)? Medical alert bracelet/necklace Will you register with disabilities office? Storage and/or delivery of medications (ADHD, refrigerated medications)? Who will administer meds (e.g., adalimumab)? What (if anything) do you want parents to know?

11. Transitioning to college Thanks! Alain Joffe, MD, MPH Director, Student Health and Wellness Center Johns Hopkins University ajoffe@jhu.edu