From Pediatric to Adult Care: Six Core Elements to Consider

Nearly one-quarter of approximately 18 million Americans 18-21 years old have chronic conditions, including rheumatic diseases. However, little guidance exists for transitioning them into adult healthcare.

According to an April Arthritis & Rheumatology study, patient and pediatric and adult provider dissatisfaction is prompting greater guidance on pivoting young rheumatic patients into effective adult care. This sentiment has led to the creation of specialty-specific transition tools for pediatric and adult rheumatologists.

Pediatric rheumatology patients experience more severe disease, existing research states, with many becoming hospitalized or developing advanced disease within a year the adult-care transition.

Consequently, investigators wrote, establishing clear transition strategies is crucial for juvenile patient outcomes.  [[{"type":"media","view_mode":"media_crop","fid":"48069","attributes":{"alt":"©MonkeyBusinessImages/Shutterstock.com","class":"media-image media-image-right","id":"media_crop_6185899911233","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5719","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"font-size: 13.008px; line-height: 1.538em; float: right;","title":"©MonkeyBusinessImages/Shutterstock.com","typeof":"foaf:Image"}}]]

“Planning for transfer is an essential part of reinforcing young adults’ engagement with their health and their new adult provider,” they said. “It is important that all individuals involved enthusiastically support the adult provider to quickly establish a solid relationship with the new young adult, so that young adult stays engaged and returns for follow-up care.”

A Childhood Arthritis and Rheumatology Research Alliance (CARRA) survey reported 56 percent of pediatric rheumatology providers are unsatisfied with transition policies for pediatric patients to adult care. They identify inadequate provider training, inadequate time, lack of reimbursement, and insufficient resources and personnel as care barriers.

The American Academy of Pediatrics, American College of Physicians, and the American Association of Family Physicians collaborated in the Got Transition: The Center for Health Care Transition Improvement report, offering primary and secondary-care provider guidance on practice-based transition support, beginning between ages 12 and 14 and ending between ages 18 and 21.

The report includes six core elements, addressing three phases of transition – preparation, transfer, and integration into adult healthcare. For pediatrics, those elements are: transition policy, tracking and monitoring, readiness assessment, transition planning, transfer of care, and transfer completion. For adults, they are: transition and young adult care policy, tracking and monitoring, orientation to adult practice, integration into adult approach to care, initial visit, and ongoing care.

The report also offers three transition packages: 1) transitioning youth to adult healthcare providers, 2) transitioning to the adult approach without changing providers, and 3) integrating young adults into adult healthcare. 

References:

Patience H. White and Stacy Ardoin. "Transitioning Wisely:  Improving the Connection From Pediatric to Adult Health Care,"

Arthritis and Rheumatology

. Article first published online: 28 MAR 2016. DOI: 10.1002/art.39554