How to Transition from a Pediatrician to Adult Healthcare Provider
One of the toughest challenges pediatricians face is facilitating the transitioning of care of their adolescent patients to their future adult healthcare providers. What IS transition? Transition is defined as “the purposeful, planned movement of adolescents and young adults with chronic physical and medical conditions from child-centered to adult-oriented health care systems” (Blum, et al. 1993. Journal of Adolescent Medicine).
This differs from the transfer of care, which refers to the actual move from one healthcare provider to another. The goal is to effectively empower the young adult patient while ensuring that they possess the necessary medical knowledge and self-management skills. As healthcare providers, we want our young adults to successfully navigate the health care system as independent individuals. The process of transitioning from pediatric to adult-centered health care should be seamless in a planned manner, and should occur when the adolescent or young adult is in a stable place, both physically and emotionally. Challenges to a smooth transitioning process may occur, and include inadequate preparation of the patient, parental fears, and the pediatric provider’s own reluctance.
What are the stages of transition and goals at each stage?
Optimally, transitioning should occur over an extended time period with defined goals as outlined below.
Ages 12-14 years: Transition process begins at clinic visits with the healthcare provider’s assessment of transition readiness. The adolescent should have dedicated one-on-one time with their healthcare providers. He/she should be able to identify their specific disease and medications, and to verbalize/understand the importance of adherence.
Ages 15-17 years: Transition process continues with ongoing assessment of transition readiness and increasing participation by teen during each visit with the healthcare provider. The teenaged patient should know their medical history, answer disease-related questions, and have increasing private time with the provider.
Ages 18-21 years: Completion of the transition process should take place during this time, including a complete independent clinic visit (without parents). The young adult should receive a medical summary document outlining the course of their disease. In addition, patients should demonstrate clear understanding of insurance coverage, schedule clinic appointments, call in/pick up prescriptions, and directly contact their healthcare providers with questions/updates.
Strategies for fostering independence, communication, and adherence
Fostering independence may be difficult for parents as they are transferring control of care to their child. Open and honest communication is a crucial component of this process, and the healthcare team must encourage active participation by the adolescent patient and the family. To ensure successful care transitioning, it is important to engage and educate the adolescent patients so that they can understand their disease and develop strong self-management skills. This will enhance treatment adherence and further the process towards independent functioning.