Health Care Transition From Pediatric to Adult Care: an Evidence Based Guideline

Abstract

PurposeFor consistent quality of treatment of young people with chronic health care needs, a structured transition from pediatric medicine to adult medical care is essential. Currently, most countries have no guidelines on health care transition (HCT) based on systematic evidence research. To close this gap guidance to support the transition was developed in Germany.MethodsTwenty-five experts in the management of adolescents and young adults with different chronic conditions were invited to take part in the guideline group. Based on a systematic literature search recommendations for transition were drafted. Where evidence was lacking, recommendations were developed using collective expert consensus. The consensus process was independently moderated using a Delphi approach. The final draft was reviewed and endorsed by all major German medical societies.ResultsThe clinical recommendations provide guidance for all chronic somatic diseases. After assessment of transition readiness, an individualized plan for transition should be drawn up. Key elements here are a responsible coordinator, age-adapted patient education, involvement of parents, web-based interventions, joint visits and a structured summary for the receiving physician. The aim is the gradual transfer of responsibility for disease management to the young person themselves.ConclusionAs only a few randomized controlled studies on HCT are available, evidence-based statements are possible for some but not all areas of transition. However, this guideline may help to develop globally accepted standards. These standards should be established, implemented and financed by individual national health systems to allow appropriate support for young people.