Transition From Pediatric to Adult Care: Internists' Perspectives

Abstract

Internists clearly stated the need for better training in congenital and childhood-onset conditions, training of more adult subspecialists, and continued family involvement. They also identified concerns about patients' psychosocial issues and maturity, as well as financial support to care for patients with complex conditions.

Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home

“…Internists find it challenging to care for a child or youth with special health care needs when the youth lacks preparation to be his or her own health advocate and the referring physician sends only minimal information about the youth and/or his or her condition. 17 Despite the recent spread of the familycentered medical home model for the redesign of primary care, payment reforms for non-encounter-based services (such as transition planning and care coordination) still have not materialized to a significant degree. Finally, with relatively few model practices exemplifying high-quality transition supports, training providers in the principles of health care transition remains challenging.…”

“…This office policy should clearly describe the goal of transition as part of lifelong preparation for a successful adult life and articulate how transition planning facilitates the patient's movement from a pediatric to an adult care mode. 17 Additional components of the office policy are described later in the algorithm.…”

“…For young adults with complex health care issues, direct communication between pediatric and adult providers is essential, because adult medical personnel may be unfamiliar with certain pediatric conditions. 17 For youth with complex needs, families are almost always a significant part of this conversation, because they are likely to be highly involved in not only caring for the youth but also arranging for, and supervising, others who provide care. The provider, youth, and family must jointly prepare a portable medical summary and, for children with special health care needs, a care plan, which should be delivered to the patient (or his or her legal guardian) and to the receiving provider.…”

Health Care Transitions for Adolescents and Young Adults With Special Health Care Needs: Where Are We Now?

“…Indeed, similar transition issues were expressed by internal and family medicine providers responding to surveys. 26,27 Why Have Health Care Transitions Not Become an Efficient Standard of Care? This is a fair question, particularly in the era of integrated medical organizations and electronic medical records.…”

“…29 Other barriers to providing adult primary care to youth with special needs is lack of training in congenital and childhood illnesses, lack of time and lack of reimbursement for time to coordinate care. 11,13,21,26,30 No doubt, low volumes of transitioning special needs young adults in most medical practices (and each patient's unique set of issues) contribute to providers' perception or actuality of failing to keep current with proper treatment of these individuals.…”