Changing doctors is never easy. For teenagers new to advocating for their own healthcare, or those who have a chronic illness such as diabetes or cystic fibrosis, it can be even more challenging to make the transition.
A new clinical report provides detailed guidance to pediatricians, family physicians, and internists to support all adolescents, including those with special healthcare needs, as they transition to an adult model of healthcare. The clinical report, ?Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home,? from the American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), and American College of Physicians (ACP), was published in the July 2011 issue of Pediatrics.
Because finding adult primary and specialty care providers for youth with chronic conditions has been a challenge for pediatricians, youth, and families, this new clinical report will improve access to adult healthcare. The transition requires help from the doctors on both sides, including preparing the adolescent to take charge of his or her own healthcare. Most young people with chronic illnesses will survive into adulthood and will need to find physicians who are trained in treating those conditions.
Ideally, children should transition to adult-oriented healthcare between the ages of 18 and 21 years. For adolescents seeing a pediatrician, the transition will involve choosing a new physician, transferring medical records, and communicating treatment histories and insurance information. Although adolescents seeing a family physician may stay in the same practice, they may still need to transfer specialty care to adult subspecialists.
All adolescents face unique health issues and have complex needs when it comes to care, but this is particularly true for teens dealing with chronic disease or disability. Having a medical home can provide stability during this time of change, and this report provides excellent guidance for family physicians and their care teams to help young people and their families follow a healthy path to adulthood.
However, internal medicine specialists and subspecialists are often not prepared for the medical and social support needs of young adults with chronic or rare health conditions. This paper calls for all transitions in care to be based on adequate preparation, proactive communication, and early engagement of patients, families, and referring and accepting physicians in the process. The paper also provides strategies and formulas to overcome common challenges, as well as a series of useful algorithms.
Implementing these policies will serve all of our patients but will be particularly beneficial to youth with special healthcare needs and the providers who assume their care. The report suggests that transition planning begin at age 12 years and occur at age 18 years, but clearly the timing at either end of the process must be individualized based on the adolescent?s developmental level, the complexity of his or her chronic condition or conditions, the readiness of the adolescent and family to begin the planning process or to change providers, the characteristics of the current medical home, and the ability to identify a suitable adult medical home.
- American Academy of Pediatrics, American Academy of Family Physicians, and American College of Physicians, Transitions Clinical Report Authoring Group. Supporting the health care transition from adolescence to adulthood in the medical home. Pediatrics. 2011;128(1):182-203. Full text available at: http://pediatrics.aappublications.org/content/128/1/182.full.pdf+html. Accessed August 18, 2011.
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