Peds to Primary Care

Making the Transition From Pediatric to Primary Care

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Changing doctors is never easy. For teenagers new to advocating for their own healthcare, or those who have a chronic illness like diabetes or cystic fibrosis, the transition can be even more challenging.

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, the American Academy of Family Physicians (AAFP), and the American College of Physicians, 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 healthcare providers on both sides, including preparing adolescents to take charge of their 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. 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.

Roland Goertz, MD, MBA, FAAFP, president of the AAFP notes, “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.

The clinical report includes the following recommendations, as well as targeted algorithms to help guide you through the process:

  • For patients aged 12 to 13 years, begin discussions with parents and youth about office transition policies (expected age of transfer; patient, family/caregiver; and medical home responsibilities in the transition process), and provide the transfer policy in writing. Review each patient’s medical record to identify any special healthcare needs.
  • For patients aged 14 to 15 years, develop a written transition plan with patients and their parents or guardians.
  • For patients aged 16 to 17 years, review and update the transition plan to reflect changes in the patient’s medical status and patient or parent concerns, and prepare the patient for adult care. A “pretransfer” visit to the adult medical home might be worthwhile.
  • For patients aged 18 years or older (depending on the patient’s developmental level), the patient should be transferred to adult care; in family medicine practices, an adult medical care model should be initiated at this point.
  • For youth with special healthcare needs, transition planning can be facilitated by developing a registry of patients in the practice with special needs; continuously update written care plans (including advance directives and details about the youth’s developmental level and readiness to assume responsibility for self-care) and care coordination plans (including information about the specific co-management responsibilities of the primary care physician and each subspecialist).
  • Identify the adult medical home (and subspecialists) that will accept the patient, and provide the full range of care and coordination needed.
  • The authors call for adequate reimbursement for transition care planning and for adequate insurance for youth throughout the transition process and into young adulthood.The report represents an extension of a 2002 consensus statement on healthcare transitions for young adults that was co-authored by the same three national medical organizations. The report also coincides with the launch of a new National Health Care Transition Center. The center is funded by the U.S. Maternal and Child Health Bureau in the Health Resources and Services Administration, which works with pediatric and adult primary care practices to develop tools to implement the specific guidance outlined in the report.

Jill Shuman, MS, ELS
Published on August 23, 2011

Source: Academy of Pediatrics; American Academy of Family Physicians; 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);182-200.