New Guidance Aims to Help Transition Youths From Pediatric to Adult Care

Before AAFP member Laura Pickler, M.D., sat down to write a portion of a guideline on health care transitions for adolescents and young adults, she talked to young people, parents and health care professionals in separate focus groups.

What she found were physicians frustrated by young patients who couldn't give their own health history, weren't ready to be treated as adults, and arrived at their new medical home without charts or adequate documentation. Meanwhile, adolescent and young adult patients complained that they were treated like children and were frustrated that they couldn't talk to their physicians about sensitive topics without having their parents in the room.

"Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home" provides detailed guidance on how to plan and execute optimal health care transitions for young patients. A collaborative effort of the AAFP, the American Academy of Pediatrics and the American College of Physicians, the report follows an algorithm -- which can be enhanced for youth with chronic conditions -- from age 12 through the transfer of care to an adult medical home.

"The goal of this document is to get everybody on the same page so family physicians know what to expect when they are asked to provide a medical home to a transitioning young adult," said Pickler, an assistant professor of family medicine, pediatrics and otolaryngology at the University of Colorado School of Medicine, Aurora. "A pediatrician also will know what to expect, and then we can start having relationships with them that are more collaborative and helpful from the patient perspective."

The report, which was published in the July issue of Pediatrics, specifically covers the respective roles of primary care physicians and subspecialists and outlines how to prevent omissions and redundancies in care.

"This document lets pediatricians know what the family physician is going to need. It also helps family physicians know what they can ask for," said Pickler.

Although much of the report deals with the pediatrician's role in preparing young patients to transition to an adult medical home, it also notes that primary care physicians receiving these patients should ensure that the following conditions are met:

In addition, the report lays out goals for young patients to achieve, such as scheduling their own appointments, obtaining medications, having one-on-one dialogues with a physician, and becoming familiar with their own medical history and medications. Many transition-readiness assessment tools and skills checklists exist that physicians can use to evaluate transitioning patients' abilities in this regard and target relevant patient education, if needed.

Of particular importance, says the report, is effectively and efficiently transitioning young adults with special health care needs. When such patients transition from their pediatric to their adult medical home, the receiving physician has a responsibility to help them transfer from their pediatric subspecialists to adult subspecialty care.

According to Pickler, there have been extreme cases of young adults with special needs, such as transplant patients, who have died during care transitions because they ran out of medication.

"Kids have died because no one picked up the ball," she said. "That's why this is important. There are big things that can go wrong during this time, and senders and receivers need to be on the same page."

Family physicians don't always play the role of receiver, however, and Pickler said the report also can help guide family docs whose young adult patients are leaving their practice as they go off to college, start new jobs or have changes in insurance.

"The transition period is a formidable time for a young adult in that they have to do some things for themselves that they've never had to do before," she said. "It's kind of nice if a family physician can have the same nice, well thought out handoff (for a transitioning young patient) as he or she does for a patient going to or from a hospital or to or from a nursing home."