From the Journals

Pediatricians fall short on transition to adult care

Publish date: September 17, 2018
By
Jeff Craven

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A long way to go on the road to transition

While researchers and clinicians have been discussing how to improve the poor health outcomes seen in the transition from pediatric to adult care for youth with special health care needs for decades, there has been little improvement, Megumi J. Okumura, MD, wrote in an accompanying editorial.

In 2016, 41% of youth with special health care needs had a discussion about the transition from pediatric to adult care, a figure that is “largely unchanged from 2010,” she noted.

One hurdle is the lack of a gold standard for measuring an ideal transition. Is it successful scheduling of an appointment with adult provider or having a job and being able to manage one’s own disease?

“Until our health system supports pediatric providers in offering adequate transition planning, it will be difficult to expect any uptick in these measures. In addition, we still need to understand why some adolescents fail in their transition and transfer and how to develop the appropriate interventions to improve health outcomes for these patients,” Dr. Okumura wrote.

Dr. Okumura is with the division of general pediatrics at the University of California, San Francisco. These comments are adapted from an accompanying editorial (Pediatrics. 2018 Sep 17. doi: 10.1542/peds.2018-2245). She reported having no relevant conflicts of interest.


 

FROM PEDIATRICS

Many adolescent patients, both with and without special health care needs, are not receiving guidance from their physicians about transitioning to adult care, according to recent findings published in Pediatrics.

Young teen girl at doctors office Rawpixel/iStock/Getty Images

Lydie A. Lebrun-Harris, PhD, of the Maternal and Child Health Bureau at the Health Resources and Services Administration, and her colleagues examined data from 20,708 youth aged 12-17 years with and without special health care needs obtained from the 2016 National Survey of Children’s Health. The aim was to determine the current level of transition planning to adult care from a pediatric or other health care provider (HCP).

Parents and caregivers were asked whether a doctor or HCP had spent time alone with the adolescent during the last year, had discussed the transition to adult care, and had actively helped the adolescent “gain self-care skills or understand changes in health care” when they reached the age of 18 years.

Overall, 17% of youth with special health care needs and 14% of youth without met all three transition elements.

The figures were higher for individual measures. For instance, 44% of youth with special health care needs spent time alone with an HCP within the past year, 41% discussed transition to an adult provider, and 69% reported an HCP had worked with them to understand health care changes and gain self-care skills.

Youth without special health care needs were more likely to discus the shift to adult care with HCPs than those with special needs, but special needs youth were more likely to have met the other two transition measurements (P less than .001).

Being older (aged 15-17 years) were associated with an increased prevalence of meeting the overall transition measure and the individual elements among both youth with and without special health care needs.

“Findings from this study underscore the urgent need for HCPs to work with youth independently and in collaboration with their parents and/or caregivers throughout the adolescent years to improve transition planning,” Dr. Lebrun-Harris and her colleagues wrote.

The study was supported by the Health Resources and Services Administration and the National Alliance to Advance Adolescent Health. The authors reported having no relevant conflicts of interest.

SOURCE: Lebrun-Harris LA et al. Pediatrics. 2018 Sep 17. doi: 10.1542/peds.2018-0194.

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