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Vital Signs

 
Spring 2014

Transitioning from Pediatric to Adult Healthcare

The life expectancy of children with complex illnesses has increased dramatically over the past three decades.

As a result, many adolescents must learn to manage their own chronic diseases or disabilities when they become adults. The key to a smooth transition from childhood to adult care, experts say, is planning ahead. “Physicians sometimes hesitate telling their pediatric patients and families that it’s time to begin the transition to adult-based healthcare because they don’t want to worry them,” explains Debra Lotstein, MD, MPH, medical director of the UCLA Med-Peds Transition Care Program. “But planning these transitions early is crucial because adolescents with complex, chronic conditions need uninterrupted access to appropriate, high-quality healthcare, or they risk becoming very sick.”

Transitioning from Pediatric to Adult HealthcareApproximately 15 percent of children in the United States aged 17 and younger have complex medical conditions, ranging from asthma, diabetes and congenital heart disease to juvenile inflammatory arthritis, cystic fibrosis, neurological disabilities and organ transplantation. As many as 60 percent of these patients experience gaps in medical care, health-insurance coverage or both during their transition from adolescence to adulthood. To avoid these problems, patients should begin the transition to adult-based healthcare between the ages of 12 and 18, Dr. Lotstein says: “Early planning prevents problems and helps to decrease anxiety for the patients and their parents.”

At UCLA’s Med-Peds Transition Care Program, preparing for the transition involves evaluating patients’ current and future healthcare needs and connecting patients with appropriate providers to meet those needs; addressing insurance-related issues to prevent gaps in health coverage when children are no longer eligible for coverage under their parents’ health plans; educating patients about self-care related to their conditions; and helping patients plan realistic education and career goals.

In the Adolescent/Young Adult Transitional Care Program for Congenital Heart Disease at UCLA, “we try to help patients and their parents understand their condition using an age and developmentally tailored approach,” says pediatric cardiologist, Leigh Reardon, MD, program director. “Many years after heart surgery, some of our patients believe they’re living on borrowed time, while others feel like they’re invincible.” Although an increasing percentage of children with congenital heart defects are surviving into adulthood and leading active, productive lives, they may still face certain challenges related to lifestyle and career choices.

Transitioning from Pediatric to Adult Healthcare“Some patients don’t understand why they should anticipate future challenges such as the potential detrimental effects of pregnancy or certain types of exercise,” he says. “Discussing their personal goals and recommendations early on helps to prevent them from being disappointed or from unintentionally hurting themselves later.” Another important goal in the transition process, Dr. Reardon says, is helping young patients develop medical independence.

“There’s an interesting dynamic that occurs when an adolescent takes ownership of their healthcare from their parents. They often feel empowered and begin participating in their care in ways that make them feel that they are not defined by their medical condition,” Dr. Reardon says. “Simple steps like scheduling appointments or refilling prescriptions can help make the transition to the adult setting much more successful. Ultimately, we promote independence so that our patients can learn how to make positive choices for their lives and participate in their own care and decision-making as they become adults.”





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