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ACP: Internists crucial component in pediatric to adult health care transition

To lessen the current health care gap among young adults aged 18 to 25 years, internists can help prepare these patients for a successful transition from pediatric to adult care, according to an article by the ACP published in Annals of Internal Medicine.

“The journey from adolescence to adulthood often crosses an ‘abyss in care.’ Neither pediatric nor adult medicine practices are structured to truly meet the unique needs of this ‘emerging adult’ cohort,” M. Carol Greenlee, MD, of Western Slope Endocrinology, and colleagues wrote. “The transition from pediatric to adult care may benefit from improvements in information sharing, communication, and collaboration; however, more steps must be taken. Internists must understand the unique requirements of these emerging adults and how to address these needs to better engage with young adults and transition them into their practices,” they added.

Health care is often a low priority for most emerging adults due to other demands and concerns, yet they have high rates of substance abuse, severe mental health conditions, STDs and accidental injuries, according to Greenlee and colleagues. Young adulthood is a crucial period for the prevention of chronic adult-onset conditions; however, approximately 30% of emerging adults do not have a regular physician or medical home. In addition, although they have more access to health insurance under the Patient Protection and Affordable Care Act, they use outpatient services significantly less (with the exception of female reproductive health care) and emergency care significantly more than their younger and older peers.

According to Greenlee and colleagues, an ideal system of transitioning emerging adults into adult care successfully must include pediatric and adult medicine practices working together. A mutual transfer agreement should be developed in which the pediatric practice provides an updated medical summary and assessment of the patient’s self-care knowledge and skills to the adult medicine practice. Shared care between the practices may be implemented for an agreed period of time to familiarize internists with certain childhood-onset conditions, as well as relieve transition-related anxiety of the patient and family.

Furthermore, Greenlee and colleagues emphasize that internists acknowledge that treating a young adult patient requires a different approach than an older adult patient. Internal medicine practices may have to employ methods to enhance some young adults’ self-care knowledge and skills. Prior to advising a new young adult patient to undergo therapeutic or treatment changes, internists should establish mutual trust.

“The unique needs of emerging adults have not received the attention they deserve from either adult or pediatric clinicians,” Greenlee and colleagues concluded. “This inattention has led to gaps in care quality, patient dissatisfaction, and increased health care costs. ... All young adults need better health care systems and approaches that are suited to their developmental and life stage. In recognition of this need, tools and resources have been developed and are available to assist clinicians. By following the recommendations outlined [in the guidelines], using these resources, internists can begin bridging the practice gaps that exist.” – by Alaina Tedesco

Disclosure: The authors report no relevant financial disclosures.