Successful health care transition requires pediatrician, adult sleep provider involvement
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Key takeaways:
- There are various patient, family, provider and system factors that act as barriers to transitions.
- The recommended transition process starts when the child is aged 12 to 14 years to achieve six core elements.
BOSTON — Transitioning a pediatric sleep patient to adult care requires awareness from both pediatricians and adult providers on transition barriers and recommendations, according to a presentation at the CHEST Annual Meeting.
“[The health care transition process] requires planning, transfer and integration into the adult health care system,” Mariam Louis, MD, MSc, FCCP, professor of medicine and associate chief of the division of pulmonary, critical care and sleep medicine at the University of Florida and director of the University of Florida Health Sleep Program, said during her presentation.
Louis highlighted five medical complications that could potentially arise if an individual of transition age (12 to 26 years) is involved in a poorly structured transition program: “poor medication adherence, discontinuity of care, patient dissatisfaction, higher ED and hospital use and higher costs of care.”
When thinking about these complications, it is also important to consider that there are various patient, family, provider and system factors that act as barriers to transitions, Louis said.
“Examples [of patient factors] are the desire of the patient for independence, which may conflict with their ability to manage their condition ... and limited knowledge,” Louis said. “For their entire lives, the medical decisions have been made by the family or their guard, and now all of a sudden, they’re being asked to make some of the decisions, and they may not have the understanding.”
In terms of family factors, Louis noted that parents/guardians may not want to leave their pediatric providers.
“Some families have a very hard time letting go of their pediatricians and may even harbor some negative beliefs about adult care,” Louis said. “So, you can imagine, any lack of communication between the adult and the pediatric provider only reinforces that negative perception, and it makes the transition all the more difficult.”
Provider factors that impede on the transition from pediatric to adult care include inadequate coordination and communication between the two parties, as well as the fact that adult providers lack training on congenital and childhood-onset conditions, according to Louis.
Lastly, insurance and fewer resources in adult care are system factors that can negatively impact the transition process.
“Particularly here in the United States, as the child develops older, there may be some insurance coverage and limited access because they outgrow their parents’ insurance,” Louis said.
“In many of the adult care settings, such as where I practice, we have limited resources,” Louis continued. “I don’t have all the necessary equipment. I may not have a multidisciplinary team to help support the patient and help support the transition.”
Although it is clear that there are numerous barriers to the transition from pediatric to adult care, Louis presented current recommendations from a 2018 clinical report published in Pediatrics involving the American Academy of Pediatrics, the American Academy of Family Physicians and the American College of Physicians.
According to the recommendations, the transition process on the pediatrician side should start when the child is aged 12 to 14 years to achieve six core elements: “transition policy; transition tracking and monitoring; transition readiness; transition planning; transfer and/or integration into adult-centered care; and transition completion and ongoing care with adult clinician.”
Louis noted that guidance on the transition process for adult sleep providers is made up of the same core elements but slightly differs based on what should be carried out for each element.
“[In] the first element, the adult needs to create and discuss with the patient at the age of 12 to 14,” Louis said. “I can tell you, we certainly don’t do that, but that needs to be initiated.
“Again, track the progress, and when it’s deemed that the patient is ready, have a welcome discussion [including] frequently asked questions to the patient and your guardian,” Louis continued.
In addition to following the recommended elements, Louis highlighted six ways to overcome the outlined barriers.
According to Louis, it is beneficial to get senior leadership involved, build an infrastructure and create a quality improvement team with all stakeholders.
“If you get the pediatrician, if you get the adults, if you get the patient advocates, you’ll be amazed at what you can actually accomplish,” Louis said.
Specifically on the adult provider side, Louis emphasized the importance of seeking out additional knowledge.
“It’s OK to call the pediatrician and say, ‘I have this patient who has [this condition]. What do I do? I’ve never seen one before since med school,’” Louis said. “It’s OK because you want to provide the best medical knowledge.”
The remaining three ways to overcome health care transition barriers according to Louis include raising awareness, involving yourself in advocacy groups and checking out websites focused on this transition, such as https://www.gottransition.org/.