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FEATURE

WANTED
The Transition – Forty-something pediatrician seeks adult

providers interested in caring for young adults
Special Needs Patients Become Adults with special healthcare needs.
By Ruchi Kaushik, MD, MPH Hobbies/Interests: Crossword puzzles, bak-
ing, and children with medical complexity.
Fears: Snakes, Loop 410, and young adult pa-
Okay, all joking aside, this is truly a serious issue. At what point long-ter m
tients with new-onset adult problems.
is it time for pediatricians to say to our families, “It’s time to move relationship,
on. We both have different paths. I think we should see other peo- not set them up for a date with the emergency department. It is
ple. I promise, it’s not you, it’s me”? At the same time, we deeply time for us to elicit not only a parent’s understanding, but also a
care for our patients and families and know they are not looking for teen’s understanding of their problem list, medications, and symp-
a one-night stand in the emergency department, but, rather, a long- toms requiring urgent medical care.
term, committed relationship with a new doctor. It is time to face reality; the reality is, however, that identifying
So, why is this an issue? Well, the truth is that advancements in adult health care providers can be challenging. In an ideal world, we
medical knowledge and technology have allowed us to improve out- would compile a list, a directory of sorts, of local and regional adult
comes for children and youth with special health-care needs. Over primary care and subspecialty providers who are interested in caring
85% of children born today with chronic medical conditions will for young adults with chronic medical conditions, with insurance
live into adulthood. As of 2010, more than half of all individuals network information. We would create a transition seminar, a quar-
1
with cystic fibrosis were over the age of 18. Over the next decade, terly lecture series given by pediatric specialists to educate adult
2
roughly 90,000 people with congenital heart disease are expected to providers about childhood-onset disorders to prepare them for the
3
enter adulthood. Indeed, there are currently 18 million young adults millions of teens entering adulthood. We, the exes, would shake
18-21 years of age – one in five has chronic conditions. 4 hands with the new “bride-to-be,” open the door and share all the
And yet, we pediatricians remain so attached to our patients. We secrets to foster a smooth, safe, and quality transition.
are afraid to let go or afraid adult providers will not be comfortable
caring for our patients; similarly, our patients are afraid of moving Ruchi Kaushik, MD, MPH, FAAP, Assistant Professor, Pe-
on and not ready to trust a new doctor. But it is time to face our diatrics, Baylor College of Medicine, Medical Director, ComP-
5
fears. Evidence suggests that health outcomes improve for young CaN (Comprehensive Peds for Complex Needs), Medical Director,
adults with chronic conditions when they have smoothly transi- The Children's Hospital of San Antonio Blog (CHofSAblog.org),
tioned into an adult model of care. 6 The Children's Hospital of San Antonio, \ruchi.kaushik@bcm.edu
So, why shouldn’t pediatricians continue to see young adults with
disorders that begin in the prenatal or immediate postnatal period References:
into adulthood? Well, while we are great at immunizing, develop- 1. Reid GJ, Irvine MJ, McCrindle BW, Sananes R, Ritvo PG, Siu SC,
mental screenings, and discussing anticipatory guidance, we may not Webb GD. Prevalence and correlates of successful transfer from pediatric
be so great at recognizing signs of diseases that typically present in to adult health care among a cohort of young adults with complex con-
genital heart defects. Pediatrics. 2004;113(3 Pt 1):e197-205.
adulthood, Pap smearing, discussing family planning, or recalling
2. Tuchman LK, Schwartz LA, Sawicki GS, Britto MT. Cystic fibrosis
the timing of other important preventive screenings. Certainly, these
and transition to adult medical care. Pediatrics. 2010;125(3):566-573.
are all topics we can brush up on, but what’s more important than
3. Warnes CA, Liberthson R, Danielson GK, Dore A, Harris L, Hoffman
transferring to adult care is transitioning to the adult model of care. JIE, Somerville J, Williams RG, Webb GD. Task force 1: the changing pro-
Fortunately, the National Alliance to Advance Child Health has file of congenital heart disease in adult life. Journal of the American College
developed “Got Transition”, a cooperative agreement with the Ma- of Cardiology. 2001;37(5):1170-1175.
ternal and Child Health Bureau aimed to improve transition from 4. Transition of PSHCNs to adult medical care webinar series. NYMAC.
pediatric to adult health care with new and innovative strategies for http://aapdc.org/event/transition-of-pshcns-to-adult-medical-care-webi-
health professionals and youth and families via its website, www.got- nar-series/2015-02-11/. Accessed March 15, 2019.
5. O’Sullivan-Oliveira J, Fernandes SM, Borges LF, Fishman LN. Tran-
transition.org. The site’s resources assist providers who are both
sition of pediatric patients to adult care: an analysis of provider perceptions
transitioning out and accepting young adults with sharing transition
across discipline and role. Continuing Nursing Education. 2014;40(3):113-
policies, tracking and monitoring, assessing transition readiness, cre-
142.
ating portable medical summaries and transferring care.
6. Tuchman L, Schwartz M. Health outcomes associated with transition
It is time for pediatricians to assert, “we need to talk…” to our from pediatric to adult cystic fibrosis care. Pediatrics. 2013;132(5):e847-853.
patients and families, inform them of the expiration date of our re- 7. Got Transition. gottransition.org. www.gottransition.org/ index.cfm?.
lationship, but ensure they are mentally prepared to enter a new Accessed March 15, 2019.
28 San Antonio Medicine • November 2019