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AAP National Conference: Ensure your patients are ready to navigate adult system of care :

October 23, 2016

Can you imagine having a wedding without planning? Or going to college without preparing?

Yet many teens and young adults leave their pediatricians without any guidance on how to navigate the adult system of care.

“Is it fair to throw a young adult into a new game without knowing the rules?” asked Patience White, M.D., M.A., FAAP, co-director of Got Transition: Center for Health Care Transition Improvement. “No, it’s not really fair.”

Dr. White shared tools and resources to help pediatricians prepare their patients for the move to an adult provider during a session titled “Transition Strategies: Pediatric to Adult Care.”

While transition historically has focused on youths with special needs, it is important for all patients, said Dr. White, a member of the AAP Section on Rheumatology.

Patient visits to pediatricians tend to drop off in high school, and many teens leave their pediatrician without being connected to an adult provider. As a result, they use the emergency department more, costs increase and their health suffers, Dr. White said.

Furthermore, there are 9 million teens with chronic conditions who would benefit from transition planning, she said.

“It’s important for any life change to do planning, particularly if you have a chronic illness,” she added.

Among the resources Dr. White shared are the 2011 clinical report Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home from the AAP, American Academy of Family Physicians and American College of Physicians ( and the Six Core Elements of Health Care Transition 2.0 (

The Six Core Elements include 1) developing a transition policy, 2) tracking and monitoring youths’ progress, 3) assessing transition readiness, 4) planning for the transition, 5) transferring care and 6) completing the transfer.

Pediatricians often say they don’t have time to implement a transition system.

“You don’t want to say you have to do soup to nuts here. But if you could do a few (of the steps), that would really be helpful for everybody in the process,” she said.

For example, practices could devote one of their regularly scheduled staff meetings to discuss at what age they would like patients to transition to an adult provider. Once a consensus has been reached, the policy is posted on the practice website so patients know what to expect and all physicians are consistent.

Practices also can administer assessments to identify patients’ needs and goals for self-care.

Dr. White said she gives her patients a readiness assessment starting at age 12 to 14 years. Then at each visit, she tackles one skill they need to work on such as how to make an appointment or how to summarize their disease, allergies and medications at the beginning of a medical appointment.

Practices also can enlist their office staff to find adult providers, and they can use their electronic health record system to develop medical summaries for patients to take to their new doctor.

“So many people are looking for a process,” Dr. White said. “I think we have a pretty good one that is adaptable, customizable, which people need.”

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