Review Article

Improving Transitions of Care for Healthy Adolescents and Young Adults

Authors: Shannon Leung, MD, MPH, Mason Walgrave, MD, Sarah Mennito, MD, MSCR

Abstract

Objectives: To explore the gaps in care within the transition process from pediatric to adult medicine for healthy and noncomplex adolescents and young adults and to highlight the importance of identifying and adapting interventions to improve transitions for this population.

Methods: Three researchers independently completed searches in PubMed, PsychINFO, and CINAHL Complete. The review used the following inclusion criteria: English-language original research articles published between January 2007 and January 2018 involving care transitions for male and female patients ages 13 to 24 years with diagnoses that may be managed only by a primary care provider. Studies were excluded if they were reviews or commentaries, included only specialist providers, or primarily investigated children with special healthcare needs. The articles selected based on these inclusion and exclusion criteria, as well as those identified through review of references of included articles and known articles not found through those searches, were analyzed for suitability.

Results: Nine studies were included in the review. Limited consensus existed on how transitions of care should be approached for healthy and noncomplex adolescents, despite the 2002, 2011, and 2018 policy statements and clinical reports providing guidelines on transition processes. Perceptions about when to initiate the process, what to discuss about transitions, and how to approach those conversations varied among providers.

Conclusions: The literature is limited regarding transitions of care from pediatric to adult medicine for healthy and noncomplex adolescents and young adults. Areas for intervention were identified from these studies and have yet to be explored. Additional research is needed to overcome transition obstacles and to tailor interventions to help healthy and noncomplex adolescents and young adults at this vulnerable time of their lives.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. US Census Bureau. Annual Estimates of the Resident Population for Selected Age Groups by Sex for the United States, States, Counties, and Puerto Rico Commonwealth and Municipios: April 1, 2010 to July 1, 2017. https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk. Accessed August 28, 2019.
2. Data Resource Center for Child & Adolescent Health. 201-2017 national survey of children’ health: child and family health measures. http://www.childhealthdata.org/browse/survey/results?q=6444&ampr=1. Accessed December 10, 2018.
3. Centers for Disease Control and Prevention, National Center for Health Statistics. Health, United States, 2017, table 53. https://www.cdc.gov/nchs/data/hus/2017/053.pdf. Accessed May 5, 2019.
4. National Institute of Mental Health. Major depression. https://www.nimh.nih.gov/health/statistics/major-depression.shtml. Accessed May 5, 2019.
5. Centers for Disease Control and Prevention. National Center for Health Statistics. LCWK3. Deaths, percent of total deaths, and death rates for the 15 leading causes of death in selected age groups, by race and Hispanic origin, and sex: United States, 2016. https://www.cdc.gov/nchs/data/dvs/lcwk/lcwk3_hr_2016.pdf. Accessed May 5, 2019.
6. Bloom SR, Kuhlthau K, Van Cleave J, et al. Health care transition for youth with special health care needs. J Adolesc Health 2012;51:213-219.
7. Gabriel P, McManus M, Rogers K, et al. Outcome evidence for structured pediatric to adult health care transition interventions: a systematic review. J Pediatr 2017;188:263-269.e15.
8. Reiss JG, Gibson RW, Walker LR. Health care transition: youth, family, and provider perspectives. Pediatrics 2005;115:112-120.
9. American Academy of Pediatrics, American Academy of Family Physicians, American College of Physicians-American Society of Internal Medicine. A consensus statement on health care transitions for young adults with special health care needs. Pediatrics 2002;110(6 Pt 2):1304-1306.
10. American Academy of Pediatrics, American Academy of Family Physicians, American College of Physicians., et al. Supporting the health care transition from adolescence to adulthood in the medical home. Pediatrics 2011;128:182-200.
11. Got Transition. About Got Transition. https://gottransition.org/about/index.cfm. Accessed October 3, 2018.
12. White PH, Cooley WC, Transitions Clinical Report Authoring Group American Academy of Pediatrics American Academy of Family Physicians American College of Physicians. Supporting the health care transitions from adolescence to adulthood in the medical home. Pediatrics 2018;142:e2018587.
13. Feudtner C, Feinstein JA, Zhong W, et al. Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation. BMC Pediatr 2014;14:199.
14. Searing LM, Cantlin KA. Nonurgent emergency department visits by insured and uninsured adults. Public Health Nurs 2016;33:93-98.
15. Sieck CJ, Hefner JL, Wexler R, et al. Why do they do that?: looking beyond typical reasons for non-urgent ED use among Medicaid patients. Patient Exp J 2016;3:22-30.
16. Williams W, Lu P, O’ A, et al. Surveillance of vaccination coverage among adult populations-United States, 2015. MMWR Surveill Summ 2017;66:1-28.
17. Beal SJ, Nye A, Marraccini A, et al. Evaluation of readiness to transfer to adult healthcare: what about the well adolescent? Healthcare 2014;2:225-231.
18. Burke R, Spoerri M, Price A, et al. Survey of primary care pediatricians on the transition and transfer of adolescents to adult health care. Clin Pediatr (Phila) 2008;47:347-354.
19. Davidson LF, Doyle M, Silver EJ. Discussing future goals and legal aspects of health care: essential steps in transitioning youth to adult-oriented care. Clin Pediatr (Phila) 2017;56:902-908.
20. Hall CL, Newell K, Taylor J, et al. ‘ the gap’-mapping services for young people with ADHD transitioning from child to adult mental health services. BMC Psychiatry 2013;13:186.
21. Maddux MH, Ricks S, Bass J. Preparing patients for transfer of care: practices of primary care pediatricians. J Community Health 2015;40:750-755.
22. Marcer H, Finlay F, Baverstock A. ADHD and transition to adult services-the experience of community paediatricians. Child Care Health Dev 2008;34:564-566.
23. McManus M, White P, Barbour A, et al. Pediatric to adult transition: a quality improvement model for primary care. J Adolesc Health 2015;56:73-78.
24. Nicoteri JA, Arnold EC. The development of health care-seeking behaviors in traditional-age undergraduate college students. J Am Acad Nurse Pract 2005;17:411-415.
25. Suris JC, Akre C. Key elements for, and indicators of, a successful transition: an international Delphi study. J Adolesc Health 2015;56:612-618.