Perspectives

Transitions of Care for Healthy Young Adults: Promoting Primary Care and Preventive Health

Authors: Laurie Graves, MD, Shannon Leung, MD, Prashant Raghavendran, DO, Sarah Mennito, MD, MSCR

Abstract

The transition of care between pediatric and adult medicine is a challenging time for patients and physicians. This longitudinal process encompasses much more than the physical transfer of a patient between providers. Established transition of care processes and literature exist for many chronic disease populations, but little focus has been directed toward the transition of care and the delivery of preventive medicine for healthy young adult patients. The 18- to 30-year-old age group is a heterogenous population that often engages in high-risk behaviors and has high rates of preventable morbidity and mortality. A significant number of these patients do not receive routine primary care and are high users of costly emergency services. Without a continuous source of care, many young adults do not receive age-appropriate screening or preventive health guidance. Structured transition practices improve outcomes in the chronic disease population, and anticipatory guidance has a positive effect on patient lifestyle modification. Adult providers should use these practices to ensure the successful integration of healthy young adult patients into an adult medical home. By establishing an ongoing source of preventive care, providers could reduce morbidity and mortality in this vulnerable population.

 

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References

1. Callahan ST, Cooper WO. Changes in ambulatory health care use during the transition to young adulthood. J Adolesc Health 2010;46:407-413.
2. 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;110:1304-1306.
3. 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.
4. 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 transition from adolescence to adulthood in the medical home. Pediatrics 2018;142:e20182587.
5. Gabriel P, McManus M, Rogers K, et al. Outcome evidence for structured pediatric to adult care transition interventions: a systematic review. J Pediatr 2017;188:263-269.e15.
6. Reid GJ, Irvine MJ, McCrindle BW, et al. Prevalence and correlates of successful transfer from pediatric to adult health care among a cohort of young adults with complex congenital heart defects. Pediatrics 2004;113( 3 Part 1 ):e197-e205.
7. Jensen PT, Karnes J, Jones K, et al. Quantitative evaluation of a pediatric rheumatology transition program. Pediatr Rheumatol Online J 2015;13:17.
8. McQuillan RF, Toulany A, Kaufman M, et al. Benefits of a transfer clinic in adolescent and young adult kidney transplant patients. Can J Kidney Health Dis 2015;2:45.
9. Fortuna RJ, Robbins BW, Halterman JS. Ambulatory care among young adults in the United States. Ann Intern Med 2009;151:379-385.
10. Centers for Disease Control and Prevention, National Center for Health Statistics. Emergency department visits. https://www.cdc.gov/nchs/fastats/emergency-department.htm. Accessed December 7, 2018.
11. Berk ML, Fang Z. Young adult insurance coverage and out-of-pocket spending: long-term patterns. Health Aff (Millwood) 2016;35:734-738.
12. Jackson GL, Powers BJ, Chatterjee R, et al. The patient-centered medical home: a systematic review. Ann Intern Med 2013;158:169-178.
13. VanGompel EC, Jerant AF, Franks PM. Primary care attributes associated with receipt of preventive care services: a national study. J Am Board Fam Med 2015;28:733-741.
14. Ferrante JM, Balasubramanian BA, Hudson SV, et al. Principles of the patient-centered medical home and preventive services delivery. Ann Fam Med 2010;8:108-116.
15. Nelson CS, Higman SM, Sia C, et al. Medical homes for at-risk children: parental reports of clinician-parent relationships, anticipatory guidance, and behavior changes. Pediatrics 2005;115:48-56.
16. Brindis CD, Twietmeyer L, Park MJ, et al. Improving receipt and preventive care delivery for adolescents and young adults: initial lessons from top-performing states. Matern Child Health J 2017;21:1221-1226.
17. Bass JL, Christoffel KK, Widome M, et al. Childhood injury prevention counseling in primary care settings: a critical review of the literature. Pediatrics 1993;92:544-550.
18. DiGuiseppi C, Roberts IG. Individual-level injury prevention strategies in the clinical setting. Future Child 2000;10:53-82.
19. Ozer EM, Adams SH, Orrell-Valente JK, et al. Does delivering preventive services in primary care reduce adolescent risky behavior? J Adolesc Health 2011;49:476-482.
20. Ozer EM, Urquhart JT, Brindis CD, et al. Young adult preventive health care guidelines. Arch Pediatr Adolesc Med 2012;166:240-247.
21. Centers for Disease Control and Prevention. National Vital Statistics System. https://www.cdc.gov/nchs/nvss/deaths.htm. Accessed April 12, 2018.
22. US Preventive Services Task Force. Published recommendations. https://www.uspreventiveservicestaskforce.org/BrowseRec/Index. Accessed July 8, 2019.
23. Centers for Disease Control and Prevention, National Center for Health Statistics. No usual source of health care among adults. https://www.cdc.gov/nchs/health_policy/adults_no_source_health_care.htm. Accessed December 7, 2018.
24. Bain A, Wong CA, Slap G, et al. Common and costly hospitalizations among insured young adults since the Affordable Care Act. J Adolesc Health 2016;59:61-67.
25. Mosher WD, Jones J, Abma JC. Intended and unintended births in the United States: 1982-2010. Natl Health Stat Rep 2012;( 55 ):1-28.
26. The National Alliance to Advance Adolescent Health. Got Transition. https://www.gottransition.org/index.cfm. Accessed December 10, 2018.
27. American College of Physicians Pediatric to Adult Care Transitions Initiative, Condition-Specific Tools. https://www.acponline.org/clinical-information/high-value-care/resources-for-clinicians/pediatric-to-adult-care-transitions-initiative/condition-specific-tools. Accessed April 9, 2019.