154. Transitions of Adolescents With Eating Disorders: How Well are We Doing?

Abstract

With a mean age of diagnosis of 18 years, eating disorders patients often require health care transition between the pediatric and adult health systems during the course of their treatment and recovery. We sought to determine whether adolescent medicine clinical programs have specific health care transition (HCT) protocols for eating disorders patients and whether protocols are consistent with current guidelines outlined by the 2011 Clinical Report on HCT within a medical home outlining six core elements. We invited all 27 adolescent medicine fellowship directors in the United States and Canada to anonymously participate in a 55 item internet survey assessing current services for eating disorders patients, current transition pratice for all patients and specifically for eating disorders patients; percevied barriers to health care transition, and perceived needs for transition support. 16 program directors (59% response rate) participated. Most programs reported having treatment teams in place for outpatient (n=13/16) and inpatient (n=12/16) treatment of eating disorders patients. 44% of the programs (n=7/16) reported having a formalized transition protocol for any patients, and only two programs out of 16 reported a specific eating disorders (ED) transition protocol. Very few programs (n=4/16) address the six core elements of HCT in their current practice, regardless of whether there is a formal transition protocol reported. 75% of respondants (n=12/16) stated that they would consider implementing a formalized transition protocol for eating disorders patients. Respondants rated items on a 0-100 scale of significance of barriers to health care transition, where a score of 100 was most significant. Respondants rated insurance issues (median score 82/100)and patient reluctance to leave pediatric care (median score 72/100)as the most significant barriers to health care transition with patient reluctance to engage in adult care (median score 65/100),lack of reimbursement for transition services (median score 62/100), poor communication between pediatric and adult providers (median score 56/100), and patient distrust of adult providers also as barriers (median score 57/100). Only two programs reported currently having a care coordinator to assist with health care transition of these patients to adult care although most respondants (n=14/16) perceived a care coordinator as helpful in support of transition. While many programs report having general health care transition services for their patients, few programs report specific formal transition programs for eating disorders patients needing health care transition. Some aspects of the approach to health care transition in the general population may not be appropriate for eating disorders patients and emphasis on meeting their specific needs may be helpful. In our survey, the idea of establishing a specific health care transition protocol for eating disorders patients was well received. Future research should assess if specific health care transition strategies for this population are more effective and appropriate.