Chronic somatic disorders-The way to adulthood medicine structures

Abstract

Transition is the structured crossing over of an adolescent patient from treatment by a pediatrician to that by an adult doctor. The transition falls in a difficult phase of life that includes the end of puberty, finding ajob, obtaining training, gaining increasing autonomy, and "cutting off" from parents and the parents' home. In this article, problems with transition are explained with afocus on patients with chronic inflammatory bowel diseases. Structured transition programs are presented.There are different groups of patients who transfer to the adult care system: adolescents with diseases that are well known(1) or unknown(2) in adult medicine and adolescents with disabilities who are treated in social pediatric centers (SPZ)(3). For the final group there are currently no adequate treatment structures in the adult care. Medical centers for adults with intellectual and multiple disabilities (MZEB) are currently being established. In all groups transition is understood as adynamic process in which the patient, the parents, as well as the pediatric, adolescent and adult caregivers/physicians are involved. This generally runs over a long period of time and does not rely solely on a passive handover or transfer. Cancellation of therapy with subsequent problems is very common in this phase and sometimes very harmful for the affected patient. Structured cross-sector and cross-indication transition programs with case management elements, such as the Berlin Transition Program (BTP), offer support of patients in this phase of life and can prevent the consequences of inadequate adherence to therapy. The German Society for Pediatric and Adolescent Medicine (DGKJ), the German Society for Internal Medicine (DGIM), and the German Society for Neurology (DGN) have established a transition working group that supports the BTP.