Transition health care for adolescents

Abstract

The American Academy of Paediatrics, the American Academy of Family Physicians, and the American College of Physicians have updated their collective 2011 clinical guidance in a new report, Supporting the Health Care Transition from Adolescence to Adulthood in the Medical Home. According to new data, a health-care transition plan is in place for only 17% of American adolescents who have special health-care needs and for only 14% of adolescents who do not have special needs. Health-care needs in adolescence span prevention to treatment of acute, emerging, and long-term conditions. Care needs to focus on the adolescent person and their wider family and be reflected in appropriate health-system infrastructure. Quality of care during the transition into adulthood affects health-care uptake, quality of life, educational achievement, and overall wellbeing. For the 1% of adolescents with severe, complex health conditions, continuity of health care into adulthood can be challenging alongside other life transitions during adolescence (eg, leaving education, leaving home, and parenthood). The guidance presents the Six Core Elements of Health Care Transition—evidence-led packages that rely on communication between stakeholders across different aspects of health-care provision. The packages are designed for paediatric practices transferring care to adult practices, adult practices taking over care from adolescent care providers, and family general practices continuing to provide care across the lifespan. Each package focuses on the importance of preparation, transfer, and integration into adult health care and recognises that patient-centred care for adolescents and young adults means attending to their needs, while appreciating the importance of family. Focusing on health transition is a welcome step for adolescent health in the USA and will address the alarming shortfall in transition planning. The principles and benefits of preparation, transfer, and integration are universal, but the challenges in managing these transitions will be considerable in countries without such infrastructure or resources, severely limiting the global potential of the recommendations.