Transition of Pediatric Patients to Adult Care
The importance of successfully transitioning pediatric patients to adult care is increasingly recognized as more children with chronic diseases are living to adulthood. The aim of this study was to investigate the current state of provider perceptions across disciplines regarding transition of pediatric patients to adult care. Focus groups made up of providers of various roles and experience levels were conducted. A total of six major themes were identified. We conclude that pediatric providers share common concerns about transitioning pediatric patients to adult care. We reinforce many of the issues raised in the literature and also discuss a sense of professional ego that was identified as a barrier to successful transition, which is not widely reported in other studies.
Health care providers across disciplines increasingly recognize the importance of successfully transitioning our pediatric patients to adult care. A consensus article published jointly by the American Academy of Pediatrics, American Academy of Family Physicians, and the American College of Physicians, Transitions Clinical Report Authoring Group (2011) calls for transition planning to become a standardized part of care provided to all pediatric patients. This can be a daunting task for the generally healthy pediatric population, let alone for children coping with chronic disease. A position paper from the Society for Adolescent Medicine appropriately states that "many adolescents with chronic conditions are at higher risk than peers for unnecessary dependency, developmental difficulties, and psychosocial delay" (Rosen, Blum, Britto, Sawyer, & Siege, 2003, p. 309). However, the time of transition can also be seen as an opportunity. The same paper goes on to suggest that a successful transition process can help to enhance autonomy, responsibility, and self-reliance.
The recognition of the importance of transition has prompted a growing body of literature that examines patient and provider experience through the transition process. The hope is that the information gathered from these studies will eventually guide the creation of objective criteria for transition programs. Much of the current literature is devoted to examining patients' lived experiences or provider perceptions at the physician level. However, there are fewer studies that report the consensus opinion of the health care team as a whole.
In pediatrics in general, and particularly at our large tertiary care pediatric institution, we take a multi-disciplinary, family-centered approach to disease management. As a result, multiple providers are often involved in the care of our patients we are trying to transition to adult care; these include physicians, physician assistants, nurse practitioners, nurses, and social workers – the disciplines at our institution that are directly responsible for transitioning the patients from pediatric to adult care. We recognize the importance of each team member in the success of our patients, and thus, the importance of including all team members in the effort to improve transitional care. To this end, we expound on a previous survey study at our institution (Fernandes et al., 2011) by conducting descriptive focus group analysis to assess provider experience in transitional care across discipline and role.
Abstract and Introduction
Abstract
The importance of successfully transitioning pediatric patients to adult care is increasingly recognized as more children with chronic diseases are living to adulthood. The aim of this study was to investigate the current state of provider perceptions across disciplines regarding transition of pediatric patients to adult care. Focus groups made up of providers of various roles and experience levels were conducted. A total of six major themes were identified. We conclude that pediatric providers share common concerns about transitioning pediatric patients to adult care. We reinforce many of the issues raised in the literature and also discuss a sense of professional ego that was identified as a barrier to successful transition, which is not widely reported in other studies.
Introduction
Health care providers across disciplines increasingly recognize the importance of successfully transitioning our pediatric patients to adult care. A consensus article published jointly by the American Academy of Pediatrics, American Academy of Family Physicians, and the American College of Physicians, Transitions Clinical Report Authoring Group (2011) calls for transition planning to become a standardized part of care provided to all pediatric patients. This can be a daunting task for the generally healthy pediatric population, let alone for children coping with chronic disease. A position paper from the Society for Adolescent Medicine appropriately states that "many adolescents with chronic conditions are at higher risk than peers for unnecessary dependency, developmental difficulties, and psychosocial delay" (Rosen, Blum, Britto, Sawyer, & Siege, 2003, p. 309). However, the time of transition can also be seen as an opportunity. The same paper goes on to suggest that a successful transition process can help to enhance autonomy, responsibility, and self-reliance.
The recognition of the importance of transition has prompted a growing body of literature that examines patient and provider experience through the transition process. The hope is that the information gathered from these studies will eventually guide the creation of objective criteria for transition programs. Much of the current literature is devoted to examining patients' lived experiences or provider perceptions at the physician level. However, there are fewer studies that report the consensus opinion of the health care team as a whole.
In pediatrics in general, and particularly at our large tertiary care pediatric institution, we take a multi-disciplinary, family-centered approach to disease management. As a result, multiple providers are often involved in the care of our patients we are trying to transition to adult care; these include physicians, physician assistants, nurse practitioners, nurses, and social workers – the disciplines at our institution that are directly responsible for transitioning the patients from pediatric to adult care. We recognize the importance of each team member in the success of our patients, and thus, the importance of including all team members in the effort to improve transitional care. To this end, we expound on a previous survey study at our institution (Fernandes et al., 2011) by conducting descriptive focus group analysis to assess provider experience in transitional care across discipline and role.
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