Improving the transition of adolescents from disadvantaged backgrounds from pediatric to adult primary care providers.

Abstract

BACKGROUND\nThe lack of structured transition interventions for adolescents aging out of pediatric care is associated with poor health outcomes.\n\n\nMETHODS\nWe assessed the effectiveness of a transition protocol that aimed to improve the transfer of adolescents to adult primary care. Chart reviews were conducted on 21- and 22-year-old patients seen 18 months before and after protocol implementation. Completion of an adult medicine appointment scheduled within 6 months from the last pediatric visit was the primary outcome of interest.\n\n\nFINDINGS\nIn pre-implementation period, 20.9% of patients versus 39.3% in post-implementation period were transferred. Transfer was higher in patients who had a dedicated transition visit, had a transition order placed, and were tracked during the transfer process.\n\n\nDISCUSSION\nA transition protocol can increase the number of adolescents who transfer to adult care. Once a patient is ready to transition, a dedicated transition visit is ideal; however, providers should incorporate transition care during any clinical encounter. While an electronic transition order can facilitate appointment scheduling, patient tracking and appointment reminders can help ensure appointment completion. In addition, all clinical staff should receive transition training and clinicians should be frequently reminded about the need to transition their patients. However, even with these efforts to support transition, the majority of patients did not do so, which indicates a continued need to develop and evaluate transition interventions.\n\n\nPRACTICE IMPLICATIONS\nImplementing a transition protocol in pediatric clinics can improve the transition of adolescents aging out of pediatric care and may diminish gaps in medical care that can be associated with poor health outcomes.