Surveys of pediatricians indicate that finding time to provide adolescents with appropriate guidance for their health care issues is a significant concern. Within pediatric cardiology programs, the guidance around lifestyle and health care is often provided by allied health professionals, but these resources are stretched thin.
One of the most serious challenges facing doctors and patients is the lack of funding for case management that spans the period of transfer. Many of the problems faced by young people – particularly those with chronic disease – relate to financial and psychosocial issues. Although most states provide funding to support advanced practice nursing and social services to pediatric programs, this support does not exist in the adult health care system except in the most extreme cases. Successful transfer requires not only a smooth takeoff, but also a secure landing. These resources must be developed for at least the 20-something population to ensure continued access to the appropriate health care providers.
My advice to clinicians is to start before the hormone surge. Preteens are often the most receptive. It's helpful to begin the conversation with the patient and family as soon as possible, and to repeat it often.
ROBERTA G. WILLIAMS, M.D., is a pediatric cardiologist at Children's Hospital in Los Angeles. She is a member of the committee that developed the statement. She reported that she had no financial disclosures.
