Closing the Gap: Youth Transitioning to Adult Care in BC

For a physician, there are few greater joys than successfully extending the life of a child or youth with a chronic condition. Having the opportunity to add years of healthy living to the life of a child speaks to our most basic desire when we enter medicine, and thanks to advances in medical technology, that opportunity has become a reality for many. Today, physicians can more successfully manage chronic conditions in youth, not only cystic fibrosis, but also HIV/AIDS, type 1 diabetes, and some neurological conditions. Indeed, advances in medical technology now mean that approximately 90% of children and youth with complex or chronic illness can expect to reach age 20.

This profound success in extending the life of these youth into adulthood has created, however, created a big challenge: how to successfully transition pediatric patients to an adult care system that never expected to care for them. The challenge extends beyond access to care. The transition between pediatric and adult care systems occurs at the same time as young patients simultaneously leave the school system, enter adulthood, and take on other responsibilities. Managing their health and navigating a complicated health care system is an additional burden during an already-complicated stage of life. Moreover, because these patients have a significant risk of accelerated mortality and morbidity, a successful transition into adult care can be a matter of life and death.

In this policy paper, the Doctors of BC defines successful transition as the provision of uninterrupted, coordinated, developmentally appropriate, and psychologically sound health care to young adult patients as they move out of pediatric care and into the care of an adult health care provider. We outline the population at risk and the dangers associated with poor transition, explore several transition frameworks, examine BC’s success in transitioning and, finally, offer 10 recommendations for the realization of successful transition for young patients with complex or chronic illness. Among the most significant are the recommendations that:

1. Pediatric patients with complex and chronic illness should have, in addition to pediatric care providers, a family physician from birth.
2. Pediatric patients graduating from pediatric care should have individualized transition plans.
3. A method for the identification and ongoing tracking to evaluate successful transition and long-term health outcomes should be developed.

For the full policy paper, please see “Closing the Gap: Youth Transitioning to Adult Care in BC”.