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Transitions of Care Medicine


Learn how and when a child moves on to adult medical care.


TransitionsTouroWhen Andrew Siegel, M.D., was going through his residency, he observed older teens in an autism clinic working on behavioral issues. He was captivated by the process but surprised by how quickly it concluded.

“They ‘graduated’ them at 18 and they still had a lot of work to go,” Dr. Siegel says. “But they would send them on their way and these patients just got lost …. I remember thinking, ‘These patients badly need somebody to take over their care.’”

The experience directly inspired his decision to focus his Internal Medicine-Pediatrics training on transitioning children to adult medical care.

What is transitions of care medicine?
Transitions of care medicine, Dr. Siegel says, is when a child — usually 14 or older from a healthy population — doesn’t want to see a pediatrician anymore and is ready to move to adult medical care. Another huge element of transitions of care includes older pediatric patients, some well in to their 20’s, who have congenital diseases or childhood illnesses like cancer or diabetes and have been seen by their pediatricians for decades but need to move on as manifestations of their condition progress to an adult level.

How is Touro focused on transitions of care?
Touro, Dr. Siegel says, is more invested than most. When he presented his idea to spearhead the focus among the Crescent City Physicians group, the answer was an enthusiastic “Yes!” “I’ve just been so overwhelmed about how they’re constantly there for people,” he says. “We never say no to anyone … we’re taking extra time to help these children, so they don’t seem like numbers but actual faces and families.”

Is transitions of care medicine on the rise?
As medical care advances, children with previously life-shortening conditions live longer. Dr. Siegel feels that the need for transitions of care medicine will only increase.

“I think this is going to be the new wave,” Dr. Siegel says. As evidence, he cites one of the newest board-certified specialties: adult congenital heart disease, with which Dr. Siegel cares for adults transitioning from pediatric heart disease specialists. Some specialties are already trained in both pediatric and adult care, and understand the gap. Other diseases have always had good transition care; hemophiliacs in particular have a great model of lifetime care, he says.

“Sometimes those childhood diseases don’t go by the wayside,” Dr. Siegel says. “Sometimes you don’t grow out of it. So transitioning to adult care is important.”

Frequently Asked Questions on Teens Transitioning to Adult Healthcare
(Provided by The National Alliance to Advance Adolescent Health, gottransition.org)

Teaching a teenager or young adult to manage their own healthcare is a rite of passage just like preparing to change schools or learning to drive. Thinking ahead and asking your provider for input can smooth the way in transition.

What is a good age to start thinking about finding an adult doctor?
Ideally at the earliest age that is developmentally appropriate. That varies by family and each child’s personality and medical condition. The earlier you start thinking about transition, the more time you’ll have to plan for all the upcoming changes. It takes time to find a new practice and gain independence.

I like my pediatrician. Why do we have to change doctors?
Training and experience differs from Pediatrics to Adult Medicine. Having a different provider just makes sense — you wouldn’t want your child to have the same math teacher at 17 years old as they did at 8 years old. Your teen may express they no longer want to be in a pediatric environment with babies and toys. Healthcare is a very personal experience, so it makes sense that the transition includes finding a new health provider that can relate to them during this phase of their life.

My child has type I diabetes and has been seeing this doctor for more than a decade.
Children with chronic conditions need adult specialists who can help manage their individual situation for life. Unfortunately, some childhood diseases create adult problems that pediatricians and childhood specialists can’t handle. Your transition might be time-consuming but is extremely important. Consider seeking out a local Med-Peds physician like Dr. Siegel who is a transitions of care specialist focused on bridging the gap between childhood and adult care.

I’m already in a family practice so I don’t need to transition. Or do I?
At an age deemed appropriate by guardians and a physician, a child can start to see the doctor by himself. He can learn to make his own appointments and handle his insurance card. At 18 years old, he is old enough to sign forms and deal with prescriptions. Also, any specialists like a dermatologist or psychiatrist will expect an eventual switch to adult care.

My child is only 10. Do I need to think about transitioning already?
You can begin to encourage healthcare independence at an age even earlier than 10. Have your child sign in when you arrive. Let your child sit next to the doctor. Let them answer (and ask) questions. With each success, you can add another layer of responsibility.

Touro’s physician referral “Find A Doctor” service can also help with physician transition. Children and adults of all ages should receive annual wellness visits. Let Touro make an appointment for you today: (504) 897-7197 or touro.com/findadoc.