Barriers to Transition

Abstract

Children with complex health problems require multi-disciplinary care. Using the case of congenital urological disorders as an example, children and adolescents with urinary tract involvement require care by multidisciplinary teams. At some point as adolescents or young adults they are moved to an adult service. This is a transfer from a multiple intervention health model to a single clinician environment during a time coinciding with other major life changing events.

Failed transition from pediatric to adult care negatively affects health outcomes, as it is associated with non-adherence to treatment recommendations and increased hospital admissions. Surrogate markers of the efficacy of transition include the proportion of patients lost to follow-up, inappropriate or preventable hospital admissions and medication or self-management non-adherence rates.

This chapter outlines the issues facing the pediatric care team, the adult services receiving the young person and the adolescent and their family during the transition of care. The aim is to identify current or potential roadblocks that limit healthcare systems successfully addressing the medical, psychosocial, educational and vocational needs of adolescents who live with their lifelong condition. Instead of a process focused on service transition and transfer, the intention is to support a holistic concept of moving young people with congenital disorders into adulthood and independence.