From
EUPSA/ERNICA
Transition of Care - A general overview by Silja Kosolove
With Dr. Silja Kosolove
Part of
Diabetes 3 items
Chapter 1 of 8 · Fundamentals
Transfer failures
Introduction and the case against abrupt transfer
Expert statements on this page
No expert statements were drawn from this page.
Host summaries · secondary, not cited in answers
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
If adolescents are left to survive on their own without structured transition, they will not adhere to care in adult hospitals, their health outcomes will diminish, and many will not survive.
Abrupt transfer without transition is more expensive due to emergency admissions and unplanned procedures compared to planned care.
In many countries the age limit from pediatric to adult care has risen and is now most often 18 years.
In Finland the general limit of pediatrics is still 16 years.
When a 16-year-old is transferred to adult care and engages in risky behavior, adult professionals are mostly not familiar with legal requirements of making child protection notifications.
Biological development is just one small part of adolescent development; psychological and social changes occur simultaneously.
Adolescents move from concrete thinking where rules apply uniformly to abstract thinking, though they still feel invulnerable ('you can walk in front of a truck and the truck is supposed to stop').
Illness, nutrition, and stress affect adolescent development and may lead to the developmental conflict being greatest right at the time when young people should leave pediatric care.
The last bits of the human brain to develop are in the frontal lobe, where planning for the future, problem-solving, and emotional and behavioral control are learned.
Emotional centers develop earlier than frontal lobe, so young people have 'a car with really nice transmission but no brakes'—the brakes develop later.
Young people who appear noncompliant, defiant, and risk-taking are simultaneously very insecure, wondering whether they will be loved or find meaningful work.
Medical follow-up can resemble the relationship young people have with their parents, and as they struggle for autonomy they may rebel against medical care.
In many studies, both our own and from other centers, quality of life has always been better when judged by young people themselves than when judged by their parents or carers.
Transfer is simple moving of paper; transition is a process requiring preparation and a welcoming recipient on the other side.
The recommended age to meet patients alone for at least part of the appointment is from age 12.
Treatment advice should be given directly to the patient even if the parent is in the room.
There is growing evidence that single days of coaching for transition have very low or no impact.
There is growing evidence that joint consultations with pediatric and adult teams both present (even via Teams) builds trust and may lead to better outcomes.
WHO has mapped adolescent medicine training availability in Europe; much of Europe is gray (no response), implying training is not happening.
Great discrepancies in treatment plans between pediatric and adult teams should be built into a more uniform approach; this has been a struggle in liver and kidney transplant patients in Finland.
Youth-friendly healthcare must be acceptable, accessible, and affordable to youth.
The most important attitude professionals working with young people need to show is respect; adolescents are very good at sensing whether you respect them.
In adult healthcare during the first couple of years after transition, consultations should be more frequent and longer than for other adult patients.
Young people need one named contact person for questions between consultations; most times they don't call, so workload concerns are unfounded.
From the perspective of general practice, continuity of care is key, with strong evidence for management continuity, information continuity, and relationship continuity leading to better outcomes.
The process of transition cannot be on the shoulders of one single person; it must be a holistic approach in the whole hospital so that when that person retires or falls ill, transition continues.
Two Finnish colleagues described that cognitive skills develop logically but psychosocial skills take a dip during teenage years, with the timing and depth of the dip being very individual.