(From the November 2015 Issue of PediatricsOnline)
The transition from adolescence to young adulthood is difficult for any person, but for individuals with a chronic illness such as diabetes, the transition from pediatric to adult care can be intimidating. The gap in most programs between pediatric care and adult care is well recognized, and the Section of Endocrinology at Nationwide Children’s has been working for more than three years to bridge this gap. In December 2014, Nationwide Children’s embarked on a new initiative to provide the support and education needed to ease the transition to adult care for patients with diabetes. The Young Adult Diabetes Transition Program is continuing to grow, with weekly transition clinic sessions now in place.
The program has a unique approach to transition with respect to its focus on patient and family readiness and its innovations to increase provider awareness and preparedness.
As part of planning for the clinic, the team used a multilevel questionnaire to test transition readiness in patients, families and providers. As expected, the results revealed that patients and families had poor levels of readiness. More surprisingly, there was a poor level of transition readiness even at the provider level. The transition program used this information to address the problem of transition readiness from all angles including improving patient and family education and enhancing provider awareness.
“Transition is not a one-day process that can be tackled during a single point of care,” says Manmohan K. Kamboj, MD, interim chief of the Section of Endocrinology at Nationwide Children’s. “Providers should begin discussing the transition process with patients aged 16 years and older. Once they are ready, the patients can take charge of the management of their chronic illness and be transitioned to adult care.”
“Within the clinic we assess readiness to transition and foster confidence, self-management and self-advocacy skills,” says Bethany Glick, a medical social worker in the transition program. “Role play techniques are utilized to assist patients in planning for their first visit and to speak confidently about their diabetes and care needs.”
Some specific areas of focus are:
Anticipatory guidance and motivational interviewing with goal setting are provided throughout the transition planning process. A transition notebook, containing resources and information about diagnosis and treatment history, is provided for patients to bring to each appointment. They can also use this notebook for visits with the adult provider.
In the final stages of the transition process, when both the provider and the patient are ready, the patient begins to meet with the adult provider at the pediatric clinic, maintaining the same environment in the setting of a new provider. After one to three visits, once the patient is comfortable with the new provider, he or she can be transferred to the adult clinic at The Ohio State University Wexner Medical Center or an alternative office or provider. The individualized approach of the transition program team enables providers to adjust the timing and process to meet the needs of each patient’s unique situation.
In addition to providing the support and education that transitioning patients with diabetes need now, the transition program is also developing better methodologies for transition preparedness and establishing plans to aid patients in the future. The plan is to follow these patients for at least two years after they transition to obtain and integrate feedback from providers and patients who have participated in the program.
To date, the transition program for young adult diabetes management has been well received by patients and providers alike, and Nationwide Children’s looks forward to growing this exemplary program in the years to come.