1. Adolescent Care Transfer to Transition

2. “I would there were no age between ten and three and twenty, or that
youth would sleep out the rest; for
there is nothing in the between but
getting wenches with child,
wronging the ancientry, stealing,
fighting”.
William Shakespeare

5. Follow-up of adolescent patient
Transfer to adult clinic (crisis situation)
Long-term retention at paediatric clinic
Failure to attend
Discharged

6. Transitional care
“The purposeful, planned movement of adolescents and young people with chronic physical and medical conditions from child-centred to adult-orientated health care systems.”

7. Key Public Health Issues
Obesity
Smoking
Alcohol consumption
Pregnancy

8. Top 10 topics with GP Sex Depression Stress Size/shape
Relationships Drugs
Diet Pregnancy
General health Contraception

9. Health related behaviour
Exercise
Diet
Smoking
Drugs
Alcohol
Sexuality

13. Why give adolescents special consideration
Numbers
Workload
Illness appears/worsens
Mortality
Little concern
Great anxiety
Childhood survivors

16. Paediatric Medicine RBHSC
(Oct 04 – Sept 05)
Age Inpatients Outpatients
(Yrs) (Bed days) New Review DC
% 52% % %
% 42% % %
% % % %

17. Cases notified to N. Ireland register 1989-2003
140
120
100 80
Cases 60 40 20
’03
'89
'90
'91
'92
'93
'94
'95
'96
'97
'98
’99
’00
’01
’02
Year

19. ‘I don’t believe its going to do me any harm at all
‘I don’t believe its going to do me any harm at all. You’re all just trying to scare me. I won’t believe anything you say unless I can meet someone who has had bad things happen to them because of their diabetes’
14 year old male

20. Age versus HbA1c 6 8 12 14 5 10 15
HbA1c (%)
Age at visit

24. Health care services for
Children Adults
Family centred Patient centred
Socially orientated Disease orientated
Informal and relaxed Formal and direct
School/life progress Glycaemic control/
complications

25. Young adult survey 17 – 20 years Privacy and confidentiality
Short waiting times
Informality
Approachable physician
Continuity of care

26. Storm and Stress
The challenge of adolescence is to achieve the desired independence and autonomy, while at the same time, maintaining close and supportive ties with the nuclear family

27. Transition clinics Cystic fibrosis Congenital heart disease
Metabolic diseases
Juvenile arthritis
Diabetes and endocrine

28. Paediatric Conditions Requiring Adult Handover
Hypothalamic/Pituitary Disease
Thyroid Disease, Parathyroid Disease
Polyglandular autoimmune disease, MEN
Congenital adrenal hyperplasia - Addison’s
Adrenarche - PCO, Cushing’s
Insulin resistance
Hypogonadism; Turner’s/Klinefelter’s; Intersex Sporadic endocrine tumour

29. Barriers to good transition
Circumstances
Paediatrician
Patient
Parent

30. Principles of successful transition
1. Transition policy for every paediatric
clinic
Preparation for transition
3. Timing – growth and puberty completed
In good health

31. Principles of successful transition
5. Skill to cope with adult clinic
An identified person in both teams
7. Management links between clinics
8. Evaluation of arrangements

32. Adolescent and Transitional Care Responsibility of the Paediatric Team