Yesterday, our weekly small group topic "Transitions in Health Care," referring to the process of transitioning pediatric patients with special needs/chronic illnesses from pediatricians to adult providers. The take home was that such transitions are hard and need to facilitated long before the child reaches "adult age" or age 18.
A couple examples of cases used in class: 20 yo Hispanic female with h/o Type 1 diabetes presenting to ED with out of control blood glucose after losing her health insurance at age 18 (why the heck does she have to be Hispanic??). 22 yo college student with h/o ALL treated at age 5 presenting to student health center for routine physical. Her pediatrician back home has been looking out for her before this. What issues need to be considered? How can we facilitate management of conditions that began in childhood in an adult setting?
One of my astute classmates asked at the end: "Why don't pediatricians and the new adult provider pick up the phone and have a 15 minute conversation about the patient?" Duh. Seems like a no-brainer. After all, in inpatient medicine, we have sign-out at the end of every shift, right? Yet, of course, the answer lies in financial incentives: because insurance companies don't reimburse for this, then these conversations just don't happen. Grr... another piece in this frustrating reality of how reimbursement strategies often limit effective healthcare delivery!
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