Transition to adult health care for adolescents and young adults with chronic conditions: position paper of the Society for Adolescent Medicine.

Facilitating a smoother transition for adolescents with chronic health conditions from the child to the adult health care system has been a topic of numerous expert panels, conferences, and policy statements [1–7]. As stated in the original 1993 Society for Adolescent Medicine’s (SAM’s) position paper, “systemic inertia, fueled by insufficient information about transition options and outcomes, helps maintain an outdated status quo” [4]. The goals of an organized, coordinated transition to adult health care for young people with chronic conditions are: to optimize health and to facilitate each young person’s attaining his or her maximum potential. Proactive transition to the adult health care system encourages young people to be successfully integrated into a comprehensive care system to meet their complex needs. The transition must include primary, secondary, and tertiary care with a careful delineation of a financing system that will support a comprehensive care program. There remain numerous questions about many of the basic transition mechanisms. For example, who most needs a deliberate transition plan, at what age should transition planning begin, how should the transfer of medical care occur, what preparation is required, and in what manner should the actual transfer of care take place? One of the most basic questions remains: What are the effective strategies to engage the adult health care system in the care of these young people? Although transition principles have been described and a variety of models have been proposed and implemented, outcome data are still lacking, especially those that would support one model over another. Without a definitive model, the best approach at this time is to advocate for certain principles that would facilitate an effective transition to the adult health care system. Principles of Successful Transition