Transition: The Patient in a No-Man´s Land

The need for transition from pediatric to adult health services developed from better survival rates of congenital diseases. Quality of life, Independence, and health preservation are to be considered. Perspectives on transition differ between patients, families, health professional and administrators.

Non-systematic review and discussion of transition dilemas in a structured format.

Medical transition occurs during late adolescence/ early adulthood. Patients are expected to have increased longevity, need lifeterm follow-up and present varying degrees of complexity. Patients' fundamental wishes may conflict with caregivers' considerations. Technical decisions must be balanced, taking into account patient´s social, cognitive, motor and psychological conditions, and the needs of their family caregivers. Difficulties by pediatric healthcare professionals in mastering adult diseases, and challenges encountered by adult-specialized physicians in managing sequelae or ensuring continuity of care for pediatric conditions, are the rule. Patients afflicted by with chronic complex conditions may prove financially challenging. For families, transitioning from from paediatric care to adult-oriented medicine is destabilizing and distressing. The idealization of an unattainable normality is prevalent and detrimental, leading to the abandonment of therapeutic strategies deemed socially undesirable.

Transition care urgently requires planning by health administrators. Patients should be transferred to adult care only after clinical stabilization. Three models of transition have been suggested (direct transfer, protocol and age-driven; permanence under pediatric assistants control with eventual consultation with adult experts and gradual transition, permeated by a period of conjoint assistance). The last format is considered ideal.