Planning For Adult Practices

A Recommended Approach to the Young Adult with Growth Hormone Deficiency Transitioning to Your Adult Endocrinology Practice

Background for Transition Visits

A patient transitioning from Pediatric to Adult Endocrinology is a special situation. A team approach can be very effective.

The patient is not yet fully initiated into the “adult model” and may require assistance and support.

Parents should be allowed to attend appointments if the patient desires, especially initially. It is recommended that the patient complete a visitor information form to inform the new provider who, if anyone, can attend appointments. Consider asking the patient to sign a form allowing the healthcare team to communicate with the patient’s parents.

Extra consideration in scheduling and confirming the appointment may be necessary.

The patient may also need assistance with:

• The “unknown” of a new facility (directions, parking issues, etc.)
• Insurance issues
• Expectations for what to bring to appointment:
  
  • Insurance card
  • Paperwork from former pediatric endocrinologist that includes prior laboratory tests and treatment regimens.
  • Forms for the new physician (online, mailed, etc.)
  • List of medications or actual prescription bottles

The new healthcare team should greet the patient with the awareness that s/he is transferring care and provide support and assistance with the check-in process and paperwork.

• Confirm contact information for the patient, ask about her/his preferred name, and how s/he prefers to be contacted (cell phone, text, or email, depending on practice situation).
• If you have a “Welcome to the Practice” guide, consider providing this information to your new patient

The First Encounter: Allow Ample Time

Review HIPAA and determine if parents/others are permitted to receive/hear information about the transitioning young adult.

Review contact information during office hours and for evenings/weekends in case questions arise or for any urgent management issues.

Review the clinical summary with the patient or, if the patient is transitioning without a summary from her/his prior physician, cover the items on the clinical summary during the history process.

• Pay special attention to anxiety, fears, substance abuse, coping, and family stressors
• If the patient receives glucocorticoid therapy, does s/he know the concept of stress dosing? Does the patient have a written “protocol” to manage these situations and when to call for additional care? Does the patient wear a MedicAlert™ identification bracelet or necklace?

Ask about any concerns or questions: If you have a fact sheet on the topic of interest, consider providing it to the patient.

Discuss care plan for ongoing follow-up:

• Discuss expectations of how an 'adult' clinic will work in the future (how the patient can get the most out of the visit).
• Discuss how to handle interim questions–Crisis and Non-urgent (When do you want the patient to call? With whom should they speak–staff, nurse, physician? What is the best way to communicate?)
• Let the patient know if there is a specific urgent care/ER/hospital in which the physician works and assess if it is covered by the patient’s insurance.
• Discuss where to go to have lab tests performed.
• Assess need for/willingness for any additional education.