When is a Pediatric Patient No Longer a Pediatric Patient

Melissa Reider-Demer, MSN, RN, CPNP; Tresa Zielinski, MSN, RN, PCCNP, APN-NP; Sue Carvajal, MSN, RN, CPNP-AC; Kathleen Anulao, MSN, RN, FNP, APRN, BC; Linda Van Roeyen, MS, RN, APN/NP

Disclosures

J Pediatr Health Care. 2008;22(4):267-269. 

In This Article

Background

With advances in treatment of childhood diseases, 90% of children with severe disabilities now survive into adulthood (American Academy of Pediatrics [AAP], 2002). Pediatric HCPs face increasingly complex issues surrounding disease-specific resources, the issue of reimbursement versus acquisition of health insurance, and support services for these patients. Difficulties that arise in transitioning chronically ill adolescents to adult HCPs for primary and specialty care are well documented in the literature (Betz, 1998). Because adult providers may be unfamiliar with the diagnostic course or the care required by these patients, pediatric providers may choose or be called upon to extend their provision of services well into the adult years (Betz, 1998).

Previously, the statements of pediatric health care organizations regarding appropriate transition age were presented only as vague guidelines. In Children Medical Services, Council on Child and Adolescent Health, 1988 defined the age limits of pediatrics to be from fetal life until age 21 years. This concept was subsequently endorsed by the National Association of Pediatric Nurse Practitioners (NAPNAP, 2002). NAPNAP supports the PNP role as a provider of health care for individuals older than 21 years for patients with unique needs or for young adults during the transition to adult health care (NAPNAP).

To guide pediatric practitioners seeking to transition chronically ill adolescents to adult HCPs, the AAP issued the following statement in 2002: "The goal of transition in health care for young adults with special health care needs is to maximize lifelong functioning and potential through the provision of high-quality, developmentally appropriate health care services that continue uninterrupted as the individual moves from adolescence to adulthood." This consensus document has been approved as policy by the AAP and the American College of Physicians (ACP)-American Society of Internal Medicine (AAP, 2002). Health care providers are called upon by the Healthy People 2010 statement to maintain quality age-appropriate care, advocate for health care insurance for those with special needs, and negotiate for appropriate compensation for care (AAP, 2002). The national goals statement for the transition of adolescents with chronic illness lays a solid foundation for advances in the quality of health care as pediatric patients become adults (AAP, 2002).

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