Chronically ill children also grow up

Transition: When chronically ill children grow up

05/10/2014

In the past, many chronically ill children often died prematurely. Thanks to medical progress, they are often getting older nowadays; This reveals a gap in the medical care. A relatively young field of medicine is seeking better care: transition medicine.

27 percent of adolescents suffer from chronic diseases
About 27 percent of 12- to 18-year-old children and adolescents suffer from a chronic illness; this was stated by the President of the Professional Association of Paediatricians, Dr. med. Wolfram Hartmann, last year. When chronically ill people grow up, doctors are not always up to the task. As a rule, pediatricians pass their patients on to adult doctors when they reach the age of 18. There are often gaps in questions that are more complex to answer in people with chronic conditions such as asthma, diabetes or CF (CF), such as sexuality, career choice or the desire to have children. In addition, in adults often new health complications are added, such as hypertension, osteoporosis or joint disease. „These patients need better care in adult medicine“, said Silvia Müther, board member in the German Society for Transitional Medicine, to the news agency dpa. Transition medicine is the transition from child-centered to adult-oriented health care.

Many pediatricians are overwhelmed
Frequently, patients died in the past before becoming adults when they suffered from certain chronic illnesses. For example, in the hereditary metabolic disease cystic fibrosis, also called cystic fibrosis (CF). According to the report „Quality assurance cystic fibrosis“ By 2011, however, the life expectancy of such patients has increased enormously. While less than two percent of them were born about 35 years ago, today they are just over half. On average, they reached the age of 40 in 2011. A survey conducted by the Cystic Fibrosis Project found that nearly 40 percent of adult CF patients continue to be cared for in Paediatrics. The pulmonologist Carsten Schwarz from the CF center of the Berlin Charité said that many pediatricians are overwhelmed and that adult physicians are often not sufficiently familiar with the rare diseases.

Need for transition medicine is here
As the chairman of the German Society of Internal Medicine, Michael Manns explained, there is a need for transition medicine. „The pediatricians themselves approach internists. They want the caregiver to change“, so the expert. The pediatrician and the adult surgeon should spend two years looking after the patient, my transition specialist. Among other things, this will be tested at the Christiane Herzog CF Center at the Frankfurt University Hospital. There are adult doctors part of the team and therefore adolescent patients do not have to suddenly switch to foreign doctors. Christina Smaczny, senior physician at the Frankfurt CF outpatient clinic, said that such structures should be financially supported. Currently, the centers survived only through donations. She believes it makes sense to include the costs as a precaution firmly in the program of health insurance. However, the association of statutory health insurance funds, GKV, sees this differently: „These problems are not solved by more money, but by a better cooperation between the doctors“, a spokesman said.

Everything is faster in adult medicine
In adult medicine many things are different than in pediatrics. „Everything is much faster“, says Berlin-based pediatrician Silvia Müther, who is on the board of the German Society for Transition Medicine. It is often difficult for adolescents to take responsibility without their parents alone. Also the head of the Department of Pediatric Endocrinology and Diabetology at the University of Duisburg-Essen, Prof. Dr. med. med. Berthold P. Hauffa, made a similar comment last year: „In adult medicine, many young people enter a whole new world. In paediatrics they were accustomed to accepting the advice given by the pediatrician together with their parents and simply trusting the doctor's treatment prescriptions.“ But it is still a long way to a nationwide better and more structured transition. (Ad)