[Care continuity for patients during transition from childhood to adulthood--the perspective of pediatrician]

Abstract

To promote the effective transition, that is, "the purposeful, planned movement of adolescents and young adults with chronic neurological conditions from child-centered to adult-oriented health care system," we should consider the following requirements in Japan. 1. The transition program must be settled as a comprehensive and individualized system in disease-specific and severity-oriented manners to cover the age-dependent sequelae and developmental issues. 2. We should not regard the patient (family) resistance to transition as a barrier, rather esteem of the personal bond between child neurologist and patient (family) is the key factor to facilitate the long-term follow-up. 3. We must make a system for the participation of various occupational categories (social worker and nurse practitioner, etc.) other than the doctor in the transition program. 4. The child neurologist should take an active part as the specialist of lifelong neurology and coordinator that promotes the transition program.