The role of general practitioners in transitioning adolescents with chronic conditions to adult health care

Abstract

General practitioners (GPs) play a key role in ensuring continuity of care for adolescents and young adults (AYAs) with chronic conditions (CCs). However, their involvement during the transition from pediatric to adult care remains limited, contributing to unsuccessful transitions. The purpose of this study is to explore the role of GPs during transition by analyzing their involvement in the care of various CCs. The study involved GPs of 112 AYAs treated in a children's hospital in Paris for CCs (diabetes mellitus, inflammatory bowel disease, epilepsy, sickle cell disease), transferred to adult care between 2017 and 2018. The study consisted of two parts: (1) Quantitative analysis combining retrospective data from Electronic Health Records (pathology, comorbidities, social history) and a phone survey of GPs (role in transition, factors facilitating their involvement); (2) Qualitative analysis (longer surveys with 27 GPs) exploring their experiences and expectations in communicating with hospitals about transition. Fifty percent of AYAs were registered with a GP during the transition, and fewer than 20% of GPs were involved in the care of their CC. GPs were more involved in cases of CC instability. According to GPs, their roles included identifying care disruptions, referring to adult services, facilitating coordination, ensuring continuity of care, providing primary care services, and offering psychological support. In conclusion, although few GPs were involved during the transition; most considered their involvement essential for its success. To improve transitional care, it is crucial to inform and actively involve GPs. These results suggest the need to improve cooperation between hospitals and GPs. What is Known: • General practitioners (GPs) have the potential to play a pivotal role in the transition of adolescents and young adults (AYAs) with chronic conditions (CCs) to adult healthcare systems. • Despite this potential, GPs are rarely involved in the transition process, leading to unsuccessful transitions, characterized by loss of follow-up and increased morbidity and mortality. What is New: • Few GPs were involved in managing the CC of AYAs during transition, although their involvement was more common during periods of CC instability; indeed, GPs believe their role includes providing primary care and psychological support, as well as coordinating care and identifying disruptions, but they face challenges due to communication barriers with hospitals. • Recommendations to enhance GP involvement include implementing structured protocols, improving communication pathways between primary and secondary care, and providing targeted training to strengthen their role in facilitating successful transitions.

Keywords: Adolescent health; Care coordination; Chronic condition; General practitioner; Primary care; Transition to adult care.