2021 Volume 38 Issue 2 Pages 112-122
We retrospectively examined the medical and consultation records of 22 patients to investigate the important aspects of post–transition medical care, the benefits and challenges that come with transitioning from the pediatric to adult departments, and how patients should be transitioned. These patients transitioned from pediatric to adult departments in our hospital after a pediatrician–neurologist transition consultation. The primary diseases were cerebral palsy in 17 cases, Lennox–Gastaut syndrome in 2 cases, and congenital malformation syndrome, Down syndrome, and autism spectrum disorder in 1 case each. Medical care was optimized by reviewing the diagnosis, adjusting antiepileptic medications, and assessing for dysphagia. We advised patients and their families to improve their comprehension of the disease so that they can determine future care policies. With the cooperation of medical social workers (MSWs) and home visit support nurses, we promoted community–based healthcare coordination and reviewed the allocation of social resources for appropriate use of welfare services. The challenges that we found was that the transition from pediatric to adult healthcare required individual support and took time. Interprofessional collaboration with pediatricians, adult clinicians such as neurologists, MSWs, home visit support nurses, and other professionals can improve the transition.
