Pediatricians Seen Failing Kids With Asthma in Moving to Adult Care

NEW ORLEANS — Only a minority of teenagers with asthma got substantial advice and assistance from their pediatricians in how to manage their condition as adults, according to a small single-center study reported here.

Young adults surveyed about their experiences in transitioning to adult asthma care mostly got no help from their regular doctors until they reached age 18, if they got any help at all, reported Suzanne Ngo, MD, of Children’s Hospital of Colorado in Denver.

In two cohorts of respondents — one drawn from asthma patients currently under treatment in the University of Colorado health system (n=19), the other being students or staff at the university (n=27), both ages 18-30 when contacted — only about 40% said concepts about the transition were introduced during pediatric clinic visits before age 18, Ngo said at a poster presentation at the American College of Allergy, Asthma, and Immunology annual meeting.

Somewhat reassuringly, few pediatricians did nothing at all. In both cohorts, more than half of respondents said their pediatricians talked to them about self-management, on a regular basis and for dealing with exacerbations.

On the other hand, hardly any respondents said their pediatricians made arrangements with an adult-care physician to take over the individual’s case, either with a referral or handing over the patient’s records.

Although the survey was hampered by small numbers of respondents, one of the more interesting aspects was that the two cohorts differed markedly in their recalled experiences.

The group currently under treatment in the university’s health system (“hospital cohort”) were identified from electronic health records and contacted proactively to participate. Those who were students or staff (“university cohort”) had responded to advertisements seeking participants self-identifying as having asthma.

As one might expect, their histories and sociodemographics were quite different. The university cohort was considerably older (median age 25 vs 21), had more white people (59% vs 47%), and was better educated on average (85% with bachelor’s or advanced degrees vs 21%). About half of the hospital cohort were still on their parents’ insurance, compared with 30% of the university cohort.

Surprisingly, though, 47% of the hospital cohort — again, those with records of being treated at the university — said they currently had no regular asthma provider, and 16% were still seeing a pediatrician. Four-fifths of the university cohort said they had a regular adult-care provider.

Other differences between the cohorts included the following, indicating better transition care for the hospital cohort:

• 79% of the hospital cohort versus 33% of the university cohort said their pediatrician had checked their ability to explain (and thus presumably understand) asthma
• 95% of the hospital cohort versus 56% of the university cohort said the pediatrician had taught them how to manage exacerbations

Both of those had P-values less than 0.01. Other advantages for the hospital cohort that fell short of statistical significance included talks with the patient’s parent or guardian and aspects of regular self-management.

Respondents were also asked to list what they saw as barriers to smooth transition. The hospital cohort found them less daunting than the university group. The latter were dissatisfied with the information they received, and also complained of difficulties in navigating the healthcare system. Many also said they had financial worries and were unused to managing their own care. Also, a fair number noted that they didn’t have asthma symptoms.

Ngo told MedPage Today that, in general, the results reflect poorly on pediatricians, but said their practice burdens may not provide enough time for them to spend with patients on transitioning as opposed to the many other topics that have to be covered. She said pediatricians may need more education on the need to start transition discussions early — ideally, prior to age 14 — and they could do a better job of identifying adult providers to take over the patients’ care.

The problems may be especially severe for patients going to college, she added, based on findings from the university cohort; they may be in special need of clear plans for the transition.