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Transition Clinic |
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Patients who have suffered from chronic childhood illness benefit from transitioning into an adult program designed to meet their evolving adult needs. There is a substantial body of literature addressing this transition process in congenital heart disease. Programs for adults with congenital heart disease differ from the pediatric model in the following ways:
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- Focus on physical aging: The adult is physically aging rather than physically developing. Adults with chronic illness often age at an accelerated rate physically, leading to early development of multiple adult-type co-morbidities. This is addressed in an adult program.
- Focus on adult-type co-morbidities: These co-morbidities are often different than pediatric chronic issues. For example, the management of diabetes, renal disease, systemic hypertension, liver disease, psychiatric illness, and even heart failure and arrhythmias are different in the adult versus the pediatric patient.
- Change in hospital visit dynamics: The dynamics of the visit evolve from a doctor-parent-patient triangle to a horizontal adult relationship. This, of course, should not preclude the inclusion of family members; rather, the relationship should just remain patient-focused.
- Focus on problem-solving strategies: As young people develop, they move from using emotional coping strategies to problem-solving strategies. Chronic illness often interferes with this development and has been associated with depression and anxiety. An adult clinic can focus on, and recognize the importance of developing these strategies.
- Focus on patient education: An adult clinic works to promote the patients? understanding of the major cardiovascular issues, including basic anatomy and physiology of their congenital heart disease and surgical repair/palliation, as well as raise awareness of potential problems they may face in the future with an emphasis on the importance of follow-up, adherence to medical care, and prevention. This also includes:
- Knowing which signs and symptoms are important to watch for.
- Knowing why certain medications are prescribed and the potential side effects.
- Being informed about major generic health issues like sexual health, substance abuse, exercise and nutrition, and insurability.
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