Pediatrician and adult doctor in one visit. There is a proposal

The Ombudsman has appealed to Health Minister Jolanta Sobierańska-Grenda regarding the transition of minor patients with chronic diseases from pediatric to adult care. As Marcin Wiącek points out, this is one of the still under-regulated elements of the health care system.

"This is a key, and still insufficiently regulated, element of the health care system. The lack of consistent, uniform and universal rules for the transfer of patients with chronic diseases leads to the risk of treatment interruptions, worsening prognosis and additional organizational burdens for both patients, their families and healthcare providers," the Ombudsman points out.

The problem affects many areas of medicine, but, as the RPO points out, it is particularly pronounced in the case of patients requiring long-term, highly specialized treatment.

Cystic fibrosis - the best organized model

In the Ombudsman's opinion, the relatively best-organized transition model currently functions in cystic fibrosis. The pediatric centers plan the transfer of the patient in advance, information sharing and cooperation of medical teams are ensured, and the transfer takes place both vertically and horizontally when the patient changes residence. At the same time, the RPO notes the significant limitations of this model. - However, the shortage of specialized centers and their capacity remains an important constraint, justifying the creation of new facilities or strengthening the capacity of existing ones, the letter to the Health Minister reads.

Pediatric oncology: growing number of adult patients

A much more difficult situation applies to pediatric oncology. As the Ombudsman notes, the number of adult oncology patients is growing dynamically, and some adult patients, treated since childhood, prefer to continue their care in pediatric centers. - In practice, the National Health Fund approves continuation of treatment in pediatric centers, the Ombudsman points out. At the same time, a high percentage of children requiring further treatment or long-term post-treatment supervision persists, which, according to the Ombudsman, requires clearly defined and predictable pathways for transfer to adult care.

Rheumatology: risk of discontinuation of therapy

In rheumatology, the problem of transfer of care is multifaceted and includes not only medical, but also social, psychological, legal, organizational and financial issues. A key goal is to ensure continuity of treatment beyond the patient's 18th birthday, especially in patients who have achieved remission during their developmental years. The RPO stresses the importance of timely cooperation between pediatric and adult centers - at least 12 months before the planned transition - and full transfer of medical records. - The lack of uniform rules and insufficient cooperation between pediatric and internal medicine rheumatology promotes discontinuation of therapy, which is one of the greatest risks for this group of patients, the Ombudsman alarms. In this context, the Ombudsman points to the need for the dissemination of the transition chart for patients with a diagnosis of juvenile idiopathic arthritis, developed by the Polish Society of Rheumatology.

Neurology: the most complex process

Transfer of care in neurology is among the most complex processes, according to the RPO. This is due to the diversity of disease entities, the large number of patients treated under drug programs and the significant group of patients with rare diseases. - It is necessary to develop standards for transferring patients between pediatric and adult neurology with the participation of the Ministry of Health, the National Health Fund, national consultants, scientific societies and patient organizations, Marcin Wiącek stresses. The spokesman also draws attention to financial problems related to drug programs, differences in the quota system between pediatric and adult centers, and the lack of opportunities for formalized, joint patient transfer.

"There is a lack of opportunity for a pediatric neurologist, an adult neurologist and the patient and their caregivers together to be able to meet and discuss what care should look like," - he points out.

Among other things, the RPO proposes the introduction of a joint visit model - inpatient and teleportation - which could be billed simultaneously by both centers.

Call for systemic action

The Ombudsman points to the need to implement systemic solutions.

"Systemic measures are needed to ensure a smooth and safe transition of patients from pediatric to adult care, without interruptions in treatment or loss of continuity of specialty care." - he stresses.

The RPO has asked the Health Minister to present her position on the issue, including information on the actions taken and the ministry's plans for the coming period.

Source: RPO