Transition from pediatric to adult care for diabetic adolescents in the Paris-Ile-de-France area.

Aim. - The purpose of this study was to evaluate the conditions in which di abetic adolescents are transferred from pediatric to adult health care, and to record the opinions of the physicians about this issue. Methods. - A questionnaire-based study was performed among all the pediatri cians in the hospital setting and all the diabetologists from the Paris-Ile -de-France area. Questionnaires from 50 pediatricians and 51 diabetologists were completed (response rate: 68%). Results. - 1) Not enough information was transmitted: a quarter of the diab etologists were visiting for the first time without any information on the adolescent, and only half the pediatricians received feedback information f rom the internists after the first visit. And yet, when considered it was i mportant to be kept informed after the first visit and the following ones. 2) Medical relationships were poor: more than three out of four pediatricia ns and diabetologists had none or very few professional meetings, and two t hirds of them were not aware of the way the others were working. 3) Eighty percent of pediatricians and diabetologists considered that the transfer of diabetic adolescents had to be organised in order to keep the coherence of medical follow-up, to minimise the psychological effects of the transition and to avoid a complete break in the patient follow-up. 4) The expectation s of the pediatricians were: the validation of their previous follow-up thr ough the feedback information from diabetologists and the continuity of the medical follow-up; those of the diabetologists were: to gain the patient's confidence and to master the patient's previous history, in order to provi de a better follow-up. 5) According to the opinion of both pediatricians an d diabetologists, the main errors to avoid were, by the paediatricians, to miss the rime and the preparation of the transfer and, by the diabetologist s, to denigrate the previous pediatric management and to change the insulin regimen immediately. Conclusion. - This study demonstrates a lack of communication between physi cians of pediatric and adult health care centres. But it also underlines th eir recognition of the importance of the transition's stakes and their comm on motivations in order to improve it. (C) 1998 Elsevier, Paris.