. 2016 Nov 16;5(6):R44–R54. doi: 10.1530/EC-16-0028

Table 4.

Factors contributing to successful transitional healthcare.

Disease-specific considerations (GHD, PWS, TS, SGA, CCS)	Generic considerations
• Identify which patients to test for endocrine dysfunction and which would benefit from GH replacement • Decide which stimulation test to use • Use specific disease markers to gauge successful intervention, i.e., IGF-I levels, BMD, lipid profiles, and possibly HbA1c and QoL measures • Aim to improve adult height, normalise body composition, and bone density • Preserve fertility (particularly for patients with TS or CCS) • Determine timing of subsequent follow-up visits once GH therapy is stopped	• Be approachable and welcoming; adolescents like eye contact, facial expressions, friendliness • Make the clinic environment more youth friendly, i.e., relaxed dress code for providers, availability of magazines/television channels geared towards young adults • Permit consultations with adolescents alone, clearly emphasise confidentiality, and tell patients what to expect in age-appropriate terms • Be willing to hear concerns about sexual health, substance abuse and mental health issues • Institute flexible access, i.e., extended clinic hours to accommodate school/job schedules, and use of email/texting/video chats • Avoid having young adults make key decisions at times of excitement or stress (i.e., holidays, final examinations, etc.) • Remember that healthcare is just one of many concerns for the young patient as they are also dealing with education, budding sexuality, separation from parents, navigating friendships, etc. • Engage young adults in self-management education and skills training • Work to establish joint provider sessions involving members from paediatric and adult treatment teams • Utilise a transition coordinator and/or specialised young adult clinics

Disease-specific considerations (GHD, PWS, TS, SGA, CCS)

Generic considerations

• Identify which patients to test for endocrine dysfunction and which would benefit from GH replacement
• Decide which stimulation test to use
• Use specific disease markers to gauge successful intervention, i.e., IGF-I levels, BMD, lipid profiles, and possibly HbA1c and QoL measures
• Aim to improve adult height, normalise body composition, and bone density
• Preserve fertility (particularly for patients with TS or CCS)
• Determine timing of subsequent follow-up visits once GH therapy is stopped

• Be approachable and welcoming; adolescents like eye contact, facial expressions, friendliness
• Make the clinic environment more youth friendly, i.e., relaxed dress code for providers, availability of magazines/television channels geared towards young adults
• Permit consultations with adolescents alone, clearly emphasise confidentiality, and tell patients what to expect in age-appropriate terms
• Be willing to hear concerns about sexual health, substance abuse and mental health issues
• Institute flexible access, i.e., extended clinic hours to accommodate school/job schedules, and use of email/texting/video chats
• Avoid having young adults make key decisions at times of excitement or stress (i.e., holidays, final examinations, etc.)
• Remember that healthcare is just one of many concerns for the young patient as they are also dealing with education, budding sexuality, separation from parents, navigating friendships, etc.
• Engage young adults in self-management education and skills training
• Work to establish joint provider sessions involving members from paediatric and adult treatment teams
• Utilise a transition coordinator and/or specialised young adult clinics

BMD, bone mineral density; CCS, childhood cancer survivors; GHD, GH deficiency; IGF-I, insulin-like growth factor I; PWS, Prader–Willi syndrome; QoL, quality of life; SGA, small for gestational age; TS, Turner syndrome.