Recommendation 6: Paediatric–adult transition Item What it does Committee recommendation What would be different Why Not an MBS item Better co-ordinated support for An ongoing and sustainable service Current models are funded Patients are transitioning from a adolescents and young adults, who (or funding for a service) should be through grants and charitable paediatric system, where parents Funding of services to have poorer outcomes than other created to provide support for the donations, which may not be and the health care team assume support the care of transplant recipients, including a care of adolescent patients with sustainable and result in variable great responsibility, to an adult patients during the high incidence of the transplant complex kidney disease. services being available across system where they need to become transition from (graft) being rejected (late acute Australia. Clinicians across responsible for their own care—a paediatric to adult rejection episodes). Australia have been searching for shift that can require upskilling. services, particularly for As this issue involves both public sustainable funding for this model They also move from a youth adolescent patients and private systems; both primary for several years, and it remains friendly environment to an adult and with complex kidney and acute care; and the an ongoing challenge. often elderly environment, disease. involvement of non-medical and experience the other healthcare providers such as youth challenges of adolescence. This workers, the Committee leads to them disengaging and recommended that the issue of developing negative health paediatric–adult transition of outcomes like hospital admissions patients with complex kidney and loss of transplants. In the UK a disease be referred to an dedicated service has been shown appropriate government or to prevent transplant failures which body or group, such is beneficial for patients and may as the Council of Australian save $250,000 - $350,000 for each Governments, to be addressed in avoided failure. an appropriate and sustainable way.
Recommendation 6: Paediatric–adult transition Item What it does Committee recommendation What would be different Why Not an MBS item Funding of services to support the care of patients during the transition from paediatric to adult services, particularly for adolescent patients with complex kidney disease. Better co-ordinated support for adolescents and young adults, who have poorer outcomes than other transplant recipients, including a high incidence of the transplant (graft) being rejected (late acute rejection episodes). An ongoing and sustainable service (or funding for a service) should be created to provide support for the care of adolescent patients with complex kidney disease. As this issue involves both public and private systems; both primary and acute care; and the involvement of non-medical healthcare providers such as youth workers, the Committee recommended that the issue of paediatric–adult transition of patients with complex kidney disease be referred to an appropriate government or body or group, such as the Council of Australian Governments, to be addressed in an appropriate and sustainable way. Current models are funded through grants and charitable donations, which may not be sustainable and result in variable services being available across Australia. Clinicians across Australia have been searching for sustainable funding for this model for several years, and it remains an ongoing challenge. Patients are transitioning from a paediatric system, where parents and the health care team assume great responsibility, to an adult system where they need to become responsible for their own care—a shift that can require upskilling. They also move from a youth friendly environment to an adult and often elderly environment, and experience the other challenges of adolescence. This leads to them disengaging and developing negative health outcomes like hospital admissions and loss of transplants. In the UK a dedicated service has been shown to prevent transplant failures which is beneficial for patients and may save $250,000 - $350,000 for each avoided failure.