This issue is faced by patients with other chronic illnesses of childhood that extend into the adult years, such as congenital heart disease. A smooth transition process requires a close interface between pediatric and adult providers. Patient trust in adult providers to a large degree depends on a vote of confidence in those physicians by the pediatricians. A good working relationship is the best way to create such confidence. Further, the issue of adult care must be developed slowly for both patient and family.
Abrupt transfers are likely to work poorly.
The seeds of the concept that the patient will become an adult and will need new providers should be laid early, beginning even as early as 12 years of age. Our foremost goal as health care providers must be to keep patients in the medical care system. Only then can we execute our second goal, the delivery of true preventative care to patients with sickle cell disease. In this process we must develop programs to assess the psychosocial needs of these young people. Using this information, we can develop specific individual and programmatic interventions.