The BCPS had a Specialist Services Committee grant (led by Drs. Aven Poynter and Todd Sorokan) which focused on building supports for community pediatricians who are transitioning patients into adult care as they “age out” of pediatric care.
Besides the development of a new Medical Transfer Summary Form (based on work done by the OnTrac program), we collected and posted Division of Family Practice assists in finding family physicians for transitioning patients (as well as adult specialists). We provided a list of community resources by region, and a set of mental health guidelines.
These mental health guidelines led us to our next SSC funded project. Besides working to increase the uptake of the Medical Transfer Summary Form, we are focusing on transitioning complex patients with mental health disorders as they age out of pediatric care. This project will involve creating up to 10 “straw dog” patients (based on typical patient profiles provided by community pediatricians). Then we will “transition” these patients and see what resources are out there to support them; we know already that this is going to be an issue, so we’ll be looking for solutions that stick. We’ll be working with our Advisory Committee which includes representatives from the Ministry of Health, MCFD and the Ministry of Mental Health and Addictions) to understand what’s already been done in this regard, and what can be done.