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Transition Medicine
In 2001 there was a joint consensus by the ACP-AIM, AAP and the AAFP that adolescents and young adults with chronic illnesses need appropriate transitioning of their health care from pediatrics to the adult health care system. Many illnesses once considered to be confined to childhood must now be thought of as disease that begins in childhood but continues into adult life. The numbers of children and adolescent with chronic medical conditions has increased in the last twenty years primarily due to the advancements in medical sciences. It is estimated that approximately 30 percent of adolescents have at least one chronic illness or disability, and one third of these conditions are moderate to severe. Presently 90 percent of all children with disabilities will live beyond 20 years of age.
Each year in the United States nearly half a million children with special health care needs cross the threshold into adulthood. The median age of survival for a child with the diagnoses of cystic fibrosis is 33 years. It is estimated that there is one million adults in the United States with congenital heart disease (420,000 who have moderate to complex disease) and that number continues to increase at a rate of 5 percent per year. One out of every 640 adults between the ages of 20 and 39 has survived childhood cancer. Many of these patients will need to be followed indefinitely by an adult health care provider that not only knows how to take care of the chronic illnesses they have suffered from their cancer treatment, but also understand that many of them are at risk for early cancers of adulthood such as breast cancer in the survivor of childhood sarcomas.
Transition Medicine Clinic
Dr. Cynthia Peacock, Medical Director
Dr. Hilary Suzawa, Assistant Professor
 In January 2005, Baylor's Combined Medicine-Pediatric Program started a Transition Medicine Clinic with the goal of delivering a medical home to this special population of patients and assisting them and their families with the transitioning of services from the pediatric-subspecialist to the adult-subspecialist. Med-Peds physicians are particularly suited for this role as they are trained to take care of children, adolescents and adults with chronic illnesses. With the help of the Azzam Grant, social worker support started in January 2006. Presently the clinic is taking care of patients with diagnoses such as spina bifida, sickle cell disease, congenital heart disease, autism, down syndrome, cerebral palsy, and survivors of childhood cancer. Ongoing collaborations are in place with Texas Children's Hospital, Shriner's Hospital, Harris County Hospital District and their Adolescent Medicine Clinic, and the City of Houston. Our location is in one of the largest academic medical centers in the country which will enables us to train primary health care providers in the specific expertise needed to deliver age-appropriate health care services to adolescents/young adults who have chronic diseases or disabilities of childhood. Additionally we have become a resource for the community on transitioning of the youth with special health care needs. For more information about the Baylor Transition Medicine Clinic please contact us at 713-798-0199.
Texas Adult Congenital Heart Center
Dr. Wayne Franklin, Medical Director, 713-798-2545
Dr. Richard Friedman, Executive Director, 832-826-5639
Mickie Minor, RN, Nurse Coordinator, 713-798-2545
www.tachcenter.org
Since the first operation for congenital heart disease in 1944, there have been many advances in the field of cardiology. Up until that time, most children with severe congenital heart disease (CHD) did not survive. Due to advances in congenital heart surgery, cardiac catheterization, non-invasive imaging, and critical care, the majority of these children now reach adulthood. In fact, it is now estimated that the number of adults with CHD exceeds the number of children with heart disease and there are over 1 million adults with CHD in the United States alone.
Nonetheless, many of these adults with CHD are not receiving care in centers that specialize in this field. These patients span two fields—pediatric cardiology and adult cardiology—subspecialties that have traditionally been completely separate. In 2004, Baylor College of Medicine, Texas Children’s Hospital, the Texas Heart Institute, and St. Luke’s Episcopal Hospital collaborated to develop the Texas Adult Congenital Heart (TACH) Center. This center of excellence aims to provide outstanding cardiac care to adolescents and adults with CHD. We know that the transition from the pediatric cardiology setting to adult cardiology is extremely important, especially since the patient and their family have often been at a pediatric hospital for their entire life. By using a combined approach with both pediatric and adult staff, we strive to make this transfer of care a unified process that will ensure optimal health care for the rest of the patient’s life.
To schedule an appointment or referral to the Texas Adult Congenital Heart Center, please call the Baylor Clinic at 713-798-2545. Please ask for the Adult Congenital Heart Center. For new patients to the Texas Medical Center, please bring any prior cardiology medical records.
“Teen Transition Night” is on Wed 12/5 at Texas Children's Hospital for the teenage congenital heart patients (16-18yo). Call above phone number for more information.
Texas Children’s Cancer Center Long Term Survivor Clinic
Dr. ZoAnn Dreyer, Medical Director, 832-822-4207
Dr. Hilary Suzawa, Assistant Professor, 832-822-4242
Gaye Hamor, Program Coordinator, 832-822-4727
During the past 20 years there have been great advances in the care of pediatric cancers. The overall cure rate of children with cancer approaches 80%. It is estimated that by the year 2010, one in every 250 adults under age 55 years will be a childhood cancer survivor. The Texas Children’s Cancer Center (TXCCC) Long Term Survivor Clinic is dedicated to preserving good health through routine follow-up and continuing education of childhood cancer survivors. Survivors are evaluated every 1-2 years in order to detect early signs of delayed side effects or “late effects” of previous cancer therapies including surgery, chemotherapy, and radiation. Currently the Long Term Survivor program follows approximately 1,000 survivors.
The TXCCC Long Term Survivor Clinic staff sees patients who were treated at Texas Children’s Hospital and also patients who received cancer treatment at other institutions. Visits in Long Term Survivor Clinic begin when a survivor has been off therapy for at least two years and is at least four years from diagnosis. Follow-up visits continue life-long. Both children and adults are seen at the TXCCC Long Term Survivor Clinic. The clinic is staffed by pediatric and internal medicine specialists.
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For new patients to be seen at the clinic a referral from the treating physician is preferred however it is not required. Patients and families can call and self-refer to the Long Term Survivor Clinic directly. Questions concerning follow-up appointments as well as becoming a new patient can be directed to Gaye Hamor, Long Term Survivor Program Coordinator, at 832-822-4727. Patients currently followed in the Long Term Survivor Clinic can arrange follow-up appointments by calling 832-822-4240.
Please note that return patient appointments are generally made a minimum of 6 weeks in advance to provide ample time for a care plan to be developed and appropriate screening and testing appointments to be scheduled. New patients should call a minimum of 10-12 weeks in advance to allow time to obtain and review prior records of therapy.
Adult Cystic Fibrosis Clinic
Dr. Marcia Katz, Medical Director
Suzanne Cumming, RN, Clinical Coordinator, 713-798-2686
Carolyn Wheeler, RN, Clinical Research Coordinator, 713-798-2687
Progress in CF life expectancy and quality of life can be attributed to more aggressive treatment, close monitoring of sufferers, and quarterly visits to CF care providers. Recent 2005 data from the Cystic Fibrosis Foundation shows the mean age of survival has increased to 36.8 years. In a generation’s time, that expectancy may go to 40. In 1957, the average patient died by age 3.
As the survival rate of people with cystic fibrosis continues to improve, there are increasing numbers of adults with CF. As people with CF age, they often present with more "adult specific" health issues such as CF related diabetes, osteoporosis, fertility and reproductive issues, and cardiac related problems such as hypertension. Adults with CF also have different non-medical issues such as education and career planning, health insurance, relationship issues, disability, and end of life and transplant issues. It is appropriate that care of adult individuals (with or without CF) should be delivered by a physician trained in adult care. Developing an Adult CF program that cares for and assists adults with CF is a priority for the CF Foundation as well as this CF Care Center.
Over the last 13 years, the Baylor College of Medicine Adult Cystic Fibrosis Center has seen a rapid growth in its patient population. These patients include those transitioned from the pediatric pulmonary center at BCM as well as those from other CF centers nationwide. However, it also includes many patients who have been newly diagnosed with CF as adults. The BCM Adult Cystic Fibrosis Center is a vibrant, dedicated academic clinical and research practice. The program’s multidisciplinary approach is geared toward assisting the adult CF patient in incorporating their chronic illness and its demanding regimen into their daily lives, allowing them to live at an independent level that is both gratifying and fulfilling. The Center is housed in the Baylor Clinic. Patients requiring inpatient services are admitted to The Methodist Hospital
The needs of adult CF patients are different from those of children who suffer from the disease. Care may include such psychological issues as autonomy, employment, reproductive support, organization, and counseling. Their physical well being may require aggressive chronic respiratory care programs, management of diabetes, osteoporosis, biliary and gastrointestinal complications, and chronic pain.
In response to this growth in adult CF patients and their special needs, BCM expanded to become a multidisciplinary team that includes clinical and research nurses, a social worker, dietitian, respiratory therapists, physical therapist, chaplain, pharmacist, hospital-based patient advocate, case managers, and a hospital-based microbiologist. Multiple subspecialties now are involved in the program including Otorhinolaryngology, Endocrinology, Gastroenterology, Thoracic Surgery, Psychiatry, Maternal-Fetal Medicine, and Pain Management. In addition, BCM has a very active Multiple Organ Transplant Center that is involved in evaluation and management of CF patients referred for lung transplantation.
Marcia Katz, M.D., Assistant Professor of Medicine at BCM, is the medical director of the Adult CF Program. Suzanne Cumming, RN is the clinical Coordinator of the program and Carolyn Wheeler, RN is the clinical research coordinator.
The Center is located on the 12th floor of the Baylor Clinic. Clinic hours are Monday 9am-12 pm and Wed 1 pm to 4 pm. Appointments can be made by calling 713-798-2400. In addition Ms. Cumming can be reached at 713-798-2686 and Ms. Wheeler at 713-798-2687.
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