Too old for the pediatrician – what to do?

The “Rhine-Main Transition Program” in Darmstadt helps chronically ill young people throughout southern Hesse to find an adult doctor.

Natalie Förster (right) and Regina Akelbein know how to find a doctor.
(Photos: dpa / Hans Dieter Erlenbach)

SOUTH HESSEN – What happens when young people with chronic illnesses grow up – and are no longer allowed to go to their long-time pediatrician? You need to find a new doctor. It doesn’t always work. Many fall through the net. The supra-regional “Rhine-Main Transition Program” tries to help them in this difficult phase of life.

The 17-year-old Tanja suffers from a painful and chronic bowel disease. She has to take medication for the severe inflammation on a regular basis. She receives almost no support from her family, and school is not going very well either. “She is overwhelmed with the whole situation and now has to find a specialist who will treat her further,” says Regina Akelbein from the Princess Margaret Children’s Clinic in Darmstadt. The case manager’s job is to support Tanja. She talks to her on the phone regularly, arranges contact with the health insurance company, provides information, provides information and tries to motivate her.

Transition is called the transition from pediatric to adult medicine. As a rule, it happens between the ages of 18 and 21 that the health insurance companies no longer cover the costs for treatment by the pediatrician.


In purely legal terms, the Rhine-Main transition program is a subsidiary of the Berlin transition project, which looks after chronically ill young people aged 16 and over. Further information and contact: (ine)

“It is a phase of life in which there is a lot going on and 1000 new tasks come up,” says Senior Physician Natalie Förster. Graduating from high school, finding a job, falling in love, cutting the cord from their parents: many young people find their own illness a nuisance in the growing up phase, some are simply overwhelmed by it. If you suddenly stop taking medication because your pediatrician is no longer allowed to prescribe it, this can lead to health complications and even be life-threatening.

The “Rhine-Main Transition Program” has been in existence for two years. It was started on the initiative of Natalie Förster and her colleague Andreas Krahl and is based at the Darmstadt children’s clinics. The team works nationally with other clinics and practices. There are currently 82 patients in the program who are being looked after by two case managers. “We have patients with inflammatory bowel disease and diabetes,” explains Natalie Förster. The aim is to gradually expand the program to include other diseases.

What makes the work of the team enormously difficult is the problem that it is extremely tedious to find a doctor for chronically ill patients who will treat them further. “Seriously ill young people often have a long history of illness behind them, they are not yet grown up and need more support,” says Natalie Förster. The discussions with the young adults are not sufficiently remunerated by the statutory health insurances, so it is extremely unattractive for the practices to care for these patients. In addition, many specialized diabetological practices are overcrowded. Personal contacts are therefore priceless for the transition program. “We are well connected in the Rhine-Main area. That is our strength, ”says Natalie Förster.

Training and advice are offered: How do I find a doctor? What information do I have to pass on? Who will issue me a severely handicapped ID? Among other things, contracts have to be negotiated with the health insurance companies to cover costs, because the transition is not included in the standard care.

The need is there, the senior doctor concluded. The team is therefore also in the process of expanding the network with committed internists and paediatricians. “This is not an automatism, a standardized service and not a sure-fire success,” says Natalie Förster: “We’ll stay tuned”.


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