We investigated the views of pediatricians and nurses on transition of care for pediatric patients with chronic disease who are about to become adults. Whereas the sample size was small, the targets of the present survey were pediatricians and nurses who were department heads at Japan's leading institutions for child health and development, and as a preliminary report, the opinions of the respondents possibly reflect the principles and practical conditions applying to transition of care in pediatric and adolescent healthcare in Japan.
The survey results showed that three-fourths of the pediatricians and all of the nurses surveyed believed that transition programs are necessary. However, only 22% of the pediatricians and 37.5% of the nurses had established processes in place. Compared with the pediatricians in this study, a higher proportion of the nurses realized the necessity of transition from pediatric to adult healthcare services and had already developed and implemented such programs. Although manuals on transition programs have been published by both physicians and nurses in Europe and the United States, the first manual in Japan was produced by nurses as recently as 2010 . According to the findings of our research, spreading the importance of this issue among pediatricians is necessary for a smooth transition of care.
Both the pediatricians and nurses attached importance to the patient's age, psychological development, and social factors when determining the transition of care. To an open-ended question as to the reason why pediatricians cannot transfer patients to adult healthcare services, many pediatricians reported a shortage of experts in adult healthcare services, and both pediatricians and nurses pointed out the lack of an established professional network covering the transition from pediatric to adult healthcare services. These findings are similar to previous reports from other countries, which mentioned the following barriers to transition of healthcare systems: lack of recognition of transition, sporadic collaboration between specialists in pediatric and adult healthcare, and shortage of training in managing CCD among adult caregivers [2, 16].
Only one-third of the pediatricians and one-fourth of the nurses stated that they were able to handle the psychosocial problems of adult patients. This suggests that healthcare professionals in pediatric departments do not appropriately address the psychosocial problems of adult patients with CCD. On the other hand, the prognosis is generally not good, although specialists in psychosomatic medicine do their best when dealing with such problems. Psychosocial problems need to be prevented, and therefore, it is necessary to establish a transition program to improve psychosocial health.
In conclusion, it is important to disseminate knowledge of transition programs among pediatricians and to develop a pediatric-adult healthcare network by communication between healthcare professionals in pediatric and adult healthcare services for the biopsychosocial well-being of adult patients with CCD.