Chronic Illness and Complex Care
Core content
Chronic illness and complex care questions focus on the medical home, care coordination, adherence, and transition. Understand family-centered care, shared decision making, and the chronic care model. Common conditions include asthma, type 1 diabetes, cystic fibrosis, sickle cell disease, epilepsy, congenital heart disease, and technology dependence such as gastrostomy tubes or tracheostomies. Know that children with special health care needs require an emergency plan, school accommodation plan, and coordinated subspecialty follow-up. Growth, development, and psychosocial adjustment must be monitored alongside disease control. Document the plan and communicate it to school and subspecialists.
Traps
Examiners test the difference between treatment failure and nonadherence. Before escalating therapy, check inhaler technique, access, cost, and side effects. Beware of polypharmacy and drug interactions, and do not overlook caregiver burnout or transition readiness. Transition to adult care should begin in early adolescence, not at age 18. Another trap is attributing symptoms to the chronic disease without considering a new, unrelated problem.
Worked example
A 14-year-old with asthma has three emergency department visits in six months. Spirometry is reduced, but review shows poor inhaler technique and no controller use because of cost. Address technique, affordability, and an asthma action plan before stepping up to more expensive therapy. Rule of thumb: when a chronic disease seems uncontrolled, first confirm adherence, technique, and access.