Health care transition: youth, family, and provider perspectives.
OBJECTIVE
This study examined the process of health care transition (HCT) posing the following questions: What are the transition experiences of youths and young adults with disabilities and special health care needs, family members, and health care providers? What are promising practices that facilitate successful HCT? What are obstacles that inhibit HCT?


METHODS
A qualitative approach was used to investigate these questions. Focus group interviews were conducted. Content and narrative analyses of interview transcripts were completed using ATLAS.ti.


RESULTS
Thirty-four focus groups and interviews were conducted with 143 young adults with disabilities and special health care needs, family members, and health care providers. Content analysis yielded 3 content domains: transition services, which presents a chronological understanding of the transition process; health care systems, which presents differences between pediatric and adult-oriented medicine and how these differences inhibit transition; and transition narratives, which discusses transition experience in the broader context of relationships between patients and health care providers.


CONCLUSIONS
This study demonstrated the presence of important reciprocal relationships that are based on mutual trust between providers and families and are developed as part of the care of chronically ill children. Evidence supports the need for appropriate termination of pediatric relationships as part of the transition process. Evidence further supports the idea that pediatric and adult-oriented medicines represent 2 different medical subcultures. Young adults' and family members' lack of preparation for successful participation in the adult health care system contributes to problems with HCT.
Reiss
John G
JG
Institute for Child Health Policy, University of Florida, Gainesville, FL 32608, USA. jgr@ichp.ufl.edu
Gibson
Robert W
RW
Walker
Leslie R
LR
D000293:Adolescent; D016497:Adolescent Health Services / Q000458:organization & administration; D000295:Adolescent Medicine / Q000458:organization & administration; D000328:Adult; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002908:Chronic Disease / Q000628:therapy*; D003266:Continuity of Patient Care; D003695:Delivery of Health Care / Q000458:organization & administration*; D006233:Persons with Disabilities; D005190:Family; D005194:Family Practice; D005260:Female; D017144:Focus Groups; D006302:Health Services Research; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D033183:Interdisciplinary Communication; D008297:Male; D010347:Patient Care Planning; D010372:Pediatrics / Q000458:organization & administration; D010817:Physician-Patient Relations