title: Patient-provider relationships across the transition from pediatric to adult diabetes care: a qualitative study.
abstract: The purpose of this study was to explore perceptions that emerging adults with type 1 diabetes (T1D) have of their patient-provider relationships across the transition from pediatric to adult care.
  
  
  
  Twenty-six emerging adults with T1D (mean age 26.2 ± 2.5 years) participated in 5 focus groups stratified by current level of glycemic control (A1C). Coded audio-recorded data were analyzed using thematic analysis and aided by NVivo software.
  
  
  
  Three major themes emerged from the analysis: (1) loss and gain in provider relationships across the transition-patients expressed 3 key responses to leaving pediatric providers that differed by A1C levels: sad reluctance and "natural progression" (mean A1C ± SD 7.4% ± 0.6%) and wanting to go (mean A1C ± SD 9.8% ± 1.0%); (2) partners in care versus on one's own-patients valued how adult providers' collaborative conversations promoted their involvement and accountability compared to "parent-centric" interactions with pediatric providers, but they also expressed ambivalence over increased independence in adult care; (3) improving provider approaches to transition-patients recommended that pediatric providers actively promote emerging adults' autonomy while maintaining parental support, communication with adult providers, and follow-up with transitioning patients.
  
  
  
  Findings highlight the importance of enhanced provider awareness of T1D emerging adults' complex feelings about the transition in care. Improved integration of individual- and family-centered approaches to developmentally tailored diabetes care is needed to augment patient and provider relationships.
authors.affiliation: Joslin Diabetes Center, Boston, Massachusetts (Dr Ritholz, Dr Wolpert, Ms Beste, Ms Atakov-Castillo)|Boston Children’s Hospital, Boston, Massachusetts (Dr Ritholz, Dr Luff, Dr Garvey)|Harvard Medical School, Cambridge, Massachusetts (Dr Ritholz, Dr Wolpert, Dr Luff, Dr Garvey)
authors.forename: Marilyn D
authors.initials: MD
authors.lastname: Ritholz
authors.affiliation: Joslin Diabetes Center, Boston, Massachusetts (Dr Ritholz, Dr Wolpert, Ms Beste, Ms Atakov-Castillo)|Harvard Medical School, Cambridge, Massachusetts (Dr Ritholz, Dr Wolpert, Dr Luff, Dr Garvey)
authors.forename: Howard
authors.initials: H
authors.lastname: Wolpert
authors.affiliation: Joslin Diabetes Center, Boston, Massachusetts (Dr Ritholz, Dr Wolpert, Ms Beste, Ms Atakov-Castillo)
authors.forename: Meg
authors.initials: M
authors.lastname: Beste
authors.affiliation: Joslin Diabetes Center, Boston, Massachusetts (Dr Ritholz, Dr Wolpert, Ms Beste, Ms Atakov-Castillo)
authors.forename: Astrid
authors.initials: A
authors.lastname: Atakov-Castillo
authors.affiliation: Boston Children’s Hospital, Boston, Massachusetts (Dr Ritholz, Dr Luff, Dr Garvey)|Harvard Medical School, Cambridge, Massachusetts (Dr Ritholz, Dr Wolpert, Dr Luff, Dr Garvey)
authors.forename: Donna
authors.initials: D
authors.lastname: Luff
authors.affiliation: Boston Children’s Hospital, Boston, Massachusetts (Dr Ritholz, Dr Luff, Dr Garvey)|Harvard Medical School, Cambridge, Massachusetts (Dr Ritholz, Dr Wolpert, Dr Luff, Dr Garvey)
authors.forename: Katharine C
authors.initials: KC
authors.lastname: Garvey
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D003142:Communication; D003922:Diabetes Mellitus, Type 1 / Q000523:psychology* / Q000628:therapy; D004644:Emotions; D005260:Female; D017144:Focus Groups; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D010465:Perception; D036301:Qualitative Research; D012984:Software; D060305:Transition to Adult Care
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human