title: Transition of adolescents with chronic health conditions to adult primary care: factors associated with physician acceptance.
abstract: OBJECTIVE
  To assess the willingness of adult primary-care physicians to transfer young adults with special health care needs (YASHCN) into their practices, and the relative impact of patient characteristics and transition supports.
  
  
  METHODS
  Survey of primary care internists and family practitioners using randomized patient characteristics and transition supports in clinical vignettes to assess physician willingness to accept a YASHCN into their practice.
  
  
  RESULTS
  404 responses were received from 601 surveys (response rate 67%). Only 44% rated themselves "willing" or "enthusiastic" to accept a YASHCN. Using four-way ANOVA testing, provider and practice characteristics significantly associated with willingness to accept included gender, years in practice, presence of YASHCN in current practice and whether the practice was accepting new patients. Patient condition and transition support significantly affected willingness to accept; training in internal medicine versus family practice did not.
  
  
  CONCLUSIONS
  Physicians providing primary care for adults express limited willingness to accept YASHCN into their practices. Provider, practice and patient characteristics affected willingness to accept. Although transition supports affected willingness to accept, effects varied markedly across diagnoses and physician gender. Findings have implications for patients and healthcare teams and policy planners.
authors.affiliation: Departments of Pediatrics and Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA.
authors.forename: Suzanne Elizabeth
authors.initials: SE
authors.lastname: McLaughlin
authors.affiliation: Departments of Orthopedics and Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Machan
authors.affiliation: Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Phillip
authors.initials: P
authors.lastname: Fournier
authors.affiliation: Department of Oncology, St. Jude's Children's Research Hospital, Memphis, TN, USA.
authors.forename: Tamara
authors.initials: T
authors.lastname: Chang
authors.affiliation: University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Katelyn
authors.initials: K
authors.lastname: Even
authors.affiliation: Baystate Children's Hospital, Springfield, MA, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Sadof
mesh_terms: D000293:Adolescent; D001291:Attitude of Health Personnel; D002908:Chronic Disease / Q000534:rehabilitation*; D005194:Family Practice; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007388:Internal Medicine; D008297:Male; D008404:Massachusetts; D060305:Transition to Adult Care
keywords: Health care transition; adolescents with special health care needs; transition to adult care