title: Experiences of health care transition voiced by young adults with type 1 diabetes: a qualitative study.
abstract: OBJECTIVE
  This qualitative study aimed to explore the experience of transition from pediatric to adult diabetes care reported by posttransition emerging adults with type 1 diabetes (T1D), with a focus on preparation for the actual transfer in care.
  
  
  METHODS
  Twenty-six T1D emerging adults (mean age 26.2±2.5 years) receiving adult diabetes care at a single center participated in five focus groups stratified by two levels of current glycemic control. A multidisciplinary team coded transcripts and conducted thematic analysis.
  
  
  RESULTS
  FOUR KEY THEMES ON THE PROCESS OF TRANSFER TO ADULT CARE EMERGED FROM A THEMATIC ANALYSIS: 1) nonpurposeful transition (patients reported a lack of transition preparation by pediatric providers for the transfer to adult diabetes care); 2) vulnerability in the college years (patients conveyed periods of loss to follow-up during college and described health risks and diabetes management challenges specific to the college years that were inadequately addressed by pediatric or adult providers); 3) unexpected differences between pediatric and adult health care systems (patients were surprised by the different feel of adult diabetes care, especially with regards to an increased focus on diabetes complications); and 4) patients' wish list for improving the transition process (patients recommended enhanced pediatric transition counseling, implementation of adult clinic orientation programs, and peer support for transitioning patients).
  
  
  CONCLUSIONS
  Our findings identify modifiable deficiencies in the T1D transition process and underscore the importance of a planned transition with enhanced preparation by pediatric clinics as well as developmentally tailored patient orientation in the adult clinic setting.
authors.affiliation: Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA ; Harvard Medical School, Boston, MA, USA.
authors.forename: Katharine C
authors.initials: KC
authors.lastname: Garvey
authors.affiliation: Adult Section, Joslin Diabetes Center, Boston, MA, USA.
authors.forename: Margaret G
authors.initials: MG
authors.lastname: Beste
authors.affiliation: Institute for Professionalism and Ethical Practice, Boston Children's Hospital, Boston, MA, USA ; Harvard Medical School, Boston, MA, USA.
authors.forename: Donna
authors.initials: D
authors.lastname: Luff
authors.affiliation: Adult Section, Joslin Diabetes Center, Boston, MA, USA.
authors.forename: Astrid
authors.initials: A
authors.lastname: Atakov-Castillo
authors.affiliation: Adult Section, Joslin Diabetes Center, Boston, MA, USA ; Harvard Medical School, Boston, MA, USA.
authors.forename: Howard A
authors.initials: HA
authors.lastname: Wolpert
authors.affiliation: Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Marilyn D
authors.initials: MD
authors.lastname: Ritholz
keywords: chronic illness; transition to adult care; type 1 diabetes mellitus; young adults