title: Exploring Adult Care Experiences and Barriers to Transition in Adult Patients with Sickle Cell Disease.
abstract: BACKGROUND
  Young adults with sickle cell anemia are at high risk for increased hospitalization and death at the time of transition to adult care. This may be related to failure of the transition system to prepare young adults for the adult healthcare system. This qualitative study was designed to identify factors related to transition that may affect the health of adults with sickle cell anemia.
  
  
  METHODS
  Ten patients currently treated in an adult hematology clinic participated in semi-structured qualitative interviews to describe their experience transitioning from pediatric to adult care and differences in adult and pediatric healthcare systems.
  
  
  RESULTS
  Participants were generally unprepared for the adult healthcare system. Negative issues experienced by participants included physician mistrust, difficulty with employers, keeping insurance, and stress in personal relationships. Positive issues experienced by participants included improved self efficacy with improved self care and autonomy.
  
  
  CONCLUSIONS
  In the absence of a formalized transition program, adults with sickle cell anemia experience significant barriers to adult care. In addition to medical history review and identification of an adult provider, transition programs should incorporate strategies to navigate the adult medical system, insurance and relationships as well as encouraging self efficacy.
authors.affiliation: Pediatric Hematology Oncology, University of Alabama, Birmingham, Alabama,USA.
authors.forename: C J
authors.initials: CJ
authors.lastname: Bemrich-Stolz
authors.affiliation: Department of Medicine, Division of Preventive Medicine, University of Alabama, Birmingham, Alabama,USA.
authors.forename: J H
authors.initials: JH
authors.lastname: Halanych
authors.affiliation: Pediatric Hematology Oncology, University of Alabama, Birmingham, Alabama,USA.
authors.forename: T H
authors.initials: TH
authors.lastname: Howard
authors.affiliation: Pediatric Hematology Oncology, University of Alabama, Birmingham, Alabama,USA.
authors.forename: L M
authors.initials: LM
authors.lastname: Hilliard
authors.affiliation: Pediatric Hematology Oncology, University of Alabama, Birmingham, Alabama,USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Lebensburger
keywords: Qualitative; Sickle cell; Transition