title: Perspectives on care for young adults with type 1 diabetes transitioning from pediatric to adult health systems: A national survey of pediatric endocrinologists.
abstract: BACKGROUND
  Healthcare transition from pediatric to adult care for young adults (YA) with type 1 diabetes (T1D) is associated with risk of adverse outcomes. Consensus recommendations exist from US professional societies on transition care for YA with T1D, but it is not known whether they have been widely adopted. We describe experiences, barriers, and provider characteristics associated with transition care in a national sample of pediatric endocrinologists.
  
  
  METHODS
  US pediatric endocrinologists identified through the American Medical Association Physician Masterfile were sent an electronic survey.
  
  
  RESULTS
  Response rate was 16% (164/1020) representing 32 states. The majority of pediatric endocrinologists (age 44 ± 10; years in practice 12 ± 11) were female (67%) and worked in academic centers (75%). Main reasons for transfer were age (49%) and glycemic control (18%). Barriers to transition included ending long-therapeutic relationships with patients (74%), lack of transition protocols (46%), and perceived deficiencies in adult care (42%). The majority of pediatric endocrinologists reported lack of transition training (68%); those who received training were less likely to have difficulty ending patient relationships [odds ratio (OR) = 0.39, P = .03], more likely to perform patient record transfer to adult systems (OR=1.27, P = .006), and less likely to report patient returns to pediatric care after transfer (OR=0.49, P = .01), independent of endocrinologist gender, years in practice, or practice type.
  
  
  CONCLUSIONS
  There is wide variation in transition care for YA with T1D among US pediatric endocrinologists despite consensus recommendations. Dissemination of educational programming on transition care and provision of actionable solutions to overcome local health system and perceived barriers is needed.
authors: Rodebaugh Diabetes Center, Division of Endocrinology, Diabetes, and Metabolism, University of Pennsylvania Health System, Philadelphia, USA.|Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
authors: Shivani
authors: S
authors: Agarwal
authors: Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA.
authors: Katharine C
authors: KC
authors: Garvey
authors: Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Denver, USA.
authors: Jennifer K
authors: JK
authors: Raymond
authors: Rodebaugh Diabetes Center, Division of Endocrinology, Diabetes, and Metabolism, University of Pennsylvania Health System, Philadelphia, USA.|Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
authors: Mark H
authors: MH
authors: Schutta
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D048909:Diabetes Complications / Q000175:diagnosis / Q000517:prevention & control; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000628:therapy*; D004704:Endocrinology / Q000193:education; D005190:Family; D019538:Health Care Surveys; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007003:Hypoglycemia / Q000517:prevention & control*; D020407:Internet; D020380:Needs Assessment; D010342:Patient Acceptance of Health Care; D010372:Pediatrics / Q000193:education; D010817:Physician-Patient Relations; D017410:Practice Guidelines as Topic; D060305:Transition to Adult Care; D014481:United States; D000078329:Workforce; D055815:Young Adult
keywords: pediatric endocrinologists; pediatric to adult transition; physician survey; type 1 diabetes; young adults