Experiences of health care transition voiced by young adults with type 1 diabetes: a qualitative study

Katharine C Garvey, Margaret G Beste, Donna Luff, Astrid Atakov-Castillo, Howard A Wolpert, Marilyn D Ritholz, Katharine C Garvey, Margaret G Beste, Donna Luff, Astrid Atakov-Castillo, Howard A Wolpert, Marilyn D Ritholz

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).

Conclusion: 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.

Keywords: chronic illness; transition to adult care; type 1 diabetes mellitus; young adults.

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