Table 2.

Barriers affecting the provision of transition support services in pediatric rheumatology practices with comparisons to American Academy of Pediatrics (AAP) responses (noted in parentheses).

BarriersMajor BarrierSomewhat of a Barrier
Pediatric staff lack sufficient time to provide transition services37% (36%)41% (45%)
Fragmentation of primary and specialty care in adult care35% (39%)41% (46%)
Adolescents/parents/physicians have developed an effective bond that is hard to break30% (32%)54% (58%)
Adolescents’ lack of knowledge about their own condition and/or skills to self-advocate at physician visits28% (19%)56% (65%)
Pediatric staff lack skills in transition planning26% (33%)47% (46%)
Lack of knowledge about or linkages to community resources that support older adolescents/young adults24% (39%)*54% (49%)
Lack of available adult specialists to care for older adolescents/young adults with special needs24% (40%)*44% (38%)
Lack of insurance reimbursement for transition services23% (38%)*35% (38%)
Lack of available family physicians and internal medicine physicians to care for older adolescents/young adults with special needs22% (41%)*41% (39%)
  • Many barriers exist for pediatric rheumatology providers, but insufficient time, fragmentation of adult care services, and difficulty to break bonds are cited as the top major barriers for CARRA respondents. Comparisons with AAP respondents showed statistically significant differences,

  • ↵* p < 0.001, in major barriers for lack of providers, knowledge, and reimbursement.