Physician-Perceived Barriers to Healthcare Transition for Young Adults With Special Healthcare Needs

Introduction Healthcare transition (HCT), or the process of moving from pediatric to adult care, can be a complex process requiring care coordination and communication, especially for young adults with special healthcare needs (YASHCN). Limited access to adult-system resources such as care coordination and social work can result in poorly facilitated HCT, leading to increased healthcare expenditures, medical complications, and loss to follow-up. Methods We conducted mixed-methods interviews incorporating structured surveys with general and subspecialty adult physicians at the University of Texas Southwestern Medical Center, a large academic medical center in Dallas, Texas. Physicians were asked to identify major, minor, or absent barriers encountered when receiving YASHCN and to describe potential solutions at both specialty-specific and system-wide levels. Quantitative responses were summarized as counts and percentages, and exact binomial confidence intervals were calculated for the proportions endorsing each barrier as major or minor. Exact binomial tests assessed whether endorsement exceeded 50%. Qualitative responses were analyzed using thematic analysis. Results Physicians reported numerous barriers to HCT, with endorsement rates ranging from 40% to 91.7%. The most frequently identified barriers included lack of residency or fellowship training in YASHCN care (91.7%), poor patient or parent preparation for the adult model of care (86.7%), inadequate care-coordination support (86.7%), limited access to adult primary care physicians (84.6%), and lack of relevant clinical guidelines (80%). Several of these were endorsed at rates exceeding 50%, indicating strong physician consensus. Additional commonly reported barriers included poor communication during provider transfers (67.7%), limited access to subspecialists (67.7%), patient or parent mistrust of adult care (75%), insufficient social work support (60%), limited time to complete paperwork (60%), difficulty accessing pediatric medical records (53.3%), limited access to needed specialty services (40%), and physicians' own limited knowledge of chronic childhood-onset diseases (46.7%). When asked to elaborate on these perceived barriers and identify potential solutions, physicians emphasized the need for better patient and caregiver education, stronger communication between pediatric and adult teams to improve access to medical records, building trust in the adult model of care, and system-level supports such as increased care coordination and social work support, standardized communication processes, and increased institutional investment in HCT services. Conclusion These physician-identified findings, supported by existing literature, highlight the importance of implementing collaborative solutions to bridge pediatric and adult care for this vulnerable patient population. These findings also highlight the importance of targeted educational efforts to improve clinician preparedness in caring for YASHCN. This stakeholder-driven approach informs the development of an evidence-based, centralized HCT clinic, serving as a crucial first step to improve HCT readiness in YASCHN and, in turn, improve health outcomes and quality of life for this vulnerable population.