Ideally, health care transition should be "family-centered, continuous, comprehensive, coordinated, compassionate, and culturally competent and developmentally appropriate as it is technologically sophisticated" (4). Access to quality health care continues to be a major issue for all young people as well as those with rheumatic disease. In the United States, a national survey of adolescents with chronic illness and severe disability conducted between 1997 and 2002 established that nearly 35% of young adults had unmet health care needs due to costs, that 19% had unmet needs due to accessibility, that one in six had no usual source of care, and that nearly one in four young adults between ages 18 and 24 years were uninsured (32). In many countries but particular to the United States, funding for health care is often lacking during the critical years when transition from pediatric-oriented care to adult-oriented care should occur (35). Similarly, the quality of transitional care is also an issue (1,36,37). A major obstacle with transition to adult-oriented care is that young people have "nowhere to go" (38). In a study of the determinants of adolescent satisfaction with a transitional care program, provider characteristics were significantly more important that the physical environment and process issues (36). Low patient satisfaction with adult providers has been reported in terms of their availability, thoroughness, respect, and knowledge base (39). Adolescents also complain about the lack of privacy and of not being asked for their opinions about their own health care in pediatric practices (40).
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