TABLE 2

Mean Likert Ratings and Wilcoxon Rank Order of Stage 2 Survey Items

ItemMean Likert RatingCategoryWilcoxon Ranka
1. Internists may not have the training in congenital and childhood chronic illnesses to prepare them to manage them beyond childhood.2.86Medical competency1
2. It is difficult to care for patients with cerebral palsy or mental retardation if the family does not stay involved.2.86Family involvement1
3. It can be difficult to meet psychosocial needs of young adults, especially those living with chronic illness.2.77Psychosocial needs1
4. Some patients may need a superspecialist to manage complex problems (eg, complex congenital heart disease).2.77Medical competency1
5. Internists often lack training in adolescent medicine, adolescent development, and adolescent behavior.2.63Medical competency1
6. It is often difficult to face disability and end-of life issues at an early age and early in the doctor-patient relationship.2.63Medical competency, psychosocial needs1
7. Managed care/financial considerations limit the time an internist is able to spend with transitioning young patients.2.57System issues1
8. The families of transitioning patients have high expectations of the amount of time/attention needed for proper care.2.55Family involvement1
9. Because patients with chronic illness are often less mature than their healthy counterparts, they may have increased adherence problems.2.49Maturity2
10. Young patients are not always ready to assume decision-making responsibility.2.47Maturity2
11. While insurance programs may cover sick children, coverage may not exist for young adults.2.45System issues2
12. Internal medicine practices often lack adequate infrastructure and staff training to deal with these patients.2.45System issues2
13. It is often challenging to make sure that the young patient does not get lost to follow-up.2.44Maturity, system issues2
14. Young patients are often ignorant of morbidity/mortality and therefore may lack motivation for preventive care.2.44Maturity2
15. Internists may be unfamiliar with local and regional services for chronically ill, young adult patients.2.42Medical competency2
16. Caring for chronically ill young patients can be potentially very time-consuming.2.42System issues2
17. It is difficult for young adult patients over 18 with chronic illness to obtain insurance because of their preexisting condition.2.40System issues2
18. Parents are often reluctant to relinquish responsibility for health care/decision-making to young adult patients.2.39Family involvement2
19. Young patients with chronic illness often have significant dependency needs.2.37Maturity2
20. It is difficult to meet the expectations of care for chronic incurable problems; often family wants a full evaluation though one has already been completed.2.37Family involvement2
21. The transition from pediatric caregivers is often poorly coordinated.2.36Transition coordination2
22. Young patients often neglect to raise issues or ask questions that their parents previously would have asked.2.35Maturity2
23. Young patients are often closed-minded to different approaches after living with their illness for so long.2.32Maturity2
24. Parents and caregivers can remain excessively protective and may not understand privacy issues.2.32Family involvement2
25. It is often difficult to obtain old records.2.30Transition coordination2
26. Internal medicine practices may not be familiar with reimbursement schedules for patients requiring coordination of services or parental consultation.2.22System issues2
27. It may be difficult to manage adolescent patients with attention-deficit disorder.2.19Medical competency2
28. Internal medicine practices are often less paternalistic than pediatric practices, which can be challenging for transitioning patients (eg, patients may not get called when they miss an appointment).2.17Maturity, system issues2
29. The literature on childhood illnesses is mostly in pediatric journals.2.17Medical competency2
30. It is often difficult to reconcile the different practice styles of pediatric and adult providers.2.14Transition coordination2
31. There is often a large time gap between the last visit with the pediatrician and the first visit with the adult provider.2.14Transition coordination2
32. It is difficult to involve a caring parent to ensure adherence without compromising the patient's growing sense of independence.2.14Maturity, family involvement3
33. It may be difficult to transition ancillary services (eg, radiograph and path) from the pediatric to the adult system; often pediatric services are more experienced with pediatric illnesses.2.11Transition coordination3
34. Patients are often ambivalent about transition: they want an adult doctor but don't want to leave their pediatrician.2.02Transition coordination3
35. Pediatricians are often unsure of whether to refer to an adult specialist or pediatric specialist in this age group.2.00Transition coordination3
36. My colleagues may be unwilling to care for teenage patients.1.98Medical competency3
37. Pediatricians sometimes use different medication doses than those used in adult medicine.1.98Medical competency3
38. Patients/families often don't know how to navigate the adult health care system.1.98Transition coordination3
39. It is often difficult to deal with sexually transmitted infections in adolescent patients.1.97Medical competency3
40. Patients/families often don't know medical history.1.97Transition coordination3
41. It can be difficult to broaden the doctor-patient relationship to include parents.1.92Family involvement3
42. Pediatricians tend to keep compliant patients and transition noncompliant patients.1.80Transition coordination3
43. It is frequently necessary to change the treatment plan because of prior inadequate care.1.74Transition coordination4
44. Young patients frequently distrust staff, often because of logistical issues (eg, procuring referrals).1.72Psychosocial needs4
45. Pediatricians are often reluctant to let go of their patients.1.68Transition coordination4
  • Item wording is identical to that in the survey.

  • a Rank order was determined by using the Wilcoxon signed-rank test. A Bonferroni correction was used to adjust for multiple comparisons, resulting in a significance level of P < .002.