| Description |
Background: In 2022, the National Survey of Children's Health reported that 86.6% of adolescents did not receive the services necessary to transition to adult healthcare (Data Resource Center for Child & Adolescent Health, 2022b). Local Problem: In Utah, 15.5% of children have special healthcare needs (Data Resource Center for Child & Adolescent Health, 2022c), and 24 out of 29 counties have a shortage of primary care physicians, with the majority of these counties being in rural locations (US Health Resources and Services Administration, 2024). Methods: A needs assessment was conducted within 73 primary care clinics to evaluate the barriers and facilitators involved in accepting AYAs with special healthcare needs. A survey was sent out to primary care providers (PCPs) across an Intermountain West state and follow-up interviews were conducted with some of the providers. Interventions: A SWOT (strengths, weaknesses, opportunities, and threats) analysis was performed, and informal discussions were conducted with community partners. Results: The needs assessment distribution included primary care providers (N=408). Of those, 11% (n=44) responded, and 5% (n=19) completed beyond the demographics section. The needs assessment participants included rural primary care providers 10% (n=2) and urban primary care providers 90% (n= 17). Clinic types included: family medicine (53%, n=10), pediatrics primary care (32%, n=6), internal medicine (16%, n=3), and med peds (0%, n=0). Barriers that were most common when PCPs try to accept AYAs with special healthcare needs were: training and/or experience gaps (54%, n=7), lack of time in appointments (39%, n=5), and lack of provider hand-off (31%, n=4). The most common barriers when trying to transfer AYAs with special healthcare needs were a lack of available adult providers (31%, n=5) and hesitancy from patients and/or family members (31%, n=5). The support necessary for the providers and their practices to care for AYAs with special healthcare needs were: a list of adult specialists who will accept care of AYAs with special healthcare needs (47%, n=9), care coordination support (47%, n=9), additional training on specific pediatric-onset chronic diseases (37%, n=7), and provider handoff/medical summaries (37%, n=7). When rural providers were asked what barriers they experience when caring for AYAs with special healthcare needs, the one rural healthcare provider's response involved the challenges of reaching sub-specialists/coordinating care (50%, n=1). When rural providers were asked what potential solutions might address the discussed barriers in rural healthcare, one responded with telehealth (50%, n=1). Conclusion: Barriers complicate accepting and transitioning AYAs with special healthcare needs, which in turn negatively affects health outcomes for this patient population. It is vital for these barriers to be addressed to ensure there is no gap in healthcare for these vulnerable patients. |
