Canadian Consensus Statements on the Transition of Adolescents and Young Adults with Inflammatory Bowel Disease from Pediatric to Adult Care: A Collaborative Initiative Between the Canadian IBD Transition Network and Crohn’s and Colitis Canada

Abstract

Objectives With the increased prevalence of childhood-onset inflammatory bowel disease (IBD), there is a greater need for a planned transition process for adolescents and young adults (AYA). The Canadian IBD Transition Network and Crohn’s and Colitis Canada joined in collaborative efforts to describe a set of care consensus statements to provide a framework for transitioning AYA from pediatric to adult care. Methods Consensus statements were drafted after focus group meetings and literature reviews. An expert panel consisting of 20 IBD physicians, nurses, surgeon, adolescent medicine physician, as well as patient and caregiver representatives met, discussed and systematically voted. The consensus was reached when greater than 75% of members voted in agreement. When greater than 75% of members rated strong support, the statement was rendered a strong recommendation, suggesting that a clinician should implement the statement for all or most of their clinical practice. Results The Canadian expert panel generated 15 consensus statements (9 strong and 6 weak recommendations). Areas of focus of the statements included: transition program implementation, key stakeholders, areas of potential need and gaps in the research. Conclusions These consensus statements provide a framework for the transition process. The quality of evidence for these statements was generally low, highlighting the need for further controlled studies to investigate and better define effective strategies for transition in pediatric to adult IBD care.

Transitional care of adolescents with inflammatory bowel disease to adult services varies widely across Australia and New Zealand

“…While recommendations had been made for improvement in the delivery of IBD care, including many aspects of transition, it appears as if considerable deficits remain. Furthermore, a number of international IBD guidelines are available to help inform the transition process 22–26 . However, these guidelines have been developed in other countries and may not account for differences in health care infrastructure, and geographic dispersion of patients and treatment centres.…”

Management and monitoring of pediatric inflammatory bowel disease in the Asia‐Pacific region: A position paper by the Asian Pan‐Pacific Society for Pediatric Gastroenterology, Hepatology, and Nutrition (APPSPGHAN) PIBD Working Group: Surgical management, disease monitoring, and special considerations

“…Transition in care is generally defined as a set of purposeful, planned movements of adolescents and young adults with chronic physical and medical conditions from child‐centered to adult‐oriented healthcare systems 80 . The main aims are to promote continuity of care, improve treatment adherence and disease knowledge, encourage independent disease management, and build confidence in the new adult healthcare team among the patients and their families 81 . A well‐planned, successfully implemented transitional process results in better disease control in terms of higher remission rate and lower rates of active disease, acute flare, emergency admission, and emergency surgery 82 …”

“…80 The main aims are to promote continuity of care, improve treatment adherence and disease knowledge, encourage independent disease management, and build confidence in the new adult healthcare team among the patients and their families. 81 A well-planned, successfully implemented transitional process results in better disease control in terms of higher remission rate and lower rates of active disease, acute flare, emergency admission, and emergency surgery. 82 Currently, few formal studies on the policy or implementation of transitional care for PIBD in Asian patients have been conducted.…”

Transition Programmes for Young Patients with Inflammatory Bowel Disease Improve Adherence to Care

“…2 As approximately 25% of patients with IBD are diagnosed before 18 years of age, we feel that a global and thorough implementation of transition programmes from paediatrics to adult care for adolescent patients with IBD should be pursued in every IBD centre so as to improve their management. 3,4 Assessing sound outcomes, as in the study by Mollah et al, is essential to establish the efficacy of these programmes in clinical practice. To do so, we evaluated 40 consecutive patients with IBD who received a diagnosis before 16 years of age and who were referred to our IBD centre, subdividing them into two groups: those who were the subject of a transition programme (n = 22) and those who were directly referred to the adult care (n = 18), and assessed the adherence to follow-up in the course of adulthood care.…”