Challenges in Transitional Care in Inflammatory Bowel Disease: A Review of the Current Literature in Transition Readiness and Outcomes

Abstract

Transitional care for patients with IBD focuses on efforts to successfully transfer care from pediatric to adult providers while encouraging the assumption of health care responsibility. As 25% of patients will be diagnosed with IBD before the age of 18 years, many will undergo this process. Efforts to enhance this process have included transition clinics and other means to improve patient comfort with transition and develop the skill of health care self-management. Currently, most pediatric practitioners provide transition care with informal education and emphasize independence without formal programs. A variety of tools to assess transition readiness have been developed. Given the varied disease process, often varied and subjective outcomes, and lack of studies such as randomized controlled trials, further data are necessary to determine the best avenue to transition and assess outcomes. Critically relevant to providing adequate care to transitioning patients includes understanding the development of self-management skills and the developmental processes relevant to young adults with IBD. Transition represents an area for quality improvement, and although progress has been made in recognition and promotion of transition practices, future directions in research will allow improved understanding of the evidence-based practices and needs of these individuals to further enhance their care.

Value of an outpatient transition clinic for young people with inflammatory bowel disease: a mixed-methods evaluation

“…Two years ago, a national guideline on transition of young people with chronic digestive diseases, including IBD, was developed in the UK 1. The need to improve care for these young people has been repeatedly emphasised,2 for instance in a topical review on transitional care for young people with IBD by the European Crohn’s and Colitis Organisation3 and in a position statement by the Italian Society of Gastroenterology 4…”

“…To support young people with IBD during their transition from paediatric to adult care and to address both the physical and psychosocial burden of their disease, a profound recommendation made is to implement transition clinics (TCs) 3 6 11 12. Although there is no common definition of a TC, the core principle is that professionals from paediatric care and adult care jointly deliver outpatient care 2 13 14. While TCs are advocated as best practice in transitional care, clinical practice in this area is just emerging and there is still little understanding about service structures, experiences and outcomes of TCs.…”

“…While TCs are advocated as best practice in transitional care, clinical practice in this area is just emerging and there is still little understanding about service structures, experiences and outcomes of TCs. This is especially true for transitional care for young people with IBD 2 15. Also, it is important for evaluation studies to consider both patient satisfaction and clinical outcomes 2.…”

“…This is especially true for transitional care for young people with IBD 2 15. Also, it is important for evaluation studies to consider both patient satisfaction and clinical outcomes 2. This study aimed to gain insight into the value of a TC compared with direct handover care for young people with IBD by employing a mixed-methods approach.…”

Transition of Inflammatory Bowel Disease Patients from Pediatric to Adult Care: An Observational Study on a Joint-Visits Approach

“…A crucial phase in the management of children with IBD is the transition from the pediatric to the adult IBD care system, requiring full achievement of maturity and of self-management and healthcare skills, not occurring at the same age for each individual [4]. The "ideal" patient ready for transition is a young independent adult on IBD clinical remission, for whom no change of medical therapy or surgical intervention are planned [5].…”