Resource utilization during pediatric to adult transfer of care in IBD

Bollegala, Natasha; Brill, Herbert; Marshall, John K.

doi:10.1016/j.crohns.2012.05.010

Cited by 37 publications

(31 citation statements)

References 15 publications

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“…2–10 While adolescents with IBD often have more medically complex disease than adults with IBD, they have lower clinic attendance and therapeutic adherence than their adult counterparts. 11,12 Pediatric and adult gastroenterologists report deficiencies in the transition readiness (ability to plan, initiate, continue, and complete the transition process) 13 of AYAs with IBD, with the highest reported deficiencies in knowledge of their medical history and treatments, self-advocacy, and care coordination. 6,10 Moreover, many clinicians overestimate transition readiness in their IBD patients.…”

Section: Introductionmentioning

confidence: 99%

Barriers and Facilitators to Successful Transition from Pediatric to Adult Inflammatory Bowel Disease Care from the Perspectives of Providers

Paine

Stollon

Lucas

et al. 2014

Inflammatory Bowel Diseases

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Background For adolescents and young adults (AYA) with inflammatory bowel disease (IBD), the transition from pediatric to adult care is often challenging and associated with gaps in care. Our study objectives were to (1) identify outcomes for evaluating transition success and (2) elicit the major barriers and facilitators of successful transition. Methods We interviewed pediatric and adult IBD providers from across the United States with experience caring for AYAs with IBD until thematic saturation was reached after 12 interviews. We elicited the participants' backgrounds, examples of successful and unsuccessful transition of AYAs for whom they cared, and recommendations for improving transition using the Social-ecological Model of Adolescent and Young Adult Readiness to Transition framework. We coded interview transcripts using the constant comparative method and identified major themes. Results Participants reported evaluating transition success and failure using healthcare utilization outcomes (e.g. maintaining continuity with adult providers), health outcomes (e.g. stable symptoms), and quality of life outcomes (e.g. attending school). The patients' level of developmental maturity (i.e. ownership of care) was the most prominent determinant of transition outcomes. The style of parental involvement (i.e. helicopter parent vs. optimally-involved parent) also influenced outcomes as well as the degree of support by providers (e.g. care coordination). Conclusion IBD transition success is influenced by a complex interplay of patient developmental maturity, parenting style, and provider support. Multidisciplinary IBD care teams should aim to optimize these factors for each patient to increase the likelihood of a smooth transfer to adult care.

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Section: Introductionmentioning

confidence: 99%

Barriers and Facilitators to Successful Transition from Pediatric to Adult Inflammatory Bowel Disease Care from the Perspectives of Providers

Paine

Stollon

Lucas

et al. 2014

Inflammatory Bowel Diseases

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“…Four of the studies were rated as weak with regard to selection bias, 28 29 34 35 as the response rate was low 28 34 35 or not applicable. 29 Dabadie et al 33 were rated as moderate as the response level was higher, and Goodhand et al 16 were rated as moderate as the individuals selected were representative of the target population. Studies using a retrospective survey design were rated as weak, 28 33-35 and Bollegala et al 29 and Goodhand et al 16 received a moderate rating as they used a cohort design and casecontrol, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…29 Dabadie et al 33 were rated as moderate as the response level was higher, and Goodhand et al 16 were rated as moderate as the individuals selected were representative of the target population. Studies using a retrospective survey design were rated as weak, 28 33-35 and Bollegala et al 29 and Goodhand et al 16 received a moderate rating as they used a cohort design and casecontrol, respectively. Only Sebastian et al 34 and Goodhand et al 16 accounted for confounders and, therefore, received a rating of strong, and all remaining studies were rated as weak as they did not account for confounders such as diagnosis, age or comorbidities.…”

Section: Resultsmentioning

confidence: 99%

“…All studies were retrospective and quantitative in nature. Bollegala et al 29 and Dabadie et al 33 adopted a chart review method, as opposed to self-report survey, which was used by the remaining studies.…”

Section: Resultsmentioning

confidence: 99%

“…28 Future considerations for studies carried out in transition clinics are that a full explanation of the processes used in the clinic is used to draw conclusions or to make comparisons. 29 The current review is limited by the methodological quality of the studies included. Similar to previous reviews conducted on transition, 37 38 the use of convenience and purposive sampling was adopted for all samples included here, making it difficult to draw conclusions that are representative of all patients who have IBD.…”

Section: Training Matters 268mentioning

confidence: 99%

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Transitioning patients with inflammatory bowel disease (IBD) from adolescent to adult services: a systematic review

Clarke

Lusher

2015

Frontline Gastroenterol

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Approximately a quarter of patients with inflammatory bowel disease (IBD) are diagnosed before 20 years of age, presenting with more extensive distribution and severity of disease than adult onset. The purpose of this review was to determine facilitators of, and barriers to, successful transition of patients with IBD from adolescent to adult services. A systematic review of IBD transition research was conducted in March 2014 searching PubMed, MEDLINE, PsycINFO, Web of Science and the Cochrane Database of Systematic Reviews databases. A hand search of reference lists and narrative reviews was carried out to maximise the potential for retrieving all relevant manuscripts. Primary studies written in English of full-length peerreviewed journal articles that investigated transition of paediatric patients with IBD to adult services were included. Studies were excluded if the primary focus was not IBD. The search produced 283 potentially relevant studies. After removing duplicates and screening for suitability, six met our inclusion criteria. Barriers to transition included system inadequacies and a lack of resources, clinical time and training. Successful transition involved joint medical visits, structured transition services, improved communication between paediatric and adult services and improved education for patients and staff. If the transition process for adolescents suffering with IBD is to improve then it is vital that more research is conducted to better our understanding of ways in which we can ensure that defined protocols are in place for a smooth transition for every adolescent, leading to improved standards and minimal disruption to care. BACKGROUNDInflammatory bowel disease (IBD) is a group of inflammatory conditions of the

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

Vernon‐Roberts,

Chan,

Christensen

et al. 2024

JGH Open

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Background and AimChildren and adolescents account for approximately 14% of inflammatory bowel disease (IBD) diagnoses. At an appropriate age and level of development adolescents with IBD have their care transferred from the pediatric to adult clinical team during a process termed “transition”. The study aim was to survey pediatric gastroenterologists throughout Australasia to identify commonality in the transition process to contribute to standardized guideline development.MethodsA descriptive survey captured key variables: transition clinic format, process and infrastructure, transition assessments, and guidelines. The survey was distributed electronically to 59 Pediatric Gastroenterologists throughout Australasia in January 2023.ResultsSeventeen (29%) clinicians completed the survey: Australia 13 (76%). New Zealand 4 (24%). Thirteen (76%) respondents had access to a dedicated IBD transition clinic. Adolescents attended transition clinics 1–7 times, and the main processes transferred were: prescription provision, biologic appointments, and adult team contacts. Transition was first discussed age 13–15 years (53%), or 16–18 years (47%), with the main discussion topics including: continuing adherence (88%), smoking (59%), alcohol use (59%), recreational drug use (59%). Transition readiness assessments were done infrequently (24%). The minority (24%) used formal guidelines to inform the transition process, but 15 (88%) considered the development of a standardized Australasian guideline as beneficial/extremely beneficial.ConclusionsThis survey highlighted that transition care for adolescents with IBD is variable across Australasia. Australasian guideline development may optimize the transition process for adolescents with IBD and improve their longitudinal outcomes.

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Resource utilization during pediatric to adult transfer of care in IBD

Abstract: Understanding the transition process can help to develop strategies needed to support patients and their families.

Cited by 37 publications

References 15 publications

Barriers and Facilitators to Successful Transition from Pediatric to Adult Inflammatory Bowel Disease Care from the Perspectives of Providers

Barriers and Facilitators to Successful Transition from Pediatric to Adult Inflammatory Bowel Disease Care from the Perspectives of Providers

Transitioning patients with inflammatory bowel disease (IBD) from adolescent to adult services: a systematic review

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

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