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Vernon‐Roberts A, Chan P, Christensen B, Day AS, Havrlant R, Giles E, Williams A. Transitional care of adolescents with inflammatory bowel disease to adult services varies widely across Australia and New Zealand. JGH Open 2024; 8:e13032. [PMID: 38268957 PMCID: PMC10805482 DOI: 10.1002/jgh3.13032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/07/2023] [Accepted: 12/21/2023] [Indexed: 01/26/2024]
Abstract
Background and Aim Children 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. Methods A 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. Results Seventeen (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. Conclusions This 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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Affiliation(s)
| | - Patrick Chan
- Department of GastroenterologyLiverpool HospitalSydneyAustralia
| | - Britt Christensen
- Department of GastroenterologyRoyal Melbourne HospitalMelbourneAustralia
| | - Andrew S Day
- Department of PaediatricsUniversity of OtagoChristchurchNew Zealand
| | | | - Edward Giles
- Department of PaediatricsMonash Children's HospitalMelbourneAustralia
| | - Astrid‐Jane Williams
- Department of GastroenterologyLiverpool HospitalSydneyAustralia
- South Western Sydney Clinical SchoolUniversity of New South WalesAustralia
- Ingham Institute for Applied Medical ResearchSydneyAustralia
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Zhou M, Xu Y, Zhou Y. Factors influencing the healthcare transition in Chinese adolescents with inflammatory bowel disease: a multi-perspective qualitative study. BMC Gastroenterol 2023; 23:445. [PMID: 38110881 PMCID: PMC10729466 DOI: 10.1186/s12876-023-03080-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/08/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND The development and implementation of the transition from pediatric to adult healthcare systems for adolescents with inflammatory bowel disease (IBD) should consider stakeholders' perceptions. This study aimed to explore the factors influencing the transition of Chinese adolescents with IBD from the perspectives of patients, parents, and healthcare providers. METHODS A descriptive qualitative research was conducted. Purposive sampling was used to recruit 36 participants, including 13 patients, 13 parents, and 10 providers, from a tertiary pediatric IBD center, a tertiary adult IBD center, and the China Crohn's & Colitis Foundation in Zhejiang Province, China. Individual semi-structured interviews were used to collect data on facilitators and barriers to the transition process. Conventional content analysis was used to analyze the interview transcripts. RESULTS Nine primary themes were identified. Patients with young age, prolonged disease duration, severe disease, academic pressures such as the Gaokao, low level of disease acceptance, limited transition consciousness, low self-efficacy, poor transition communication, and inadequate medical transition system serve as barriers. While patients with the mentality of guilt towards their parents; parents with low education levels and intensive work schedules, high levels of disease acceptance, and situations of parent-child separation; stakeholders with high transition consciousness, high transition self-efficacy, and effective transition communication act as facilitators. Furthermore, community support and hospital guide services were also contributing factors during the transition. CONCLUSIONS This study offers comprehensive insights into the factors affecting the transition of Chinese adolescent IBD patients. The process is continuously influenced by stakeholders, community, and healthcare environments and policies. Identifying these factors provides healthcare providers with a reference for developing and implementing targeted transition interventions.
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Affiliation(s)
- Mi Zhou
- School of Nursing, Zhejiang Chinese Medical University, 548 Binwen Road, Binjiang District, Hangzhou, Zhejiang, 310053, China
| | - Youjun Xu
- School of Nursing, Zhejiang Chinese Medical University, 548 Binwen Road, Binjiang District, Hangzhou, Zhejiang, 310053, China
| | - Yunxian Zhou
- School of Nursing, Zhejiang Chinese Medical University, 548 Binwen Road, Binjiang District, Hangzhou, Zhejiang, 310053, China.
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Yoo EJ, Cho SH, Park SJ, Kim TI, Kim WH, Cheon JH. Characteristics and Treatment Outcomes of Transition among Patients with Inflammatory Bowel Disease. Yonsei Med J 2023; 64:541-548. [PMID: 37634630 PMCID: PMC10462809 DOI: 10.3349/ymj.2022.0588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/07/2023] [Accepted: 06/25/2023] [Indexed: 08/29/2023] Open
Abstract
PURPOSE This study aimed to assess disease characteristics and outcomes of transition in patient care among adolescent patients with inflammatory bowel disease (IBD). MATERIALS AND METHODS Data from patients younger than 18 years who were diagnosed with IBD (Crohn's disease, ulcerative colitis, or intestinal Behçet's disease) were investigated. We categorized the patients into two groups: transition IBD group (Group A, diagnosed in pediatric care followed by transfer to/attendance in adult IBD care) and non-transition group (Group B, diagnosed and followed up in pediatric care or adult IBD care without transfer). RESULTS Data from a total of 242 patients [Group A (n=29, 12.0%), Group B (n=213, 88.0%)] were analyzed. A significantly higher number of patients was diagnosed at an earlier age in Group A than in Group B (p<0.001). Group A patients had more severe disease in terms of number of disease flare ups (p=0.011) and frequency of bowel-related complications (p<0.001). Multiple linear regression analysis showed that Group B patients had more medical non-compliance than Group A patients (β=2.31, p=0.018). After transition, IBD-related admission frequency, emergency admission frequency, disease flare frequency, and medical non-compliance were significantly improved. CONCLUSION The transition IBD group had more severe disease. Medical non-compliance was lower in the transition IBD group. Clinical outcomes improved after transition.
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Affiliation(s)
| | - Sang-Hoon Cho
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Soo Jung Park
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Il Kim
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Won Ho Kim
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hee Cheon
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea.
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Rubín de Célix C, Martín-de-Carpi J, Pujol-Muncunill G, Palomino LM, Velasco Rodríguez-Belvís M, Martín-Masot R, Navas-López VM, Ricart E, Casanova MJ, Rodríguez-Martínez A, Leo-Carnerero E, Alcaraz A, Mañosa M, Hernández V, Cobelas Cobelas MC, Sánchez C, Menchén L, Mesonero F, Barreiro-De Acosta M, Martinón-Torres N, Tejido Sandoval C, Rendo Vázquez A, Corsino P, Vicente R, Hernández-Camba A, Alberto Alonso JR, Alonso-Abreu I, Castro Millán AM, Peries Reverter L, Castro B, Fernández-Salgado E, Busto Cuiñas MM, Benítez JM, Madero L, Clemente F, Riestra S, Jiménez-Treviño S, Boscá-Watts M, Crehuá-Gaudiza E, Calvo Moya M, Huguet JM, Largo-Blanco EM, González Vives L, Plaza R, Guerra I, Barrio J, Escartín L, Alfambra E, Cruz N, Muñoz MC, Muñoz Pino MG, Van Domselaar M, Botella B, Monfort Miquel D, Rodríguez Grau MC, De La Mano A, Ber Y, Calvo Iñiguez M, Martínez-Pérez TDJ, Chaparro M, Gisbert JP. Benefits of Paediatric to Adult Transition Programme in Inflammatory Bowel Disease: The BUTTERFLY Study of GETECCU and SEGHNP. J Clin Med 2023; 12:4813. [PMID: 37510928 PMCID: PMC10381381 DOI: 10.3390/jcm12144813] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/10/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: Transition is a planned movement of paediatric patients to adult healthcare systems, and its implementation is not yet established in all inflammatory bowel disease (IBD) units. The aim of the study was to evaluate the impact of transition on IBD outcomes. (2) Methods: Multicentre, retrospective and observational study of IBD paediatric patients transferred to an adult IBD unit between 2017-2020. Two groups were compared: transition (≥1 joint visit involving the gastroenterologist, the paediatrician, a programme coordinator, the parents and the patient) and no-transition. Outcomes within one year after transfer were analysed. The main variable was poor clinical outcome (IBD flare, hospitalisation, surgery or any change in the treatment because of a flare). Predictive factors of poor clinical outcome were identified with multivariable analysis. (3) Results: A total of 278 patients from 34 Spanish hospitals were included. One hundred eighty-five patients (67%) from twenty-two hospitals (65%) performed a structured transition. Eighty-nine patients had poor clinical outcome at one year after transfer: 27% in the transition and 43% in the no-transition group (p = 0.005). One year after transfer, no-transition patients were more likely to have a flare (36% vs. 22%; p = 0.018) and reported more hospitalisations (10% vs. 3%; p = 0.025). The lack of transition, as well as parameters at transfer, including IBD activity, body mass index < 18.5 and corticosteroid treatment, were associated with poor clinical outcome. One patient in the transition group (0.4%) was lost to follow-up. (4) Conclusion: Transition care programmes improve patients' outcomes after the transfer from paediatric to adult IBD units. Active IBD at transfer impairs outcomes.
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Affiliation(s)
- Cristina Rubín de Célix
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28006 Madrid, Spain
| | - Javier Martín-de-Carpi
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
| | - Gemma Pujol-Muncunill
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
| | - Laura María Palomino
- Paediatric Gastroenterology and Nutrition Department, Hospital Infantil Universitario Niño Jesús, 28009 Madrid, Spain
| | | | - Rafael Martín-Masot
- Paediatric Gastroenterology and Nutrition Unit, Hospital Regional Universitario de Málaga, Biomedical Re-search Institute of Málaga (IBIMA), 29010 Málaga, Spain
| | - Víctor Manuel Navas-López
- Paediatric Gastroenterology and Nutrition Unit, Hospital Regional Universitario de Málaga, Biomedical Re-search Institute of Málaga (IBIMA), 29010 Málaga, Spain
| | - Elena Ricart
- Gastroenterology Department, Hospital Clínic, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - María José Casanova
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28006 Madrid, Spain
| | - Alejandro Rodríguez-Martínez
- Paediatric Gastroenterology, Hepatology and Nutrition, UGC de Pediatría, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain
| | | | - Alba Alcaraz
- Department of Paediatric Gastroenterology, Nutrition and Hepatology, University Hospital Germans Trias I Pujol, 08916 Badalona, Spain
| | - Miriam Mañosa
- Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 08916 Badalona, Spain
| | - Vicent Hernández
- Department of Gastroenterology, Xerencia Xestion Integrada de Vigo, SERGAS, Research Group in Digestive Diseases, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, 36312 Vigo, Spain
| | | | - César Sánchez
- Paediatric Gastroenterology, Hepatology and Nutrition Department, Hospital General Universitario Gregorio Marañón, 28018 Madrid, Spain
| | - Luis Menchén
- Gastroenterology Department-CEIMI, Hospital General Universitario Gregorio Marañón, Departamento de Medicina, Universidad Complutense de Madrid, 28018 Madrid, Spain
| | - Francisco Mesonero
- Gastroenterology Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Manuel Barreiro-De Acosta
- Gastroenterology Department, Hospital Universitario Clínico de Santiago, 15706 Santiago de Compostela, Spain
| | - Nazareth Martinón-Torres
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Universitario Clínico de Santiago, 15706 Santiago de Compostela, Spain
| | - Coral Tejido Sandoval
- Gastroenterology Department, Complejo Hospitalario Universitario de Ourense, 32005 Orense, Spain
| | - Alicia Rendo Vázquez
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Complejo Hospitalario Universitario de Ourense, 32005 Orense, Spain
| | - Pilar Corsino
- Inflammatory Bowel Disease Unit, Gastroenterology Department, Hospital Universitario Miguel Servet, Health Research Institute of Aragón, 50009 Zaragoza, Spain
| | - Raquel Vicente
- Inflammatory Bowel Disease Unit, Gastroenterology Department, Hospital Universitario Miguel Servet, Health Research Institute of Aragón, 50009 Zaragoza, Spain
| | - Alejandro Hernández-Camba
- Gastroenterology Department, Hospital Universitario Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Spain
| | - José Ramón Alberto Alonso
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Universitario Nuestra Señora de Candelaria, 38010 Santa Cruz de Tenerife, Spain
| | - I Alonso-Abreu
- Gastroenterology Department, Hospital Universitario de Canarias, 38320 Santa Cruz de Tenerife, Spain
| | - Ana María Castro Millán
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Universitario de Canarias, 38320 Santa Cruz de Tenerife, Spain
| | - Laia Peries Reverter
- Gastroenterology Department, Hospital Universitari de Girona Doctor Josep Trueta, 17007 Girona, Spain
| | - Beatriz Castro
- Gastroenterology Department, Hospital Universitario Marqués de Valdecilla, 39008 Santander, Spain
| | - Estela Fernández-Salgado
- Gastroenterology Department, Complejo Hospitalario Universitario de Pontevedra, 36071 Pontevedra, Spain
| | - M Mercedes Busto Cuiñas
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Complejo Hospitalario Universitario de Pontevedra, 36071 Pontevedra, Spain
| | - José Manuel Benítez
- Gastroenterology Department, Hospital Universitario Reina Sofía, IMIBIC, 14004 Córdoba, Spain
| | - Lucía Madero
- Gastroenterology Department, Hospital Universitario de Alicante, Instituto de Investigación Sanitaria y Biomedica (ISABIAL), 03010 Alicante, Spain
| | - Fernando Clemente
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Universitario de Alicante, 03010 Alicante, Spain
| | - Sabino Riestra
- Gastroenterology Department, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
| | - Santiago Jiménez-Treviño
- Paediatric Gastroenterology and Nutrition Unit, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain
| | - Maia Boscá-Watts
- Gastroenterology Department, Hospital Clínico de Valencia, 46010 Valencia, Spain
| | - Elena Crehuá-Gaudiza
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Clínico de Valencia, 46010 Valencia, Spain
| | - Marta Calvo Moya
- Inflammatory Bowel Disease Unit, Department of Gastroenterology and Hepatology, Hospital Puerta de Hierro, 28222 Madrid, Spain
| | - José María Huguet
- Gastroenterology Department, Consorcio Hospital General Universitario de Valencia, 46014 Valencia, Spain
| | - Ester-María Largo-Blanco
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Consorcio Hospital General Universitario de Valencia, 46014 Valencia, Spain
| | - Leticia González Vives
- Gastroenterology, Hepatology and Nutrition Unit, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain
| | - Rocío Plaza
- Gastroenterology Department, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain
| | - Iván Guerra
- Gastroenterology Department, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
| | - Josefa Barrio
- Paediatric Gastroenterology Unit, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
| | - Laura Escartín
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
| | - Erika Alfambra
- Gastroenterology Department, Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, Spain
| | - Noelia Cruz
- Gastroenterology Department, Hospital Doctor José Molina Orosa, 35500 Las Palmas, Spain
| | - M Carmen Muñoz
- Gastroenterology Department, Hospital Universitario de Basurto, 48013 Bilbao, Spain
| | | | | | - Belén Botella
- Gastroenterology Department, Hospital Universitario Infanta Cristina, 28981 Madrid, Spain
| | - David Monfort Miquel
- Gastroenterology Department, Centro Consorci Sanitari Terrassa, 08227 Terrassa, Spain
| | | | - Agustín De La Mano
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital de Henares, 28822 Madrid, Spain
| | - Yolanda Ber
- Gastroenterology Department, Hospital de San Jorge, 22004 Huesca, Spain
| | | | | | - María Chaparro
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28006 Madrid, Spain
| | - Javier P Gisbert
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28006 Madrid, Spain
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Dohos D, Váradi A, Farkas N, Erős A, Müller KE, Karoliny A, Gombos E, Nemes É, Vass N, Tárnok A, Hegyi P, Sarlós P. Hungarian Linguistic, Cross-Cultural and Age Adaptation of Transition Specific Questionnaires in Patients with Inflammatory Bowel Disease. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040711. [PMID: 37189959 DOI: 10.3390/children10040711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/31/2023] [Accepted: 04/09/2023] [Indexed: 05/17/2023]
Abstract
Objective: In the TRANS-IBD clinical trial, the outcomes are measured with selected validated questionnaires. Cross-cultural and age adaptations of the Self-Efficacy Scale for adolescents and young adults (IBD-SES), the Transition Readiness Assessment Questionnaire (TRAQ), and the Self-Management and Transition Readiness Questionnaire (STARx) were performed. Methods: Linguistic and cultural adaptation was carried out with the usage of reliability coefficients (Cronbach's α coefficients, Spearman's rank correlation), and with confirmatory factor analysis (CFA; root Mean Square Error of Approximation [RMSEA], Comparative Fit Index [CFI], and Tucker-Lewis Index [TLI]). Results: 112 adolescents participated in the study (45.5% male, mean age 17 ± 1.98 years). CFA was acceptable in the IBD-SES and the TRAQ. Internal consistency was acceptable in IBD-SES and good in TRAQ (0.729; 0.865, respectively). Test-retest reliability was good in IBD-SES, but below the acceptable threshold in TRAQ (ρ = 0.819; ρ = 0.034). In STARx tools, RMSEA showed poor fit values, CFI and TLI were below acceptable fit values, and internal consistency was not satisfied (0.415; 0.693, respectively), while test-retest reliabilities were acceptable (ρ = 0.787; ρ = 0.788, respectively). Conclusions: Cross-cultural, age-specific adaptation was successfully completed with IBD-SES and TRAQ. Those are comparable to the original validated versions. The adaption of the STARx tools was not successful.
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Affiliation(s)
- Dóra Dohos
- Institute for Translational Medicine, Medical School, University of Pécs, 12 Szigeti Street, HU-7624 Pécs, Hungary
- Szentágothai Research Centre, University of Pécs, 20 Ifjúság Street, HU-7624 Pécs, Hungary
- Heim Pál National Institute of Pediatrics, 86 Üllői Street, HU-1089 Budapest, Hungary
| | - Alex Váradi
- Institute for Translational Medicine, Medical School, University of Pécs, 12 Szigeti Street, HU-7624 Pécs, Hungary
| | - Nelli Farkas
- Institute for Translational Medicine, Medical School, University of Pécs, 12 Szigeti Street, HU-7624 Pécs, Hungary
| | - Adrienn Erős
- Heim Pál National Institute of Pediatrics, 86 Üllői Street, HU-1089 Budapest, Hungary
| | - Katalin Eszter Müller
- Institute for Translational Medicine, Medical School, University of Pécs, 12 Szigeti Street, HU-7624 Pécs, Hungary
- Heim Pál National Institute of Pediatrics, 86 Üllői Street, HU-1089 Budapest, Hungary
- Department of Family Care Methodology, Faculty of Health Science, Semmelweis University, 17 Vas Street, HU-1088 Budapest, Hungary
| | - Anna Karoliny
- Heim Pál National Institute of Pediatrics, 86 Üllői Street, HU-1089 Budapest, Hungary
| | - Eszter Gombos
- Heim Pál National Institute of Pediatrics, 86 Üllői Street, HU-1089 Budapest, Hungary
| | - Éva Nemes
- Department of Pediatrics, Clinical Center, University of Debrecen, 98 Nagyerdei Boulevard, HU-4032 Debrecen, Hungary
| | - Noémi Vass
- Albert Szent-Györgyi Clinical Center of Pediatrics and Child Health Centre, University of Szeged, 14-15, Korányi Street, HU-6725 Szeged, Hungary
| | - András Tárnok
- Department of Pediatrics, Medical School, University of Pécs, 7 József Attila Street, HU-7623 Pécs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Medical School, University of Pécs, 12 Szigeti Street, HU-7624 Pécs, Hungary
- Szentágothai Research Centre, University of Pécs, 20 Ifjúság Street, HU-7624 Pécs, Hungary
- Centre for Translational Medicine, Semmelweis University, 26 Üllői Street, HU-1085 Budapest, Hungary
- Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, 9 Gaál József Street, HU-1122 Budapest, Hungary
| | - Patrícia Sarlós
- Institute for Translational Medicine, Medical School, University of Pécs, 12 Szigeti Street, HU-7624 Pécs, Hungary
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, 13 Ifjúság Street, 7624 Pécs, Hungary
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Hungarian Linguistic, Cross-Cultural, and Age Adaptation of the Patient Satisfaction with Health Care in Inflammatory Bowel Disease Questionnaire (CACHE) and the Medication Adherence Report Scale (MARS). CHILDREN 2022; 9:children9081143. [PMID: 36010034 PMCID: PMC9406584 DOI: 10.3390/children9081143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/24/2022] [Accepted: 07/26/2022] [Indexed: 12/02/2022]
Abstract
Background: The TRANS-IBD study examines the superiority of joint transition visits, with drug adherence and patient satisfaction among the outcome measures. Our aim was a cross-cultural, age- and disease-specific adaptation of the ‘Medication Adherence Rating Scale’ (MARS) and ‘Patient satisfaction with health care in inflammatory bowel disease questionnaire’ (CACHE) questionnaires in patients with inflammatory bowel disease (IBD). Methods: Linguistic and cultural adaptation using test and re-test procedures were performed. Internal consistency with Cronbach’s α coefficients, confirmatory factor analyses with root Mean Square Error of Approximation (RMSEA), Comparative Fit Index (CFI), and Tucker-Lewis Index (TLI) were determined. Results: A total of 122 adolescents and 164 adults completed the questionnaires (47.5% male, mean age 17 ± 1; and 29.3% male, mean age 38 ± 11, respectively). In the MARS questionnaire, Cronbach’s α scores were found good in adolescents (0.864) and acceptable in adults (0.790), while in the CACHE questionnaire, scores were rated as excellent in both populations (0.906 and 0.945, respectively). The test-retest reliabilities were satisfactory in both groups (MARS questionnaire: r = 0.814 and r = 0.780, CACHE questionnaire: r = 0.892 and r = 0.898, respectively). RMSEA showed poor fit values in the MARS questionnaire and reasonable fit values in the CAHCE questionnaire, CFI and TLI had statistically acceptable results. Conclusion: Age-and disease-specific Hungarian versions of the questionnaires were developed, which are appropriate tools for TRANS-IBD RCT and daily IBD care.
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Mollah T, Lee D, Giles E. Impact of a new young adult inflammatory bowel disease transition clinic on patient satisfaction and clinical outcomes. J Paediatr Child Health 2022; 58:1053-1059. [PMID: 35170119 DOI: 10.1111/jpc.15907] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 01/20/2022] [Accepted: 01/26/2022] [Indexed: 01/09/2023]
Abstract
AIM The transition from paediatric to adult care for patients with inflammatory bowel disease (IBD) is associated with an increased risk of treatment non-adherence, hospitalizations and emergency department (ED) use. We established a new young adult IBD clinic (YAC) in Melbourne to capture this at-risk population. We aimed to assess patient satisfaction as well as clinical outcomes. METHODS All patients who attended the YAC between its inception in November 2016 and November 2018 were recruited to our YAC group, 61 patients in total. A control group was selected from the pre-existing adult clinic (AC) at our service, 34 patients in total. IBD-related ED (IBD-ED) visits were collected for all patients. We compared IBD-ED visits in the 2 years before and after attending the clinic for the first time. Patient satisfaction was assessed using the IBD-Patient Satisfaction Questionnaire. RESULTS There was an overall decrease in IBD-ED visits between the pre-clinic and post-clinic periods in both the YAC (42.9% reduction) and AC (69.2% reduction) (P < 0.001). Patient satisfaction was high amongst both services with YAC patients indicating higher satisfaction with communication (P = 0.015). CONCLUSION There was a reduction in IBD-ED visits in both the YAC and the AC, high patient satisfaction, and statistically higher satisfaction with communication in the YAC. We speculate the importance of a YAC is to capture those patients in the peri-transitional period at risk of being lost to follow-up or not previously referred for specialist care.
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Affiliation(s)
- Taha Mollah
- Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia
| | - Dongju Lee
- Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia
| | - Edward Giles
- Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia
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8
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García-Rodríguez F, Raygoza-Cortez K, Moreno-Hernandez L, García-Pérez R, Garza Lopez LE, Arana-Guajardo AC, Jáquez-Quintana JO, Villarreal-Treviño AV, de la O-Cavazos ME, Rubio-Pérez N. Outcomes of transitional care programs on adolescent chronic inflammatory systemic diseases: systematic review and meta-analyses. Pediatr Rheumatol Online J 2022; 20:15. [PMID: 35177101 PMCID: PMC8851760 DOI: 10.1186/s12969-022-00670-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/22/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Patients with juvenile chronic inflammatory systemic diseases (jCID) are vulnerable to many circumstances when transitioning to adult-centered healthcare; this increases the burden of disease and worsen their quality of life. METHODS MEDLINE, Embase, Web of Science and Scopus were searched from inception to March 16th, 2021. We included observational, randomized controlled trials and quasi-experimental studies that evaluated a transitional care program for adolescents and young adults with jCIDs. We extracted information regarding health-related quality of life, disease activity, drop-out rates, clinical attendance rates, hospital admission rates, disease-related knowledge, surgeries performed, drug toxicity and satisfaction rates. RESULTS Fifteen studies met our inclusion criteria. The implementation of transition programs showed a reduction on hospital admission rates for those with transition program (OR 0.28; 95% CI 0.13 to 0.61; I 2 = 0%; p = 0.97), rates of surgeries performed (OR 0.26; 95% CI 0.12 to 0.59; I 2 = 0%; p = 0.50) and drop-out rates from the adult clinic (OR 0.23; 95% CI 0.12 to 0.46; I 2 = 0%; p = 0.88). No differences were found in other outcomes. CONCLUSION The available body of evidence supports the implementation of transition programs as it could be a determining factor to prevent hospital admission rates, surgeries needed and adult clinic attendance rates.
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Affiliation(s)
- Fernando García-Rodríguez
- grid.411455.00000 0001 2203 0321Department of Pediatrics, School of Medicine and University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Av Madero Y Gonzalitos S/N, Col. Mitras Centro, 64460 Monterrey, Mexico
| | - Karina Raygoza-Cortez
- grid.411455.00000 0001 2203 0321Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, 64460 México
| | - Lesli Moreno-Hernandez
- grid.411455.00000 0001 2203 0321Department of Pediatrics, School of Medicine and University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Av Madero Y Gonzalitos S/N, Col. Mitras Centro, 64460 Monterrey, Mexico
| | - Rodrigo García-Pérez
- grid.411455.00000 0001 2203 0321Department of Pediatrics, School of Medicine and University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Av Madero Y Gonzalitos S/N, Col. Mitras Centro, 64460 Monterrey, Mexico
| | - Leticia Elizabeth Garza Lopez
- grid.411455.00000 0001 2203 0321Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, 64460 México
| | - Ana Cecilia Arana-Guajardo
- Servicio de Reumatología, Instituto de Medicina Interna. Escuela Nacional de Medicina Sistema Tec Salud, Monterrey, Mexico
| | - Joel Omar Jáquez-Quintana
- grid.411455.00000 0001 2203 0321Gastroenterology Service and Department of Internal Medicine, School of Medicine and University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Av Madero Y Gonzalitos S/N, Col. Mitras Centro, 64460 Monterrey, Mexico
| | - Ana Victoria Villarreal-Treviño
- grid.411455.00000 0001 2203 0321Department of Pediatrics, School of Medicine and University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Av Madero Y Gonzalitos S/N, Col. Mitras Centro, 64460 Monterrey, Mexico
| | - Manuel Enrique de la O-Cavazos
- grid.411455.00000 0001 2203 0321Department of Pediatrics, School of Medicine and University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Av Madero Y Gonzalitos S/N, Col. Mitras Centro, 64460 Monterrey, Mexico
| | - Nadina Rubio-Pérez
- Department of Pediatrics, School of Medicine and University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Av Madero Y Gonzalitos S/N, Col. Mitras Centro, 64460, Monterrey, Mexico.
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9
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Volpato E, Bosio C, Previtali E, Leone S, Armuzzi A, Pagnini F, Graffigna G. The evolution of IBD perceived engagement and care needs across the life-cycle: a scoping review. BMC Gastroenterol 2021; 21:293. [PMID: 34261434 PMCID: PMC8278693 DOI: 10.1186/s12876-021-01850-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 06/21/2021] [Indexed: 12/22/2022] Open
Abstract
Background The chronic and progressive evolution of Inflammatory Bowel Diseases (IBD), with its prototypical fluctuating trend, creates a condition of psycho-social discomfort, impacting the quality of life in terms of personal, working, and interpersonal. Aims In this article, we want to identify the nature and extent of the research evidence on the life experiences, the perceived engagement, the psychological, social care and welfare needs of people affected by IBD across the lifecycle. Methods Following the approach set out by Arksey and O’Malley and the PRISMA extension for scoping reviews, we conducted a scoping review in March 2019 and closed the review with an update in October 2019. It was performed using electronic databases covering Health and Life Sciences, Social Sciences and Medical Sciences, such as PubMed, Medline, Embase, Scopus, Cochrane, Web of Science, PsycInfo. Results We identified 95 peer-reviewed articles published from 2009 to 2019, that allowed to detection the main needs in children (psychological, need to be accepted, physical activity, feeding, parent style, support, social needs), adolescents (to understand, physical and psychological needs, protection, relational, gratitude, respect, and engagement) and adults (information, medical, psychological, social, work-related, practical, future-related, engagement). Although the literature confirms that the majority of the IBD units have planned provision for the different types of transitions, the quality and appropriateness of these services have not been assessed or audited for all the kinds of challenges across the life cycle. Conclusions The literature shows the relevance of organizing a flexible, personalized health care process across all the critical phases of the life cycle, providing adequate benchmarks for comparison in a multidisciplinary perspective and ensuring continuity between hospital and territory. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-021-01850-1.
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Affiliation(s)
- E Volpato
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, 20123, Milan, Italy. .,IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy.
| | - C Bosio
- EngageMinds Hub Consumer, Food and Health Research Center, Università Cattolica del Sacro Cuore, Milan, Cremona, Italy
| | - E Previtali
- AMICI Onlus, Associazione nazionale per le Malattie Infiammatorie Croniche dell'Intestino, Milan, Italy
| | - S Leone
- AMICI Onlus, Associazione nazionale per le Malattie Infiammatorie Croniche dell'Intestino, Milan, Italy
| | - A Armuzzi
- Università Cattolica del Sacro Cuore di Roma, Rome, Italy.,IRCCS Policlinico Gemelli, Rome, Italy
| | - F Pagnini
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, 20123, Milan, Italy.,Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA, 02138, USA
| | - G Graffigna
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, 20123, Milan, Italy.,EngageMinds Hub Consumer, Food and Health Research Center, Università Cattolica del Sacro Cuore, Milan, Cremona, Italy
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10
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Overview of Self-Management Skills and Associated Assessment Tools for Children with Inflammatory Bowel Disease. GASTROINTESTINAL DISORDERS 2021. [DOI: 10.3390/gidisord3020007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Self-management is a multi-modal approach for managing chronic conditions that encompasses a number of different elements; knowledge, adherence, self-regulation, communication, and cognitive factors. Self-management has been shown to be beneficial for adults with inflammatory bowel disease (IBD), and for children with IBD it may help them learn to take control of their complex treatment regimens and lead to positive disease outcomes. The development of self-management skills for children with IBD is vital in order to maximize their potential for health autonomy, but it is still an emergent field in this population. This review provides an over-arching view of the self-management elements specific to children with IBD, and highlights outcome measures that may be used to assess skills within each field as well as the efficacy of targeted interventions.
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11
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A Cross-Sectional Survey on the Transitional Care of Adolescents with Inflammatory Bowel Disease in Hungary. J Pediatr Nurs 2020; 55:e279-e285. [PMID: 32624314 DOI: 10.1016/j.pedn.2020.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 06/04/2020] [Accepted: 06/07/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE Since little is known about transitional care practices of adolescents with inflammatory bowel diseases (IBD) in Central-Eastern Europe, we aimed to investigate the currently applied transition practices in Hungary. DESIGN AND METHODS A nationwide, multicentre survey was conducted with the invitation of 41 pediatric and adult IBD centres in February 2019.We developed a 34-item questionnaire, which included single- and multiple-choice questions related to the current clinical practice of IBD transition. RESULTS The overall response rate was 31.7% (13/41); answers came predominantly from tertiary centres. Only 15.4% of the respondent centres followed international IBD guidelines. The majority of the IBD centres provided transition support; however, responses revealed a marked heterogeneity of these services. Joint visits were held only in 54% of the clinics. Gastroenterologists and next of kin are not provided education regarding transition across most centres (85 and 92%). Although adolescents received age-specific education, transition readiness was not measured. More IBD nurses and dietitians were employed in adult centres than in pediatric ones. CONCLUSIONS The current survey revealed critical gaps in the Hungarian IBD transition practices. As the beneficial effects of structured IBD transition programmes are recognized in Hungary, there is a growing need for the introduction of new, more effective transition practices. PRACTICE IMPLICATIONS Our results can serve as a basis for planning more effective transition strategies.
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12
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Rohatinsky N, Risling T, Hellsten LAM, Kumaran M. Inflammatory Bowel Disease Nurses' Perspectives: Prioritizing Adolescent Transition Readiness Factors. J Pediatr Nurs 2020; 55:29-39. [PMID: 32634732 DOI: 10.1016/j.pedn.2020.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/21/2020] [Accepted: 06/21/2020] [Indexed: 01/18/2023]
Abstract
PURPOSE Despite the wealth of knowledge and expertise that Inflammatory Bowel Disease (IBD) nurses bring to the transition process, health literature lacks nurses' perspectives on transition readiness. The purpose of study was to ask IBD nurses to prioritize care transition readiness factors for adolescents living with IBD. DESIGN AND METHODS The cross-sectional exploratory survey was researcher-developed and distributed online to IBD nurses across Canada. The survey was divided into nine transition topic categories. RESULTS Fifty-six female registered nurses from six Canadian provinces participated in the study. Overall, nurses rated all items within each transition topic category to be very important in facilitating adolescent transition to adult healthcare. The highest individual mean scores and the highest prioritized categories were within the Knowing IBD and Healthcare Provider Relationships categories, emphasizing the importance for adolescents to understand their disease and feel comfortable communicating their needs and questions to healthcare providers. CONCLUSIONS The transition process needs to be individualized and comprehensive addressing a multitude of biopsychosocial factors in order to support IBD patients and families to achieve healthy adult self-care behaviours that can foster positive health outcomes. PRACTICE IMPLICATIONS Healthcare providers, adolescents, and parents must work collaboratively to achieve identified transition goals so that the transition process is a mutually satisfying experience. A comprehensive readiness assessment tool is suggested to assist in the transition process. Transition readiness assessment must start early, be ongoing, be age-appropriate, and be individualized to the patient needs.
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Affiliation(s)
| | - Tracie Risling
- College of Nursing, University of Saskatchewan, SK, Canada.
| | - Laurie-Ann M Hellsten
- Department of Educational Psychology and Special Education, College of Education, University of Saskatchewan, SK, Canada.
| | - Maha Kumaran
- Education & Music Library, University of Saskatchewan, SK, Canada.
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13
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Erős A, Dohos D, Veres G, Tárnok A, Vincze Á, Tészás A, Zádori N, Gede N, Hegyi P, Sarlós P. Effect of joint transition visits on quality of life in adolescents with inflammatory bowel diseases: a protocol for a prospective, randomised, multicentre, controlled trial (TRANS-IBD). BMJ Open 2020; 10:e038410. [PMID: 33028560 PMCID: PMC7539589 DOI: 10.1136/bmjopen-2020-038410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 08/14/2020] [Accepted: 08/20/2020] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Inflammatory bowel diseases (IBD) are among the most common chronic illnesses diagnosed in childhood. Transition from paediatric to adult care is a crucial phase. The implementation of joint visits during the transition period in IBD is widely recommended, however, strong evidence supporting their benefit is still missing. In this trial, we aim to prove the superiority of joint visits compared with usual care in improving transition outcomes of adolescents with IBD. METHODS AND ANALYSIS This is a randomised controlled two-arm multicentre trial. A minimum of 160 adolescents with IBD aged between 16.75 and 17 years will be recruited from Hungarian tertiary IBD centres. After randomisation, eligible subjects in the intervention arm attend a total of four joint visits with adult and paediatric gastroenterologist between the ages of 17 and 18. In the control arm, adolescents meet only the paediatric gastroenterologist, but there is a balanced consultation between the two gastroenterologist regarding the patient's treatment plan. Patients in both groups receive the same training and education, the only determinative difference between the two arms is the presence of the adult gastroenterologist at the joint visits. Data will be collected at inclusion, at transfer and 12 months post-transfer. Primary outcome is the change in health-related quality of life measured with the IMPACT-III questionnaire at 1 year after transfer. Secondary outcomes include the number of patients not lost to follow-up, healthcare utilisation, disease activity, medication adherence, self-efficacy, transition readiness and patient's satisfaction. To compare the results of the two patient groups, two-sample T-test and Mann-Whitney test will be applied. ETHICS AND DISSEMINATION The Scientific and Research Ethics Committee of the Hungarian Medical Research Council approved this study (50457-2/2019/EKU). Findings will be disseminated at conferences and in medical journals. TRIAL REGISTRATION NUMBER NCT04290156.
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Affiliation(s)
- Adrienn Erős
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Heim Pál Children's Hospital, Budapest, Hungary, Budapest, Hungary
- Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Dóra Dohos
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Gábor Veres
- First Department of Pediatrics, University of Debrecen, Hungary, Debrecen, Hungary
| | - András Tárnok
- Department of Pediatrics, Medical School, University of Pécs, Pécs, Hungary
| | - Áron Vincze
- First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary, Pécs, Hungary
| | - Alexandra Tészás
- Department of Pediatrics, Medical School, University of Pécs, Pécs, Hungary
| | - Noémi Zádori
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Noémi Gede
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
- First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary, Pécs, Hungary
- Momentum Gastroenterology Multidisciplinary Research Group, Hungarian Academy of Sciences, University of Szeged, Szeged, Hungary
| | - Patrícia Sarlós
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
- First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary, Pécs, Hungary
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14
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Can a transition clinic bridge the gap between paediatric and adult inflammatory bowel disease care models? Dig Liver Dis 2020; 52:516-527. [PMID: 32234418 DOI: 10.1016/j.dld.2020.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 02/06/2023]
Abstract
Transition care in inflammatory bowel disease is increasingly recognized as challenging given the inherent differences between paediatric and adult health care models, disease characteristics and treatment strategies. Transition is a dynamic process involving adolescents and young adults that are moving from a paediatric to an adult health care setting, and it should be flexible, continually updated and tailored to each patient. The implementation of a transition clinic is essential given the increasing incidence of the paediatric population with inflammatory bowel disease and the lifelong impact of this disease. The key question is when and how to structure transition according to the adolescent's clinical, psycho-social, educational needs and expectations to ensure continuity of care. In the attempt to improve the management of transition in inflammatory bowel disease and address the wide gap between adult and child care, we provide an update of the transition clinic and we propose a "treat to target" approach in transition to facilitate an effective and successful transition programme. In the changing landscape of the treatment of inflammatory bowel disease, further studies are necessary to determine the role of the transition clinic in determining the choice and strategy of therapy and its monitoring and the adoption of newer strategies such as biomarkers guided treating to target.
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15
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Erős A, Soós A, Hegyi P, Szakács Z, Erőss B, Párniczky A, Mezősi E, Rumbus Z, Sarlós P. Spotlight on Transition in Patients With Inflammatory Bowel Disease: A Systematic Review. Inflamm Bowel Dis 2020; 26:331-346. [PMID: 31504524 DOI: 10.1093/ibd/izz173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Transition of adolescents from pediatric to adult care is of great importance in the management of inflammatory bowel disease (IBD). Our aim was to review and summarize the currently applied interventions and outcomes related to transition practices in IBD. METHODS A systematic review was performed in accordance with the PRISMA Statement. We searched PubMed, EMBASE, CENTRAL, and Web of Science databases up to February 15, 2019. Controlled studies evaluating adolescents and young adults with IBD participating in structured transition interventions or patient educational programs and single-arm (before-after) studies were included. Several individual, health care, and social outcomes were assessed. The PROSPERO registration number is CRD42019118520. RESULTS A total of 23 articles were eligible for qualitative synthesis. Eleven studies compared an intervention to a control group, whilst 12 studies were uncontrolled before-after studies. The age of the participants varied from 11 to 25 years. The most common structured transition interventions were joint visits and patient education programs. IBD nurses were operating as nominated transition coordinators in the transition process. Quality of life, patient satisfaction, self-efficacy, disease-specific knowledge, adherence rate, and nonattendance rate at outpatient clinic were identified as main health care transition outcomes besides disease-related outcomes. Despite the various study designs and methodological limitations, outcomes improved with the application of structured transition interventions in eleven of the studies. CONCLUSION These results facilitate the design of randomized controlled trials along better standards in transitional care in IBD.
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Affiliation(s)
- Adrienn Erős
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Alexandra Soós
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Clinical Medicine Doctoral School, University of Szeged, Szeged, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,Hungarian Academy of Sciences-University of Szeged Momentum Gastroenterology Multidisciplinary Research Group, Szeged, Hungary.,First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Zsolt Szakács
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Bálint Erőss
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Andrea Párniczky
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,Heim Pál Children's Hospital, Budapest, Hungary
| | - Emese Mezősi
- Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary.,First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Zoltán Rumbus
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Patricia Sarlós
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
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