Successful transition from pediatric to adult care in inflammatory bowel disease: what is the key?

Abstract

The incidence of pediatric-onset inflammatory bowel disease (IBD) is on the rise, accounting for up to 25% of IBD cases. Pediatric IBD often has extensive bowel involvement with aggressive and rapidly progressing behavior compared to adult IBD. Because IBD has a high morbidity rate and can have a lifelong impact, successful transition from pediatric to adult care is important to maintain the continuity of care. Furthermore, successful transition facilitates appropriate development and psychosocial well-being among patients, as well as comprehensive and harmonious healthcare delivery amongst stakeholders. However, there are various obstacles related to patients, family, providers, and organizations that interfere with successful transition. Successful transition requires a flexible and tailored plan that is made according to the patient’s developmental abilities and situation. This plan should be established through periodic interviews with the patient and family and through close collaboration with other care providers. Through a stepwise approach to the transition process, patients’ knowledge and self-management skills can be improved. After preparation for the transition is completed and the obstacles are overcome, patients can be gradually moved to adult care. Finally, successful transition can increase patients’ adherence to therapy, maintain the appropriate health status, improve patients’ self-management, and promote self-reliance among patients.

Knowledge of disease and self‐management of adolescents with inflammatory bowel diseases

“…In another study, age over 18 years was associated with a better knowledge of diagnosis and medication names than age under 14 years (94% and 89% compared with 45% and 58%, respectively). Similar to our study, others also reported 38%‐66% of medication non‐adherence in paediatric‐onset IBD, whereas adults show a better adherence to the treatment (69%‐82%) . A structured transition service was perceived as very important by 80% paediatric gastroenterologists, while 79% of adult gastroenterologists identified inadequacies in the preparation for transfer .…”

“…Similar to our study, others also reported 38%-66% of medication non-adherence in paediatric-onset IBD, 23 whereas adults show a better adherence to the treatment (69%-82%). 24,25 identified inadequacies in the preparation for transfer.…”

“…Our findings, strengthened by the mentioned above studies, reinforce the importance of adopting a structured transition plan and assessment of transition readiness in IBD centres and may suggest that the transition process should begin at an older age with engagement of patient, their parents and treating physicians to this process …”

“…Our findings, strengthened by the mentioned above studies, reinforce the importance of adopting a structured transition plan and assessment of transition readiness in IBD centres and may suggest that the transition process should begin at an older age with engagement of patient, their parents and treating physicians to this process. 3,[23][24][25][26] Another concerning point was that only 35% of the participants knew the effect of smoking on their disease, regardless of IBD subtype. Whitfield et al, 15 addressing the same question, showed that 56% of the patients above age 18 years knew the negative effects of smoking on their disease, compared with less than 10% in those younger than 14 years.…”

Transition clinics: an observational study of themes important to young people with inflammatory bowel disease

“…The timing of and readiness for transition has been shown to be one of the most important factors determining the success of the process of transfer of care (7,21). Patients' readiness and involvement, disease stability and health care providers' communication are some of the factors that may contribute to this process (8,13).…”