Transitions in Pediatric Gastroenterology

Bensen, Rachel; McKenzie, Rebecca; Fernandes, Susan M.; Fishman, Laurie N.

doi:10.1097/mpg.0000000000001199

Cited by 28 publications

(21 citation statements)

References 23 publications

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“…Pediatric subspecialists in other fields report caring for patients into their mid-20s or 30s in pediatric clinics. 24,25 Providers who practice at free-standing children's hospitals and have been in practice longer have been shown to be more likely to care for patients into adulthood. 26 Age is not the only factor that acts as a catalyst for the transfer to adult care.…”

Section: Discussionmentioning

confidence: 99%

“…Perceived readiness for an adult model of care, as well as life milestones such as graduation or marriage, may all prompt transfer. 24,25,27,28 Pediatric subspecialists across many fields report transferring patients when they become pregnant, develop adult comorbidities, or are found to abuse illicit substances or alcohol, which sometimes lead to precipitous transfer of patients who have not yet achieved readiness. 29 In contrast, clinicians may be hesitant to transfer patients with ongoing active disease, upcoming planned procedures, or endstage disease.…”

Section: Discussionmentioning

confidence: 99%

“…This is a trend seen across most pediatric subspecialties. [24][25][26][27]30,31,35,37,40,43 It is unclear why this barrier was seen as more prohibitive in the 2018 survey compared to the 2010 survey. In addition to the provider's relationship with the patient, adolescent knowledge and advocacy skills continue to be a barrier, echoed in findings from other chronic diseases like type 1 diabetes mellitus, inflammatory bowel disease (IBD), and various cancers.…”

Section: Discussionmentioning

confidence: 99%

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Differences in Healthcare Transition Views, Practices, and Barriers Among North American Pediatric Rheumatology Clinicians From 2010 to 2018

et al. 2021

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Objective Since 2010, the rheumatology community has developed guidelines and tools to improve healthcare transition . In this study we aimed to compare current transition practices and beliefs among Childhood Arthritis and Rheumatology Research Alliance (CARRA) rheumatology providers with transition practices from a 2010 provider survey published by Chira et al. Methods In 2018, CARRA members completed a 25-item online survey about healthcare transition. Got Transition’s™ Current Assessment of Health Care Transition Activities was used to measure clinical transition processes on a scale of 1 (basic) to 4 (comprehensive). Bivariate analyses were used to compare 2010 and 2018 survey findings. Results Over half of CARRA members completed the survey (217/396), including pediatric rheumatologists, adult- and pediatric-trained rheumatologists, pediatric rheumatology fellows, and advanced practice providers. The most common target age to begin transition planning was 15-17 (49%). Most providers transferred patients prior to age 21 or older (75%). Few providers used the American College of Rheumatology transition tools (31%) or have a dedicated transition clinic (23%). Only 17% had a transition policy in place, and 63% did not consistently address healthcare transition with patients. When compared to the 2010 survey, improvement was noted in three of twelve transition barriers: availability of adult primary care providers, availability of adult rheumatologists, and pediatric staff transition knowledge and skills (p<0.001 for each). Nevertheless, the mean Current Assessment score was less than 2 for each measurement. Conclusion This study demonstrates improvement in certain transition barriers and practices since 2010, although implementation of structured transition processes remains inconsistent.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Differences in Healthcare Transition Views, Practices, and Barriers Among North American Pediatric Rheumatology Clinicians From 2010 to 2018

et al. 2021

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“…Despite this direction, Bensen et al showed in a national paediatric gastroenterology survey that there is tremendous variability in practice across all diseases but especially IBD (48% of respondents) ( 11 ). Gray et al also recently showed that only 50% of American paediatric gastroenterologist survey respondents were familiar with current recommendations and less than 1% based their practices entirely on them ( 12 ).…”

Section: Discussionmentioning

confidence: 99%

Paediatric to Adult Transition of Care in IBD: Understanding the Current Standard of Care Among Canadian Adult Academic Gastroenterologists

Jawaid

Jeyalingam

Nguyen

et al. 2019

Journal of the Canadian Association of Gastroenterology

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Background The optimal form of health care delivery for paediatric to adult inflammatory bowel disease transition of care is unknown. The primary purpose of this study was to establish current standard of care across Canada among adult gastroenterologists. Methods Adult gastroenterologists interested in transition care were identified. Twenty-five anonymous surveys and 17 semistructured interviews representing 9 adult gastroenterology centers across 6 provinces were completed. Questions focused on the transition process, referral practices, information transfer and access to multidisciplinary resources. The need for expert guidance and transition-related quality indicators were identified. The interviews were audio-recorded, transcribed and coded in duplicate for qualitative thematic analysis. Results Transition practices included the following: transition clinic (n = 4) versus direct transfer (n = 5). Most transition patients were referred to academic centers. Transfer volume per center ranged from 12 to 100 per year. Transfer of information was optimized with shared electronic medical record and comprehensive referral package. The majority of the programs lacked consistent access to a multidisciplinary team. The strongest attributes related to health care provider interest in transition and complete information transfer. Areas for improvement included increased resource allocation: financial, logistical and personnel. All agreed that a consensus-based guidfmeline for adult phase of transition would be beneficial. Potential quality indicators included adherence to care, depression/anxiety scores and patient knowledge. Conclusions This Canadian study of adult gastroenterologists revealed that while practice patterns vary, most agree that a transition clinic with access to multidisciplinary resources would be beneficial. A consensus-based guideline and quality indicators to assess performance may standardize the adult phase of transition and optimize outcomes.

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“…In the case of patients with IBD, the transfer typically requires a request for consultation from the pediatric gastroenterologist to the adult provider, accompanied by a summary letter describing the details of the patient’s disease, treatments, complications and psychosocial history ( 6 , 7 ). In a survey of adult gastroenterologists, the sub-optimal quality of the documentation sent by pediatricians was identified as one of the barriers to a successful transfer to adult care ( 8 , 9 ). A template for a transfer letter was included in the transition guidelines produced by The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) ( 10 ).…”

Section: Introductionmentioning

confidence: 99%

Medical Summary Template for the Transfer of Patients with Inflammatory Bowel Disease from Pediatric to Adult Care

Benchimol

Afif

Plamondon

et al. 2021

Journal of the Canadian Association of Gastroenterology

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Background The transfer of information is a key aspect of the transition of adolescent patients with inflammatory bowel disease (IBD) from pediatric to adult care. This is typically accomplished through the use of a consultation letter with a medical summary of the patient being transferred. To improve the quality and completeness of information included in a transfer letter, we developed a standardized medical summary template by integrating the feedback of adult and pediatric health care providers. Methods To develop the letter template, we purposively sampled gastroenterologists or nurse practitioners caring for patients with IBD in four Canadian cities and invited them to take part in focus group discussions. Using a semi-structured approach, we explored the items deemed essential for inclusion in a transfer summary. Using the conventional content analysis framework, the focus group discussions were inductively coded to identify areas of priority for inclusion in the template. Results Four focus groups were conducted, comprising 17 health care providers of 30 invited (56.7% participation). The resulting medical summary template included the following major headings: patient/disease characteristics, therapeutics history (including medications and surgeries), clinical history and current status, noteworthy investigations, history of complications (including hospitalizations), family history, immunization history and psychosocial history. The template also addressed health system process factors (i.e., urgency of transfer, mode of delivery and confidentiality) to ensure a seamless transfer to adult care. Conclusions The standardized medical summary template should be used by pediatric providers to ensure that essential patient information and disease characteristics are sent to an adult provider.

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Transitions in Pediatric Gastroenterology

Abstract: Preferences and practices surrounding transition preparation and transfer to adult care vary widely, reflecting continued uncertainty regarding optimal transition strategies.

Cited by 28 publications

References 23 publications

Differences in Healthcare Transition Views, Practices, and Barriers Among North American Pediatric Rheumatology Clinicians From 2010 to 2018

Differences in Healthcare Transition Views, Practices, and Barriers Among North American Pediatric Rheumatology Clinicians From 2010 to 2018

Paediatric to Adult Transition of Care in IBD: Understanding the Current Standard of Care Among Canadian Adult Academic Gastroenterologists

Medical Summary Template for the Transfer of Patients with Inflammatory Bowel Disease from Pediatric to Adult Care

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