A Structured Transition Process for the Care of Adolescents with Inflammatory Bowel Disease: Does It Matter?

Abstract

Purpose: Adolescents with inflammatory bowel disease (IBD) have unique disease and psychosocial issues that require thoughtful multidisciplinary planning in care transition. Our aim was to examine the perceived requirements and barriers to a successful transition process across Canada. Methods: A 17-question web-link survey was distributed to all 393 members of the Canadian Association of Gastroenterology. Questions focusing on requirements and barriers to successful IBD care transition, as well as attitudes towards this process, were included. Results: Seventy-four responses (18.8% overall rate), which included 51 (68.9%) academic, 17 (23.0%) pediatric, and 52 (70.3%) adult gastroenterologists (GIs). Fifteen percent of adult academic GIs, compared to 34.0% of pediatric GIs, completed this study. A structured transition process was perceived as necessary and beneficial for the majority of adolescents with IBD in 71.8% and 80.3% of total respondents, respectively. Identified barriers to this process include lack of funding and resources, geographical isolation, insufficient healthcare professionals to participate, and poor transfer documentation. Only 46.5% of respondents' institutions had a structured transition process, and 31.6% had a dedicated transition clinic. Determinants for referring patients to transition clinics include patients' age, maturity, disease activity, and complexity. The most important components deemed to result in a successful transition process included: comprehensive transfer notes, complete and timely assessment by GIs transferring and receiving care. A successful transition was thought to occur when patients were fully informed of their disease and management plans. Pediatric and adult GIs hold different views toward the adolescent IBD transition process. When compared to adult GIs, significantly more pediatric GIs perceived a structured transition process as necessary (p = 0.001), and would benefit more adolescents with IBD (p = 0.002). More pediatric GIs interacted with adolescents with IBD (67.3% vs. 100%, p = 0.0072), participated (34.7% vs. 94.1%, p < 0.0001) and had a formalized transition process (34.7% vs. 82.4%, p = 0.0036). Conclusion: Pediatric GIs play a larger role than adult GIs in the structured transition process for adolescent IBD patients in Canada. Perceived barriers limiting this practice in Canada include prevailing adult GI attitudes that transition care is not necessary, and the lack of dedicated resources. Future research must focus on understanding the potential benefit and the process to achieve successful IBD care transition.