P027 TRANSITION OF CARE OF ACTIVE DUTY PATIENTS WITH IBD TO THE VETERANS ADMINISTRATION HEALTHCARE SYSTEM: TOOLKIT FOR SUCCESS

Abstract

Abstract The shift from being an active duty military patient with inflammatory bowel disease (IBD) seen in a military treatment facility (MTF) to being a veteran receiving chronic illness care within the Veterans Administration (VA) is a time of increased vulnerability and risk for loss of continuity of care, and poor disease outcomes. A transitional care program must prioritize the psychosocial growth, self-efficacy and disease-specific knowledge of active military patients who are transitioning to VA care as well as enhance collaborative management between military and VA providers. The Department of Defense (DoD) has established the Transition Assistance Program (TAP) to assist military members to civilian life, but limit preparedness in skills to navigate/understand medical care. There is currently no available data on transition readiness from active duty military medical care to VA medical care and our objective is to determine the feasibility and acceptability of a self-management intervention. Methods: We prospectively measured readiness with the use of the IBD Self-Efficacy Scale (IBD-SES) and Transition Readiness Assessment Questionnaire (TRAQ). All enrolled patients (50 active duty servicemembers) were in disease remission and underwent TAP and 50% were further randomized to undergo TRAQ-based educational and behavioral interventions via mobile applications and clinical consults. Results: Servicemembers who underwent further TRAQ-based interventions compared to those only undergoing TAP demonstrated significant improvement in medication/appointment management, tracking/managing health issues, and talking with providers (p<0.001). Furthermore, these servicemembers also demonstrated significant improvement in self-efficacy and self-management which was maintained up to 3 months post military discharge (p<0.001). Servicemembers had an average VA primary care wait time of 3.5 months and for Gastroenterology specialist of 5.4 months, resulting in >60% of servicemembers having to discontinue therapy due to lapse in care (50% rate of flares) and unnecessary therapy switch. Conclusion: This is the first and only study to assess transitioning from active duty service to VA medical care for a chronic illness. We demonstrated improved and sustained self-efficacy outcomes with a transition program for IBD along with potential limitations in the VA transition. We have an opportunity to influence the conversation of appropriate DoD transition of medical care and to develop a model of care with wider applicability.