Inflammatory Bowel Disease Transition Research Articles

N48 Exploring & evaluating the benefits of initiating an IBD Transition clinic

Abstract Background Establishing an Inflammatory Bowel Disease (IBD) Transition Clinic can bring about several significant benefits. This includes providing continuity of care, specialised care, education in new treatment, emotional support, collaboration and coordination of care, empowering patients and assisting in adherence to medication and follow up appointments. In the author's history within the Trust there has never been an established IBD Transition clinic. This has led to young adults delayed in transitioning to adult services without any formal handover. Methods The IBD Consultant Nurse felt that the young adults were given a second class service and that they were not receiving the care and advice that they needed in the difficult time of being a young adult with a long term condition. They enlisted the help of a paediatric gastroenterologist and worked with the paediatric operations team and a cohort of patients were booked into a three monthly clinic held on a Saturday as this was felt the best day for engaging both patients and family. The paediatric gastroenterologist and IBD Consultant Nurse undertook the clinic jointly. Results A number of clinics were undertaken and the IBD Consultant Nurse asked for all patients to be assigned to an adult gastroenterologist after the first appointment. At the joint clinic all medication was discussed and a personalised plan of care was adopted for all patients to allow a smooth transition into adult services. The feedback from patients and family members was extremely favourable and all patients felt that they had been given all of the required information, a personalised care plan and were prepared to be transitioned to adult care. All patients were given a post clinic questionnaire on their satisfaction of the Transition clinic. The clinic was recently stopped as a adult gastroenterologist felt that this should not have been undertaken by a nurse and that they can only be undertaken by doctors. The current waiting time to be reviewed by a gastroenterologist is currently around 65weeks which could lead to a delay in treatment. Conclusion Ideally establishing a nurse-led transition clinic requires collaboration among healthcare providers, administrative support, and resources dedicated to its development. Additionally, an emphasis on patient and family involvement in the planning and execution stages can lead to a more patient-centric and successful transition program. This clinic was extremely successful but has had to stop as the gastroenterologists feel that only gastroenterologists can undertake transition clinics and should not be nurse led. Unfortunately this will lead to transition patients having an extended delay into adult services.

Defining Transition Success for Young Adults with Inflammatory Bowel Disease According to Patients, Parents and Health Care Providers.

BackgroundThe transition from pediatric to adult care is associated with changes centered around the patient taking responsibility for their health. As the incidence of childhood-onset inflammatory bowel disease (IBD) is increasing, it is important to address gaps in transition literature—specifically, the indicators signifying achievement of transition success. The study objective was to define transition success according to patients, parents, and health care providers involved in IBD transition.MethodsThis study used the method of qualitative description to conduct semi-structured interviews with patients, parents, and health care providers. During interviews, demographic information was collected, and interviews were recorded and transcribed. Data analysis was conducted independently of each group using latent content analysis. Participant recruitment continued until thematic saturation was reached within each group.ResultsPatients, parents, and health care providers all defined transition success with the theme of independence in one’s care. The theme of disease management emerged within parent and provider groups, whereas the theme of relationship with/ trust in adult care team was common to patients and parents. Additional themes of care team management, general knowledge, care stability, and health outcomes emerged within specific groups.ConclusionThis study demonstrated differences between how patients, parents, and health care providers view transition success. This finding reveals the value of using a multifaceted definition of transition success with input from all stakeholders. Further research should prioritize the identification of factors common to patients who do not reach transition success as defined by patients, their parents, and providers.

Canadian Consensus Statements on the Transition of Adolescents and Young Adults with Inflammatory Bowel Disease from Pediatric to Adult Care: A Collaborative Initiative Between the Canadian IBD Transition Network and Crohn's and Colitis Canada.

ObjectivesWith the increased prevalence of childhood-onset inflammatory bowel disease (IBD), there is a greater need for a planned transition process for adolescents and young adults (AYA). The Canadian IBD Transition Network and Crohn’s and Colitis Canada joined in collaborative efforts to describe a set of care consensus statements to provide a framework for transitioning AYA from pediatric to adult care.MethodsConsensus statements were drafted after focus group meetings and literature reviews. An expert panel consisting of 20 IBD physicians, nurses, surgeon, adolescent medicine physician, as well as patient and caregiver representatives met, discussed and systematically voted. The consensus was reached when greater than 75% of members voted in agreement. When greater than 75% of members rated strong support, the statement was rendered a strong recommendation, suggesting that a clinician should implement the statement for all or most of their clinical practice.ResultsThe Canadian expert panel generated 15 consensus statements (9 strong and 6 weak recommendations). Areas of focus of the statements included: transition program implementation, key stakeholders, areas of potential need and gaps in the research.ConclusionsThese consensus statements provide a framework for the transition process. The quality of evidence for these statements was generally low, highlighting the need for further controlled studies to investigate and better define effective strategies for transition in pediatric to adult IBD care.

Does Parenting Style Affect Adolescent IBD Transition Readiness and Self-Efficacy Scores?

Background: Transition to adult-centered care requires adolescents with inflammatory bowel disease (IBD) to acquire a set of independent self-management skills. Transition success can be affected by maturity, cognitive development, and many other factors. Our hypothesis was that parenting style would be associated with increased self-efficacy and therefore transitions readiness. Methods: A prospective cohort survey study of adolescents with IBD and their parents from October 2018 to October 2019 was performed. Participants completed the IBD-Self-Efficacy Scale- Adolescent questionnaire (IBD-SES-A) and the Transition Readiness Assessment Questionnaire (TRAQ). Parents completed the Parent Styles and Dimensions Questionnaire (PSDQ-short form). Demographic and disease information were also collected. Results: Sixty-nine participants were included for full analysis (36 males and 33 females); mean age was 18.2 years, and average age of IBD diagnosis 13 years. Overall, 83% of participants were non-Hispanic Caucasian, and 84% reported parental annual income over USD 100,000. All 69 parents reported an authoritative parenting style. Females have significantly higher TRAQ scores than males (p = 0.0004). TRAQ scores differed significantly between age groups, with 20 to 22 years old having higher scores (p ≤ 0.0001). TRAQ and IBD-SES-A scores did not differ by parental education or parenting style. Conclusion: Given the inability to delineate different parenting, this study was unable to demonstrate a protective parenting style associated with better transitions readiness and self-efficacy scores in adolescents with IBD. Within the context of authoritative parenting, we did find that females and older adolescents had higher transition readiness scores. Additional research into psychosocial determinants of transition readiness, and the importance of multidisciplinary management with an integrated team including psychologist and social workers, can help improve IBD transition outcomes.

A98 DEFINING TRANSITION SUCCESS ACCORDING TO YOUNG ADULTS WITH INFLAMMATORY BOWEL DISEASE

Abstract Background The incidence of childhood-onset inflammatory bowel disease (IBD) diagnoses is increasing in Canada; therefore, more patients will need to transition from pediatric into adult care. The literature on transition in IBD patients has focused mainly on preparation and while transition success is often referenced, it is not clearly defined. Prior research on IBD transition success has only focused on the perspectives of the health care providers. Taking into consideration that transition is a process that greatly relies on patient involvement, patient perspectives should be represented in defining its success. Aims The primary aim is to understand patients’ perspectives on the outcomes that characterize a successful transition from pediatric to adult care. Methods This study paired a theoretical position of naturalistic inquiry with the method of qualitative description. Purposive sampling was used to recruit patients from IBD clinics at the University of Alberta and the University of Calgary. Inclusion criteria included transition within the last two years, diagnoses with IBD for at least a year prior to transitioning, and absence of comorbidities. Virtual semi-structured interviews were conducted using an established interview guide. Interviews were transcribed verbatim and then analyzed concurrently with data collection by latent content analysis using NVivo computer software. Participant recruitment and data analysis continued until no further themes emerged from the data, which signaled that thematic saturation was achieved. Results Thematic saturation was achieved after 17 interviews. Among participants, 58.8% were female; 47% had a diagnosis of Crohn’s, 47% of ulcerative colitis, and one individual was diagnosed with both. The median age at diagnosis was 15 years (IQR, 3.5). The majority (94%) of participants viewed their transition as being successful. Overall, the major themes that emerged from the data were: 1. relationship with one’s adult care team, characterized predominantly as the patient being comfortable with their new team; 2. health outcomes, characterized by disease remaining stable, and medication adherence; 3. independence in one’s care, characterized by making and attending appointments on their own, asking questions and in general having an awareness about your health and disease; 4. care stability, characterized by no drop off in care, and regular contact and follow up by their provider. Conclusions Young adults with IBD define pediatric transition success in four themes: relationship with care team, health outcomes, independence in one’s care, and care stability. Through understanding what transition success looks like from the patients’ perspectives, health care providers can help patients achieve success as they define it. Funding Agencies None

“ADULTING” WITH IBD: A NOVEL, VIRTUAL INFLAMMATORY BOWEL DISEASE TRANSITION PROGRAM FOR TEENS AND CAREGIVERS

Abstract Introduction: Rates of newly diagnosed inflammatory bowel disease (IBD) in pediatric patients increased by 133% from 2007–2016. With the rise comes an increase in patients ultimately transitioning from pediatric to adult GI care. While pediatric care is family-centered and multi-disciplinary adult care is patient-centered with expectation for autonomy. However, less than 15% of patients are fully responsible for their IBD care by late adolescents. The transition period is marked by adverse health outcomes including decreased compliance and increased disease activity and hospitalization. Our data recognized up to 74% of IBD youth reported not having discussed transition at home or with their GI providers, and a desire to receive information in person. Without guidance from the GI team patients may not have adequate time to plan for successful transition. Methods: A one-day 3.5-hour transition preparedness workshop was developed to address the demonstrated need in a pediatric GI clinic. Recruitment letters were distributed to 134 IBD youth ages 15–19. Eighteen consenting participants completed measures prior to and following the workshop (at 3 and 12 months). Assessment tools included previously validated self- and parent-reports: Patient Health Questionnaire-8, General Anxiety Disorder-7), Transition Readiness Assessment Questionnaire, IBD Self Efficacy Scale; and Helping for Health Inventory. Results: While the workshop was designed for in person the pandemic required shift to virtual had strengths and potential drawbacks. Youth across 300 miles were able to attend, as well as IBD young adult peers sharing their personal transition experiences. It is hypothesized pre-workshop data will demonstrate low levels of transition readiness and IBD self-efficacy, with increases in 3- and 12-month post-workshop data. Transition readiness is also presumed to correlate with measures of IBD self-efficacy and miscarried helping by parents. We will present program effectiveness data with factors known to both facilitate and obstruct successful transition from pediatric to adult IBD care. Conclusion: There remains a paucity of literature evaluating the efficacy of IBD transition programs. This research informs such programs by evaluating the efficacy of a one-day virtual workshop on skill development and knowledge. Assessment data and follow up after transition to adult care will provide important information to guide development of evidence-based transition planning for IBD patients.

S0816 Pediatric to Adult IBD Patient Care: A Comparison of Outcomes Between Transitional Clinic Care and Traditional Clinic Care

INTRODUCTION: Inflammatory bowel disease (IBD) is a chronic illness that impacts all age groups. For those diagnosed in childhood, transitioning from pediatric to adult IBD providers can be particularly difficult. We developed an IBD "transition clinic" (TC) at our center to help address these challenges. The aim of our study was to compare the health care utilization of patients who did and did not receive care in our IBD TC. METHODS: We performed a retrospective chart review of 18 to 26-year-old patients transitioning at our IBD center between 2017 and 2018. Data collected included demographic variables, IBD type and duration. IBD related health care resource utilization outcomes were also obtained. These include admissions and no-show rates since the start of TC or adult IBD clinic respectively and steroid use during the first two years since the start of these clinics. A chi-square test for categorical variables and student t-test for continuous variables was used for comparing the variables in both of the groups. All analysis was performed in SAS v9.4. RESULTS: We identified 50 IBD patients who were cared for in our TC and 65 who were not. While the patients seen in TC were significantly younger, each cohort had similar sex distribution, disease duration and disease type distribution (Table 1). TC patients demonstrated lower mean hospital admissions, and a trend toward fewer clinic no-shows (P = 0.05) (Table 1). CONCLUSION: We demonstrated that an IBD transition clinic can improve patient outcomes, as individuals receiving care in our TC were less likely to be admitted to the hospital. It is possible that other key outcomes (including disease activity, IBD complications and psychosocial variables) may also be impacted by this service. Thus, larger, objective studies evaluating these issues in TCs are still needed. Ultimately, identifying a more streamlined and structured, yet customizable, approach to the transition process in IBD is warranted.TABLE 1.: Demographic variables and health care utilization outcomes

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

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.

Improving IBD Transition, Self-management, and Disease Outcomes With an In-clinic Transition Coordinator.

Deficits in the preparation of patients with inflammatory bowel disease (IBD) who are transitioning to adult care are known yet studies presenting outcome data of transition interventions in IBD are lacking. We present data evaluating the impact of a transition coordinator on behavioral and clinical transition outcomes. A retrospective chart review identified 135 patients who had met with our transition coordinator and completed the Transition Readiness Assessment Questionnaire before, and 1 year after, the intervention. Changes in transition readiness, self-management skill acquisition, and clinical outcomes (eg, number of patients transferred vs "bounced back" to pediatrics, percentage of patients over age 21, changes in disease remission) were examined and compared with patients who received no intervention. Intervention participants demonstrated a significant increase in transition readiness, F(1, 134) = 24.34, P < 0.001, and self-management skill acquisition, F(1, 134) = 5.61, P < 0.05. The percentage of patients in remission significantly increased from pre- to post-intervention, χ(134) = 9.03, P < 0.01. There were no significant changes in the comparison population (Ps > 0.05). Following implementation of our programming, the percentage of patients over age 21 decreased by 33.07%. A 1-time transition coordinator-led intervention improved adolescent transition readiness and acquisition of self-management skills. The proportion of young adult patients retained in pediatric care was reduced. Benefits of hiring a transition coordinator are discussed.

Self-efficacy did not predict the outcome of the transition to adult care inadolescents with inflammatory bowel disease.

AimIt can be difficult for adolescents with inflammatory bowel disease (IBD) to make the transition from paediatric to adult care. We studied the outcomes of this process and defined what constituted a successful transition.MethodsIn 2008, 50 adolescents who attended our IBD transition clinic completed IBD‐yourself, a self‐efficacy questionnaire that we had previously developed and validated. We approached the subjects in 2014, two to six years after they transferred to adult care, and 35 agreed to take part in the current study. The outcome of transition was assessed by our newly developed Transition Yourself Score. In addition, the relationship between self‐efficacy and the outcome of the transition was measured.ResultsThe mean age of the patients was 21.8 years, and 69% suffered from Crohn's disease. The transition process was successful in 63% of cases, moderately successful in 31% and failed in 6%. A successful transition was associated with effective use of medication and clinical remission at the time of transfer, but could not be predicted by self‐efficacy. The Transition Yourself Score will be validated in future studies.ConclusionNearly two‐thirds (63%) of the adolescents who attended the IBD transition clinic had a successful transition to adult care.

A cross-sectional survey of Saudi gastroenterologists: Transition strategies for adolescents with inflammatory bowel disease

Background/Aims:The transition of adolescents with inflammatory bowel disease (IBD) from pediatric to adult care requires a well-structured standardized protocol to ensure the delivery of optimal healthcare and decrease the risk of nonadherence, hospitalizations, and complications. The aims of this survey are to evaluate current IBD transition practices adopted by gastroenterology services across the Kingdom of Saudi Arabia (KSA) and to identify the major challenges standing in the way of implementing effective transition strategies from the perspectives of pediatric and adult gastroenterologists.Patients and Methods:An online survey was distributed to KSA pediatric and adult gastroenterologists through the Kingdom's national gastroenterology association. The questionnaire included closed-ended questions regarding existing institutional transition strategies and perspectives regarding the impact of different factors on their ability to effectively transition adolescents from pediatric to adult care.Results:A total of 80 adult and pediatric gastroenterologists responded to the survey invitation. Most of the participating gastroenterologists worked at a tertiary care center (82.5%). The majority of gastroenterologist (73.8%) reported that they do not follow a defined protocol for transitioning in their current practices. However, a structured transition program was noted to be “very important” by 78.8% of gastroenterologists. The most favored method of transitioning was joint outpatient clinic attended by patient, caregiver, pediatric gastroenterologist, and adult gastroenterologist (35.9%) and the most commonly reported barrier to transitioning was “lack of proper preparation” for transitioning (53.2%).Conclusions:Although acknowledged by the majority of participants as being “very important,” no standardized IBD transition protocol is followed in the majority of practices across KSA. A well-structured national protocol for transitioning adolescents with IBD is needed.

Are Expectations Too High for Transitioning Adolescents With Inflammatory Bowel Disease? Examining Adult Medication Knowledge and Self-Management Skills.

Transition readiness assessment has focused attention on adolescent knowledge and skills, but data-driven benchmarks have not been established. Patients with inflammatory bowel disease (IBD), ages 25 to 50 years, attending an outpatient gastroenterology clinic, were recruited to complete a voluntary, confidential survey asking patients to recall medications and potential side effects, and to rate their degree of independence performing health maintenance tasks. The 141 respondents (48% response rate) had mean age of 36 years with median disease duration of 11 years. They were 60% female, 54% had Crohn disease, and 23% were diagnosed before age 18. Nearly all patients were fully independent answering doctor's questions during the visit (93%) and scheduling office visits (92%). Excluding pharmacy pick up, full independence seen in only 57%, whereas 16% significantly delegated tasks. No differences by sex, disease type, medication class, age at disease onset, or disease duration were found across levels of self-management. Almost all (97%) respondents could recall medication name, whereas fewer were able to recall dose (63%) or frequency (65%). Side effect knowledge was poor; among 81 patients on a biologic or immunomodulator, only 17 (21%) cited cancer and 22 (27%) cited infection. Adolescent IBD transition programs now have empirical data from the present study about adult benchmarks for independence in self-management skills. Further research can establish which skills correlate with medication adherence and active collaboration with the medical team. The present study also exposes important gaps in medication risk knowledge and may allow improved patient education for subgroups of adult patients with IBD.

Current Transition Practices in Pediatric IBD: Findings from a National Survey of Pediatric Providers.

Although practice guidelines have been published for transition to adult care among general chronic illness populations and specific to pediatric inflammatory bowel disease (IBD), little is known about current transition practices in IBD care. This study presents data characterizing current transition practices as reported by a national sample of pediatric providers in the United States. One hundred forty-one pediatric providers completed an online survey designed to assess current transition practices, barriers and challenges to developing and maintaining transition programming, and desired resources to improve transition services. Practices varied greatly in terms of when providers begin discussing transition and transfer, age at transfer to adult care, and patient supports provided to facilitate transition. Multiple disciplines were often involved in transition programming and 75.9% reported using objective assessment of patient transition readiness. Knowledge and application of published transition practice guidelines was limited, and few respondents reported having a written transition policy at their institution (14.2%). 99.3% of respondents reported barriers to their transition programming efforts. Additional time and instrumental supports were the most common desired resources to support transition efforts. Variability in IBD transition programming, practices, and policies reflect the emerging nature of clinical practice in this area. Understanding the current state of transition programming can inform future programming. Efforts to identify evidence-based practices in transition to adult care are needed.

Transitioning patients with inflammatory bowel disease (IBD) from adolescent to adult services: a systematic review.

Approximately a quarter of patients with inflammatory bowel disease (IBD) are diagnosed before 20 years of age, presenting with more extensive distribution and severity of disease than adult onset.The purpose of this review was to determine facilitators of, and barriers to, successful transition of patients with IBD from adolescent to adult services. A systematic review of IBD transition research was conducted in March 2014 searching PubMed, MEDLINE, PsycINFO, Web of Science and the Cochrane Database of Systematic Reviews databases. A hand search of reference lists and narrative reviews was carried out to maximise the potential for retrieving all relevant manuscripts. Primary studies written in English of full-length peer-reviewed journal articles that investigated transition of paediatric patients with IBD to adult services were included. Studies were excluded if the primary focus was not IBD. The search produced 283 potentially relevant studies. After removing duplicates and screening for suitability, six met our inclusion criteria. Barriers to transition included system inadequacies and a lack of resources, clinical time and training. Successful transition involved joint medical visits, structured transition services, improved communication between paediatric and adult services and improved education for patients and staff. If the transition process for adolescents suffering with IBD is to improve then it is vital that more research is conducted to better our understanding of ways in which we can ensure that defined protocols are in place for a smooth transition for every adolescent, leading to improved standards and minimal disruption to care.

Barriers and facilitators to successful transition from pediatric to adult inflammatory bowel disease care from the perspectives of providers.

For adolescents and young adults (AYA) with inflammatory bowel disease (IBD), the transition from pediatric to adult care is often challenging and associated with gaps in care. Our study objectives were to (1) identify outcomes for evaluating transition success and (2) elicit the major barriers and facilitators of successful transition. We interviewed pediatric and adult IBD providers from across the United States with experience caring for AYAs with IBD until thematic saturation was reached after 12 interviews. We elicited the participants' backgrounds, examples of successful and unsuccessful transition of AYAs for whom they cared, and recommendations for improving transition using the Social-Ecological Model of Adolescent and Young Adult Readiness to Transition framework. We coded interview transcripts using the constant comparative method and identified major themes. Participants reported evaluating transition success and failure using health care utilization outcomes (e.g., maintaining continuity with adult providers), health outcomes (e.g., stable symptoms), and quality of life outcomes (e.g., attending school). The patients' level of developmental maturity (i.e., ownership of care) was the most prominent determinant of transition outcomes. The style of parental involvement (i.e., helicopter parent versus optimally involved parent) and the degree of support by providers (e.g., care coordination) also influenced outcomes. IBD transition success is influenced by a complex interplay of patient developmental maturity, parenting style, and provider support. Multidisciplinary IBD care teams should aim to optimize these factors for each patient to increase the likelihood of a smooth transfer to adult care.

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

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.

Attitudes and Experiences of Adolescents in an Innovative IBD Transition Service

The predominant focus of transition in inflammatory bowel disease (IBD) management is for the young person to develop autonomy and be educated in disease awareness, self-management and decision-making within the health care setting. A joint, bimonthly transition clinic was set up in the paediatric setting, to design an effective collaborative adolescent IBD transition service tailored to meet the needs of adolescents and their parents. In this article, the extent to which this service helped in preparing adolescents and their family for transfer to adult services, while enabling joint collaborative working, will be evaluated.

Assessing the value of a pre-transfer meeting in IBD transition services

Background: The benefits of a well-managed transition for adolescents with inflammatory bowel disease (IBD) are being increasingly recognized. However, there is limited evidence to support effective means of transition. Patient feedback is important to establish the value of such services. This survey looks at how young people with IBD and their families perceived the effectiveness of a model of transition and what improvements were needed. Design: Postal questionnaire survey. Setting: Transition between paediatric services at Alder Hey Children′s NHS Foundation Trust, Liverpool and the Royal Liverpool University Hospital (adult centre). Population: Young people (adolescents) who had been through the transition process between the above centres from 2003-2008. Interventions: A semi-structured questionnaire survey designed to obtain patient feedback on transition care arrangements and provision of service. Main outcome measures: Patient information, satisfaction and suggestions. Results: 35 of 66 families returned the questionnaire. High rates of satisfaction were reported (33/35; P&lt;0.001-sign test). Feedback included provision of adequate information, opportunity to discuss change (P&lt;0.001) and reduction in perceived anxiety about the transfer (P=0.08).Conclusions: High rates of satisfaction with transition incorporating a pre-transfer meeting were expressed

P194 - Assessment of self-efficacy during transition in adolescents with inflammatory bowel disease

P194 - Assessment of self-efficacy during transition in adolescents with inflammatory bowel disease