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Pediatric to Adult Transition of Care in IBD: Establishing the Current Standard of Care Amongst Canadian Adult Academic Gastroenterologists

Background

There has been no systematic effort to define a standard of care amongst adult gastroenterologists providing IBD transition care. The purpose of this study is to establish current transition practices across Canada amongst adult gastroenterologists in high volume academic centers.

Objectives

  1. To understand how patients with IBD are being transitioned from pediatric to adult care at major IBD/Gastroenterology centers across Canada.
  2. To understand the perceived strengths and weaknesses of current IBD transition practices in Canada.
  3. To elicit possible quality indicators which could be used as metrics of measurement for the success of transition programs in IBD.
  4. To introduce the idea of a consensus-based guideline for transitioning IBD patients and gauge the interest of current healthcare practitioners.

Methods

Adult gastroenterologists with an interest in transitional care were identified via their Division Heads’ suggestions and clinical networks. Seventeen anonymous surveys and 17 semi-structured interviews representing 9 adult GI centers across 6 provinces were completed to reflect practices at the highest volume transition centers. Questions focused on the transition process, referral practices, information transfer and access to multidisciplinary resources. Strengths and weaknesses of existing programming were identified as well as transition-related quality indicators. The interviews were audio-recorded, transcribed and coded for qualitative thematic analysis.

Results

Transition practices were divided into a transition clinic (n=4) vs. direct transfer to an adult gastroenterologist (n=5). The majority of transition patients were referred to academic centers. Volume of transition patients ranged from 12 to 100 per year, most averaged 30-40 patients. Transfer of information was optimized with a shared electronic medical record system and comprehensive referral package. Majority lacked consistent access to a multidisciplinary team including psychology and social work. Strongest attributes related to healthcare providers interested in transition and meaningful transfer of information from pediatrics. Major areas for improvement included increased resource allocation: financial, logistical and personnel. All participants agreed that a consensus-based guideline for adult phase of transition would be beneficial. Potential quality indicators included adherence to care, depression/anxiety scores, patient education and patient-reported outcomes.

Conclusion

This Canadian survey of adult gastroenterologists reveals that practice patterns are varied but ideally involve a dedicated transition clinic with access to multi-disciplinary resources. A consensus-based guideline and quality indicators to track progress may assist in standardizing the adult phase of transition and optimizing outcomes.

Implications for Patient Care

Knowing that transition practices vary widely across Canada and understanding what the strengths and weaknesses are allows for a Canada-wide discussion around developing a consensus-based guideline for transitioning IBD patients in a consistent, safe and efficient manner.