Abstract
Significance
The incidence of inflammatory bowel disease (IBD) is rising around the globe. As pediatric IBD patients approach adulthood, they are in jeopardy of a lapse in care. We developed a standardized a health maintenance transition visit (HMV) to supplement standard medical care visits (SMV) to prepare patients for transition. Our aim was to assess the effectiveness of the structured HMV using the Transition Readiness Assessment Questionnaire (TRAQ) to predict readiness at time of transfer to an adult gastroenterologist.
Methods
A retrospective chart review was conducted including demographics and clinical data from HMV visits and pediatric or adult SMV visits. Clinical variables included scheduling, providers, TRAQs, Patient Health Questionnaire-9 (PHQ9), health maintenance goals, and disease status. The effectiveness of the HMV was accessed by attendance, PHQ9 screening, adherence to health recommendations, and TRAQ scores.
Results
140 patients completed at least one HMV. The patient cohort was 80% white and 59% male. Mean age was 18 ± 2 years old at the time of their first HMV. The majority of patients had a primary IBD diagnosis of Crohn’s disease (75%), followed by ulcerative colitis (21%), and unclassified IBD (4%). Most patients had inactive disease (68%) around the time of the first HMV, while a minority had mild (20%) or moderate (12%) disease activity based on PGA. The average TRAQ score at the first HMV visit was 66 ± 17. Patients who completed at least 1 prior HMV (n=8) scored significantly higher on the TRAQ when transferring to the adult care compared to patients (n=29) who were transferred at their first HMV visit (92 vs 83, p<0.05). Of the 56 patients who completed the PHQ9 depression screen, 22 had a positive screen. Of the patients with no prior diagnosis of depression, 36% had a positive screen with the severity of depression ranging from mild to severe. Across all visits, 45 patients were transferred into adult care following a HMV.
Conclusions
This study demonstrated that a structured HMV prior to transfer may increase transition readiness as assessed by the TRAQ. In addition, new diagnosis of depression was made in a significant portion of patients screened, emphasizing the importance of regular screening for psychological issues. Future studies are needed to validate these findings and potentially move towards a standard template for transition readiness in pediatric IBD patients.
Health Maintenance and Vaccination of Patients With Inflammatory Bowel Disease: Practice and Perception of Responsibility of Gastroenterologists vs Primary Care Providers