Abstract
Background
The purpose of this study was to address the grey areas influencing the transition of care (TOC) aspect in adolescents suffering from IBD. In the context of healthcare, the term ‘transition’ refers to a phase of development from one stage to another. ‘TOC’ is defined as the “purposeful planned movement of adolescents and young adults with chronic conditions from child-centred to adult-oriented health care systems” (Blum et al., 1993). The point where the adolescent becomes an adult represents a milestone not only in health care delivery but also in the wider context of knowledge of medication, education, and employment, as well as sexual and psychosocial development amongst others (Greveson et al., 2011). Although this concept of care is still in its early stages, it has found its application in various specialities of medicine, including but not limited to diabetes, juvenile rheumatology, congenital heart diseases (Afzali & Wahbeh, 2017) and gastroenterology conditions, namely inflammatory bowel disease (IBD).
Methods
From this systematic review of literature that discussed TOC, it became evident that this essential process is undervalued and understudied. Transition standards vary between healthcare services and goals. The selected 3 cross-sectional, 1 cohort and 1 multi-site comparison studies published between 2013 and 2018 analysed how IBD treatment compliance in adolescents is affected when going through an established TOC compared to no TOC. While TOC has successfully created clinical targets, identified deficiencies in knowledge, adherence, and transition readiness assessments, there are still few evidence-based tools to assist in the transition process and a relative absence of transition models that have been critically appraised (Bollegala & Nguyen, 2015).
Results
Findings determined that the establishment and attendance of IBD adolescent patients in structured TOC programmes or clinics ensure cohesive treatment adherence. Nevertheless, it was established that further studies must be carried out on the matter at hand.
Conclusion
Recommendations for clinical practice, management, education, and further studies were endorsed. Such suggestions concluded that transition should be delayed until the patient has been assessed for readiness, along with the importance of involving a multidisciplinary team and the development of practical guidelines and skills aimed for optimal, lifelong IBD management.
Treatment adherence in paediatric inflammatory bowel disease: perceptions from adolescent patients and their families
