scholarly journals Value of an outpatient transition clinic for young people with inflammatory bowel disease: a mixed-methods evaluation

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e033535 ◽  
Author(s):  
Jane N T Sattoe ◽  
Mariëlle A C Peeters ◽  
Jannie Haitsma ◽  
AnneLoes van Staa ◽  
Victorien M Wolters ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Mixed Methods ◽  
Young People ◽  
Data Collection ◽  
Bowel Disease ◽  
Control Group ◽  
Care Providers ◽  
Adult Care ◽  
Mixed Methods Evaluation ◽  
Inflammatory Bowel

ObjectiveDeveloping and evaluating effective transition interventions for young people (16–25 years) with inflammatory bowel disease (IBD) is a high priority. While transition clinics (TCs) have been recommended, little is known about their operating structures and outcomes. This study aimed to gain insight into the value of a TC compared with direct handover care.DesignControlled mixed-methods evaluation of process outcomes, clinical outcomes and patient-reported outcomes.SettingTwo outpatient IBD clinics in the Netherlands.ParticipantsData collection included: semistructured interviews with professionals (n=8), observations during consultations with young people (5×4 hours), medical chart reviews of patients transferred 2 to 4 years prior to data collection (n=56 in TC group; n=54 in control group) and patient questionnaires (n=14 in TC group; n=19 in control group).OutcomesData were collected on service structures and daily routines of the TC, experienced barriers, facilitators and benefits, healthcare use, clinical outcomes, self-management outcomes and experiences and satisfaction of young people with IBD.ResultsAt the TC, multidisciplinary team meetings and alignment of care between paediatric and adult care providers were standard practice. Non-medical topics received more attention during consultations with young people at the TC. Barriers experienced by professionals were time restrictions, planning difficulties, limited involvement of adult care providers and insufficient financial coverage. Facilitators experienced were high professional motivation and a high case load. Over the year before transfer, young people at the TC had more planned consultations (p=0.015, Cohen’s d=0.47). They showed a positive trend in better transfer experiences and more satisfaction. Those in direct handover care more often experienced a relapse before transfer (p=0.003) and had more missed consultations (p=0.034, Cohen’s d=−0.43) after transfer.ConclusionA TC offer opportunities to improve transitional care, but organisational and financial barriers need to be addressed before guidelines and consensus statements in healthcare policy and daily practice can be effectively implemented.

scholarly journals Spotlight on Transition in Patients With Inflammatory Bowel Disease: A Systematic Review

2019 ◽  
Author(s):  
Adrienn Erős ◽  
Alexandra Soós ◽  
Péter Hegyi ◽  
Zsolt Szakács ◽  
Bálint Erőss ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Transitional Care ◽  
Adherence Rate ◽  
Control Group ◽  
Qualitative Synthesis ◽  
Adult Care ◽  
Inflammatory Bowel

Abstract Background Transition of adolescents from pediatric to adult care is of great importance in the management of inflammatory bowel disease (IBD). Our aim was to review and summarize the currently applied interventions and outcomes related to transition practices in IBD. Methods A systematic review was performed in accordance with the PRISMA Statement. We searched PubMed, EMBASE, CENTRAL, and Web of Science databases up to February 15, 2019. Controlled studies evaluating adolescents and young adults with IBD participating in structured transition interventions or patient educational programs and single-arm (before-after) studies were included. Several individual, health care, and social outcomes were assessed. The PROSPERO registration number is CRD42019118520. Results A total of 23 articles were eligible for qualitative synthesis. Eleven studies compared an intervention to a control group, whilst 12 studies were uncontrolled before-after studies. The age of the participants varied from 11 to 25 years. The most common structured transition interventions were joint visits and patient education programs. IBD nurses were operating as nominated transition coordinators in the transition process. Quality of life, patient satisfaction, self-efficacy, disease-specific knowledge, adherence rate, and nonattendance rate at outpatient clinic were identified as main health care transition outcomes besides disease-related outcomes. Despite the various study designs and methodological limitations, outcomes improved with the application of structured transition interventions in eleven of the studies. Conclusion These results facilitate the design of randomized controlled trials along better standards in transitional care in IBD.

scholarly journals Monitoring adolescents and young people with inflammatory bowel disease during transition to adult healthcare

2017 ◽  
Vol 9 (1) ◽  
pp. 37-44 ◽  
Author(s):  
Alenka J Brooks ◽  
Philip J Smith ◽  
James O Lindsay
Keyword(s):  
Inflammatory Bowel Disease ◽  
Young People ◽  
Bowel Disease ◽  
Healthcare Professionals ◽  
Transition Period ◽  
Healthcare Providers ◽  
Self Management ◽  
Care Providers ◽  
Transition Into Adulthood ◽  
Inflammatory Bowel

The transition of adolescents and young people (AYP) with inflammatory bowel disease (IBD) from paediatric to adult healthcare requires coordination between healthcare care providers to achieve optimum outcomes. Transition into adulthood is a time of major challenges physically, developmentally, emotionally and psychosocially for AYP living with IBD. Healthcare professionals must monitor the AYP progress proactively with attention to each of these parameters throughout the transition period to ensure that milestones are attained, and skills for self-management are formed. Thus, achieving the desired goals in both clinical and pastoral areas requires intensive monitoring from a multidisciplinary team across healthcare providers.

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

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 73-74
Author(s):  
A Bihari ◽  
N Hamidi ◽  
C Seow ◽  
K Goodman ◽  
E Wine ◽  
...  
Keyword(s):  
Health Care ◽  
Inflammatory Bowel Disease ◽  
Young Adults ◽  
Health Outcomes ◽  
Health Care Providers ◽  
Bowel Disease ◽  
Care Providers ◽  
Adult Care ◽  
Inflammatory Bowel ◽  
The University

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

Biosimilars of Adalimumab in Inflammatory Bowel Disease: Are we Ready for that?

2019 ◽  
Vol 25 (1) ◽  
pp. 7-12 ◽  
Author(s):  
Marjorie Argollo ◽  
Gionata Fiorino ◽  
Daniela Gilardi ◽  
Federica Furfaro ◽  
Giulia Roda ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Health Care Providers ◽  
Bowel Disease ◽  
Biological Treatment ◽  
Reference Product ◽  
European Medicines Agency ◽  
Care Providers ◽  
Inflammatory Bowel ◽  
To Receive ◽  
The Ideal

Introduction: Biosimilars present a considerable potential to reduce costs related to clinical management allowing health-care providers to reinvest this money, leading to a wider access to an effective biological treatment with monoclonal antibodies (mAb). Infliximab biosimilars have already been incorporated in daily clinical practice and are currently used in all indications for which the reference product (RP) was approved. Areas covered: In the next few years, also adalimumab biosimilars will become available for the treatment of inflammatory bowel disease (IBD). In fact, several of them (ABP501, BI 695501, GP2017, and SB5) have been approved by the European Medicines Agency (EMA) with the same indications of the reference product (Humira ®). Initial preclinical data proved a strong similarity between all biosimilars and the RP. Moreover, phase 3 studies in rheumatoid arthritis and psoriasis showed no differences in terms of efficacy, safety, and immunogenicity. Data on IBD patients are urgently needed. Expert opinion: Biosimilars of adalimumab showed equivalent clinical efficacy to the RP in other immunemediated diseases. However, defining the ideal patient’s profile to receive or to be switched to a biosimilar, choosing one biosimilar vs. another, or cross-switching among biosimilars, will become the next challenge in IBD.

scholarly journals Does inflammatory bowel disease have different characteristics according to stage of adolescence?

2021 ◽  
Vol 14 ◽  
pp. 175628482098667
Author(s):  
Kata Judit Szántó ◽  
Tamás Balázs ◽  
Dóra Mihonné Schrempf ◽  
Klaudia Farkas ◽  
Tamás Molnár
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Severe Disease ◽  
Transition To Adult Care ◽  
Insurance Fund ◽  
Late Adolescent ◽  
Adult Care ◽  
Adolescent Group ◽  
Adolescent Patients ◽  
Inflammatory Bowel

Background: There is a lack of data about demographic and treatment characteristics of adolescent patients with inflammatory bowel disease (IBD). The aim of this retrospective, epidemiological study was to evaluate characteristics and therapeutic features of Hungarian adolescents with IBD. Methods: We analysed the social security databases of the National Health Insurance Fund. Adolescent patients with IBD for whom data from 2009 to 2016 were observable in the database were enrolled. Patients aged 14 to 17 years and 18 to 21 years were defined as middle and late adolescent patients. Results: The incidences of IBD were 20.12 per 100,000 middle adolescent patients and 29.72 per 100,000 late adolescent patients. Admission to gastroenterology department was higher in both groups compared with admissions to surgery department. Mesalazine was used by a high proportion of Crohn’s disease and ulcerative colitis patients. Rates of corticosteroid use were similar in both groups, with a tendency to decrease over time. The need for biologic agents was higher in the middle adolescent patients. The proportion of patients in the middle adolescent group who received anti-TNF therapy showed an increasing tendency. Conclusion: Our data suggest differences in the treatment strategies of gastroenterologists for these age groups. The greater need of anti-TNF therapy among the middle adolescent group indicates that adolescent patients before the transition to adult care may have a more severe disease phenotype. We expect that a strategy of early, effective treatment will significantly ameliorate the subsequent disease course, which is manifested in adult care.

scholarly journals The incidence and prevalence of inflammatory bowel disease in UK primary care: a retrospective cohort study of the IQVIA Medical Research Database

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Karoline Freeman ◽  
Ronan Ryan ◽  
Nicholas Parsons ◽  
Sian Taylor-Phillips ◽  
Brian H. Willis ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
General Practice ◽  
Cohort Study ◽  
Medical Research ◽  
Bowel Disease ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Research Database ◽  
Care Providers ◽  
Inflammatory Bowel

Abstract Background Our knowledge of the incidence and prevalence of inflammatory bowel disease (IBD) is uncertain. Recent studies reported an increase in prevalence. However, they excluded a high proportion of ambiguous cases from general practice. Estimates are needed to inform health care providers who plan the provision of services for IBD patients. We aimed to estimate the IBD incidence and prevalence in UK general practice. Methods We undertook a retrospective cohort study of routine electronic health records from the IQVIA Medical Research Database covering 14 million patients. Adult patients from 2006 to 2016 were included. IBD was defined as an IBD related Read code or record of IBD specific medication. Annual incidence and 12-month period prevalence were calculated. Results The prevalence of IBD increased between 2006 and 2016 from 106.2 (95% CI 105.2–107.3) to 142.1 (95% CI 140.7–143.5) IBD cases per 10,000 patients which is a 33.8% increase. Incidence varied across the years. The incidence across the full study period was 69.5 (95% CI 68.6–70.4) per 100,000 person years. Conclusions In this large study we found higher estimates of IBD incidence and prevalence than previously reported. Estimates are highly dependent on definitions of disease and previously may have been underestimated.

scholarly journals Dental and periodontal disease in patients with inflammatory bowel disease

2021 ◽  
Author(s):  
Christopher X. W. Tan ◽  
Henk S. Brand ◽  
Bilgin Kalender ◽  
Nanne K. H. De Boer ◽  
Tymour Forouzanfar ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Periodontal Disease ◽  
Bowel Disease ◽  
Health Problems ◽  
Control Group ◽  
Age And Gender ◽  
Preventive Dental Care ◽  
Dmft Index ◽  
Inflammatory Bowel ◽  
And Gender

Abstract Objectives Although bowel symptoms are often predominant, inflammatory bowel disease (IBD) patients can have several oral manifestations. The aim of this study was to investigate the prevalence of dental caries and periodontal disease in patients with Crohn’s disease (CD) and ulcerative colitis (UC) compared to an age and gender-matched control group of patients without IBD. Material and methods The DMFT (Decayed, Missing, Filled Teeth) scores and the DPSI (Dutch Periodontal Screening Index) of 229 IBD patients were retrieved from the electronic health record patient database axiUm at the Academic Centre for Dentistry Amsterdam (ACTA) and were compared to the DMFT scores and DPSI from age and gender-matched non-IBD patients from the same database. Results The total DMFT index was significantly higher in the IBD group compared to the control group. When CD and UC were analyzed separately, a statistically significant increased DMFT index was observed in CD patients but not in UC patients. The DPSI did not differ significantly between the IBD and non-IBD groups for each of the sextants. However, in every sextant, IBD patients were more frequently edentulous compared to the control patients. Conclusion CD patients have significantly more dental health problems compared to a control group. Periodontal disease did not differ significantly between IBD and non-IBD groups as determined by the DPSI. Clinical relevance It is important that IBD patients and physicians are instructed about the correlation between their disease and oral health problems. Strict oral hygiene and preventive dental care such as more frequent checkups should be emphasized by dental clinicians.

Empowered transitions: Understanding the experience of transitioning from pediatric to adult care among adolescents with inflammatory bowel disease and their parents using photovoice

2021 ◽  
Vol 143 ◽  
pp. 110400
Author(s):  
Jordyn H. Feingold ◽  
Halley Kaye-Kauderer ◽  
Michelle Mendiolaza ◽  
Marla C. Dubinsky ◽  
Laurie Keefer ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Adult Care ◽  
Inflammatory Bowel
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