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P236. The requirements of adolescents with inflammatory bowel disease for successful transition: Differing perceptions from a survey of adult and paediatric gastroenterologists

S. Sebastian1, S. McCartney2, N. Croft2, I. Arnott3, R. Russell2, T. Ahmad2, H. Jenkins2, J. Lindsay2

1Hull & East Yorkshire NHS Trust, Hull, United Kingdom; 2Adolescent & Young Persons Section, British Society of Gastroenterology, London, United Kingdom; 3Western General Hospital, Edinburgh, United Kingdom

Introduction and Aim: Preliminary data highlight the importance of appropriate transition for successful transfer of adolescents with IBD from paediatric to adult care. However, the ideal transition service has not been defined. The aim of this study was to identify the perceived needs of adolescent IBD patients for successful transition from the perspective of professionals involved in their care.

Methods: A postal questionnaire was distributed to adult and paediatric gastroenterologists with IBD clinics in the UK. The questionnaire utilised closed questions as well as ranked items on the importance of the various competencies of adolescents with IBD required for successful transition. The data is presented as mean scores ± SD for aspects of the competencies. Differences in responses between adult and paediatric gastroenterologists were assessed by Students t test and Fishers exact test as appropriate.

Table 1.
Criteria Adult gastro Paediatric gastroRank 1Rank 2Rank 3Rank 4Rank 5Rank 6
Age 18
Adult135925519111
Paeds142019756
Age 21
Adult62193863162
Paeds321127918
School leaving
Adult152104391480
Paeds223011530
Marriage/Pregnancy
Adult315336310282
Paeds028112624
Employment
Adult016375710285
Paeds1813111721
Disease in remission
Adult434640594569
Paeds291297104

Results: The response rate for paediatric and adult gastroenterologists was 53.7% (71/132) and 49.3% (358/729) respectively (p = ns). A structured transition service was perceived as very important by80.28% paediatric gastroenterologists compared to 47.55 adult gastroenterologists (p = 0.001). The suggested median age for initiation and completion of transition by both groups was 16 and 18 years respectively. However, there were differences in ranked criteria for timing of transfer between adult and paediatric gastroenterologists (Table 1). Higher proportion of adult gastroenterologists identified inadequacies in the preparation of adolescents for transfer (42.2% and 79.1% p = 0.001). The main areas of deficiency identified by adult gastroenterologists were lack of knowledge about the condition and treatment (35.4%) and co-ordination of care (40.1%) while paediatric gastroenterologists identified lack of self advocacy (30.9%) and co-ordination (29.5%). There were differences in the mean scores ± S.D for perceived importance patients` competencies between the two groups of clinicians (Table 2).

Table 2
CompetencyMean score ± SD
 Adult
gastro­enterologists
Paediatric gastro­enterologists
Understanding of disease4.19±0.774.33±0.59
Understanding of treatment4.22±0.764.47±0.49
Ability to attend clinics without parents3.20±0.423.96±0.61
Ability to take medicines independently3.97±0.834.23±0.69
Ability to undergo endoscopies without anaesthetic3.95±0.633.04±0.54
Disease in remission2.65±1.023.92±0.67

Conclusions: This survey highlights differences in the perception of adult and paediatric gastroenterologists in the management of transition care for adolescents with IBD. The perceived competencies that patients require also differed between the two groups of health care professionals. This may have implications in developing structured transition care services.

Acknowledgement: Supported by an educational grant from Warner Chilcott Pharmaceuticals.