N002. Barriers to transition care in inflammatory bowel disease: A survey of inflammatory bowel disease nurses

Y. Houston¹, J. Lindsay², S. McCartney², N. Croft², T. Ahmad², R. Russell², H. Jenkins², I. Arnott³, S. Sebastian¹

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: There is paucity of data on the transition of adolescents and young adults with inflammatory bowel disease from paediatric to adult services. IBD nurses play a crucial role in co-ordinating transition care. However, transition services are variable throughout the UK, which may represent differences in the perception of barriers to transition. Understanding these may help the development of a successful service. We aimed to survey IBD nurses on their views and experiences of barriers to transition care.

Materials and Methods: Both adult and paediatric IBD nurses were sent a structured postal questionnaire on barriers to transition care. The importance of patient related and health care organisation related issues were ranked on a Likert scale of 1 to 5 and the mean (±SD) scores were calculated. Personal experiences of barriers to service development were ranked from 1 to 5 and the proportion of those ranking I was calculated. Differences in relation to geography, hospital setting and paediatric and adult IBD nurses were compared with chi-square test.

Results: A total of 167 IBD nurses were contacted and 92 (55%) responded which included 9 paediatric IBD nurses. A majority of respondents (n = 56, 69%) work in a teaching hospital setting. 48.9% of respondents were involved in transition care. The main reasons stated for not being involved in transition care included lack of service (n = 25) and too few patients for a viable service (n = 16).The mean scores for patient related factors and organisational factors that prevent successful transition are summarised in table 1 and table 2 respectively. The 3 highest ranked barriers to a successful transition service were lack of dedicated time (20% respondents), lack of demand (19%) and lack of training (13%). There were statistically significant differences in responses of barriers and ranking based on the hospital setting (p = 0.001) and paediatric and adult IBD nurses (p = 0.02) but no significant regional difference was recorded.

Table 1
Aspect	No. (%) scoring as very important	Score, mean±SD
Lack of understanding of disease and medications	42 (45.6%)	4.31±0.88
Lack of self advocacy	35 (38%)	4.30±0.73
Parental reluctance to transfer	48 (52%)	4.41±0.82
Lack of trust in adult health care providers	51 (55.4%)	4.47±0.82
Patients'/parents' high expectation	35 (38%)	4.21±0.81

Table 2
Aspect	No. (%) scoring as very important	Score, mean±SD
Lack of funding	29 (31.4%)	3.84±1.11
Lack of interest among gastroenterologists	36 (39%)	4.02±1.14
Lack of space and time	45 (48.8%)	4.31±0.94
Lack of supportive services	44 (47.7%)	4.29±0.92
Lack of defined policies	28(30.4%)	4.02±0.96

Conclusion: A number of organisational and patient related barriers for development of a successful transition were identified in the survey of IBD nurses. Identification of these in individual situations may help in tackling these when developing the service.

Acknowledgement: Supported by an educational grant from Warner Chilcott Pharmaceuticals

Posted in: Nurses presentations: Nurses poster presentations (2011)