P421 Transitional care in Inflammatory Bowel Disease - a single center experience
Y. Ron*1, A. Yerushalmy-Feler2, A. Nachum3, I. Dotan1, S. Cohen2
1Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, IBD Center, Department of Gastroenterology and Liver Diseases, Tel Aviv, Israel, 2"Dana-Dwek" Children's Hospital, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, The Pediatric Gastroenterology unit, Tel Aviv, Israel, 3Tel Aviv Sourasky Medical Center , Health and Medical Psychological service, Tel Aviv, Israel
Inflammatory bowel disease (IBD) is a chronic disease with a natural history of relapse and remission. Approximately 25% of IBD patients are diagnosed before the age of 16 years. The approach to investigation and treatment, service provision and ideology of care differe between children and adults . This calls for an organized and planned transition process. Yet, transition clinics are still scarce. A transition adolescent-young adult IBD clinic was established in a tertiary referral center in 2013. Patients are seen conjointly by pediatric and an adult gastroenterologists, an IBD nurse, dietitian and a psychologist. The aim of this study is to quantitavely describe the importance of the trnasitional care in IBD.
We conducted retrospective review of all patient files visiting the transitional clinic. A self-efficacy questionnaire (the "IBD-yourself") was used to assess patients' skills for self-management of chronic conditions, their self-advocacy, and their healthcare utilization before and after joining our clinic. In general, each question obtained a 4 point score (1 - Yes, definitely and 4 - No,definitely not). We have also compared their self-efficacy according to disease extent, disease duration and therapeutic strategy.
Twenty one patients visited the clinic in january/2013-November/2014. The vast majority (20/21) had Crohn's disease, the average age was 19.4 ± 2.1 (range 17-27) years, and average disease duration 4.9 ± 3 (range 0.67-10) years. Ten patients (48%) were treated with immunomodualtors, 6 patients (29%) with 5ASA, 4 patients (19%) with anti TNF mediactions and 1 patient was not treated at all. The transitional process, completed by 15 (11 males). included an average of 3-4 meetings over an average of 7 ± 4.1 months. Significantly higher self efficacy score after completing the transition compared to before starting it was noticedin the following domains: knowledge of IBD (P=0.01), of diagnostic tests (P=0.0004), of medication use (P=0.003), self manegment in an outpatient clinic (P=0.016), understanding the transition process (P=0.0001) and self readiness for transition (P=0.013). A positive correlation between number of meeting and coping with IBD (r=0.56, p=0.029) was noticed as well. No correlation was found between disease extent, disease duration, therapeutic strategy and change of readiness during the transition.
An organized adolescent-young adult IBD transition clinic significantly contributes to higher cores in self manegment of IBD. The transition process is a major part o a successful transfer to the adult gastroenterologist and should be implemented in IBD Centers.