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* = Presenting author

P351 Do self-selected “Non-Transitioned” referrals from peadiatric services have lower treatment requirements?

Shaikh O.1, Harvey P.*1, Cooney R.1, Muhammed R.2

1University Hospital Birmingham, Gastroenterology, Birmingham, United Kingdom 2Birmingham Children's Hospital NHS Trust, Paediatric Gastroenterology, Birmingham, United Kingdom

Background

Best practice guidelines stipulate children with long term health problems should have their care transitioned between paediatric services and adult health services. Our paediatric IBD patients are offered an appointment in a transition clinic, however non-attendance is high. The aim of this study is to compare treatment requirement (as a surrogate marker of disease severity) and service engagement between patients choosing to attend transition clinic (transitioned) and those not (non-transitioned patients).

Methods

All known IBD referrals from Birmingham Children's Hospital to University Hospital Birmingham aged 16–18 years from 2010–13 were collected. Baseline demographics, disease status and treatment history were collected from both adult and paediatric settings. Post referral procedures, changes in treatment and clinic attendance data were collected.

Results

57 patients were identified of which 33 were transitioned. Data regarding treatment prior to referral to adult services and changes post-referral are presented below. Data is also presented for clinic attendance and follow-up length.

Table 1. Patient baseline demographics and pre-referral therapy

Non-transitionned patientsTransitionned patientsp value
Number2433
Male:Female ratio13:1114:190.385
Ethnicity (Cauc/Black/South Asian/Unknown or mixed ethnicity)14/1/1/814/1/7/11
Crohn's disease17 (70.9%)25 (75.8%)0.789
Ulcerative colitis7 (29.1%)8 (24.2%)
Pre-referral azathioprine/methotrexate use10 (41.7%)22 (66.7%)0.063
Pre-referral anti-TNF use4 (16.7%)8 (24.2%)0.492
Pre-referral IBD surgery^5 (20.8%)12 (36.4%)0.210

^Small bowel resection, stricturoplasty, and drainageof perianal abscesses.

Table 2. Post-referral therapy and engagement with adult services

Non-transitionned patientsTransitionned patientsp value
New anti-TNF use5 (20.8%)7 (21.2%)0.963
New course of steroids6 (25%)10 (30.3%)0.927
Surgical procedure4 (16.7%)7 (21.2%)0.670
Endoscopic procedure11 (45.8%)15 (45.5%)0.978
Mean days follow-up per patient (months)1361 (44.7)1351 (44.4)
Total attended clinic appointments (per patient)233 (9.7)356 (10.8)0.051
Number of non-attendances (percentage of appointments)*32 (13.7%)16 (4.5%)0.031

*Hospital baseline 2015 DNA rate was 11.1% for new patients and 8.7% for IBD follow-up clinic patients overall.

Conclusion

Fifty-eight percent of IBD patients referred from paediatric services chose to attend a transition clinic. Patients attending transition clinic are a self-selecting group in our cohort, as all are offered such a clinic appointment. Following referral both groups continue to have high therapy demands. A new course of steroids, starting Anti TNF therapy or surgical procedure was considered a surrogate for increased disease activity. Our data suggests that those attending a transition clinic are not less likely to flare, compared to those who did not attend. This is in contrast to other datasets which suggest that transition reduces disease flares. An assumption that patients choosing not to attend transition clinic have milder disease and need less intensive follow-up, is not supported by our data.