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.
^Small bowel resection, stricturoplasty, and drainageof perianal abscesses.Non-transitionned patients Transitionned patients p value Number 24 33 – Male:Female ratio 13:11 14:19 0.385 Ethnicity (Cauc/Black/South Asian/Unknown or mixed ethnicity) 14/1/1/8 14/1/7/11 – Crohn's disease 17 (70.9%) 25 (75.8%) 0.789 Ulcerative colitis 7 (29.1%) 8 (24.2%) – Pre-referral azathioprine/methotrexate use 10 (41.7%) 22 (66.7%) 0.063 Pre-referral anti-TNF use 4 (16.7%) 8 (24.2%) 0.492 Pre-referral IBD surgery^ 5 (20.8%) 12 (36.4%) 0.210
*Hospital baseline 2015 DNA rate was 11.1% for new patients and 8.7% for IBD follow-up clinic patients overall.Non-transitionned patients Transitionned patients p value New anti-TNF use 5 (20.8%) 7 (21.2%) 0.963 New course of steroids 6 (25%) 10 (30.3%) 0.927 Surgical procedure 4 (16.7%) 7 (21.2%) 0.670 Endoscopic procedure 11 (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
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.