Original articleTransition of patients with inflammatory bowel disease from pediatric to adult careTransition vers le gastroenterologue d’adultes des enfants suivis pour une maladie inflammatoire chronique intestinale
Introduction
In Brittany, the annual incidence of inflammatory bowel disease (IBD) in the pediatric population is 1.6 per 100,000 for Crohn's disease and 0.5 per 100,000 for ulcerative colitis. IBD had begun before 17 years of age in 6.7% of these children [1]. Since IBD is a chronic illness, these patients will eventually move from pediatric to adult care, requiring the involvement of ‘referring’ pediatric and ‘referral’ adult-care physicians, as well as the adolescents themselves and their families. All of these healthcare partners have to participate in a careful examination of both the risks of the transition and the practical procedures involved. The extensive body of literature devoted to this problematical issue includes reviews and guidelines proposed by various learned societies [2], [3], [4], [5], [6], but no ‘real-life’ survey of adult patients who made the transition from pediatric to adult care.
Since 1992, the pediatric gastroenterology unit at the Rennes University Hospital Center has arranged for a joint medical visit for pediatric patients with IBD scheduled for transition to adult care within the center. The patients and their parents (on their request) are invited to attend a joint visit with the pediatric and adult gastroenterologists before making the transition. The purpose of the present study was to learn more about the way patients and their parents perceived this experience as a function of transition to adult-care gastroenterology.
Section snippets
Patients and methods
Since 1992, IBD pediatric patients who reach adulthood have been invited to transfer their subsequent care to the adult gastroenterology unit of the same University Hospital Center or to another practitioner. When patients express their desire to stay within the same center, a one-hour joint visit is scheduled in the adult-care gastroenterology unit to plan for further follow-up. This consultation is conducted by both the pediatric physician currently in charge of the patient and the adult-care
Circumstances of the transition
The mean patient age at transition was 17.9 ± 0.9 years (median: 18; range: 15.5–20.5). The transition was later in one patient (aged 20.5 years at transition) because of disease-related retardation of growth and puberty. Forty-six patients had completed puberty by the time of transition. These data were missing for two patients.
At the time of transition, 26 patients were in secondary school and 11 in higher education; failing in school was noted in two patients and was disease-related in one
Discussion
Like other chronic diseases beginning in childhood, IBD eventually requires transition from pediatric to adult care [2], [3], [4], [5], [6]. ‘Successful’ transition enables uninterrupted coordinated care that is well-adapted to the patient's development and maturity both before and during the transition and probably contributes to better patient compliance to medical care in adulthood. The guidelines proposed by expert societies increasingly urge pediatric gastroenterologists to develop a
Conclusion
For pediatric patients at the Rennes University Hospital Center with IBD, transition from pediatric to adult care appears to have been a successful experience, allowing them to continue their coordinated care without interruption. Careful consideration of the developmental and growth phases of each individual patient, discussions among the pediatric physician, the patient and his family that anticipate the transition several years ahead of time, the development of joint visits since 1992 and
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2019, Journal of Pediatric NursingCitation Excerpt :A total of three of the fair-to-poor quality reviews had duplicate review and abstraction described for each step of the review (Chu et al., 2015; Embrett et al., 2016; Prior et al., 2014). A total of 71 unique primary studies were identified as eligible from the 37 reviews (Appendix D) (Akchurin, Melamed, Hashim, Kaskel, & Del Rio, 2014; Annunziato et al., 2007; Annunziato et al., 2013; Annunziato et al., 2015; Bashore & Bender, 2016; Bauman, Kuhle, Bruce, Bolster, & Massicotte, 2016; Bent et al., 2002; Betz, Smith, & Macias, 2010; Brotzman, Blake, Myers, & Reece, 2001; Bundock et al., 2011; Busse et al., 2007; Cadario et al., 2009; Chaturvedi, Jones, Walker, & Sawyer, 2009; Chaudhry, Keaton, & Nasr, 2013; Cole, Ashok, Razack, Azaz, & Sebastian, 2015; Cuttell, Hilton, & Drew, 2005; Dabadie et al., 2008; Dugueperoux et al., 2008; Dyrløv et al., 2000; Egan, Corrigan, & Shurpin, 2015; Fredericks et al., 2015; Gilmer, Ojeda, Fawley-King, Larson, & Garcia, 2012; Gimenez et al., 2013; Gleeson, Davis, Jones, O'shea, & Clayton, 2013; Gravelle, Paone, Davidson, & Chilvers, 2015; Greveson, Morgan, Furman, & Murray, 2011; Haber, Karpur, Deschênes, & Clark, 2008; Hankins et al., 2012; Harden et al., 2012; Hilderson et al., 2016; Holmes-Walker, Llewellyn, & Farrell, 2007; Hommel, Birthe, Anne, & Jannet, 2012; Huang et al., 2014; Jensen et al., 2015; Johnston, Bell, Tennet, & Carson, 2006; Kipps et al., 2002; Lane et al., 2007; Levy-Shraga et al., 2016; Logan et al., 2008; Mackie et al., 2014; Manteuffel, Stephens, Sondheimer, & Fisher, 2008; Markowitz & Laffel, 2012; Maslow et al., 2013; McDonagh, Shaw, & Southwood, 2006; McDonagh, Southwood, & Shaw, 2007; McQuillan, Toulany, Kaufman, & Schiff, 2015; Nakhla, Daneman, To, Paradis, & Guttmann, 2009; Nieboer et al., 2014; Okumura et al., 2014; Orr, Fineberg, & Gray, 1996; Pape et al., 2013; Prestidge, Romann, Djurdjev, & Matsuda-Abedini, 2012; Rapley, Babel, Kaye, & Brown, 2013; Rapley, Hart, Babel, & Kaye, 2007; Remorino & Taylor, 2006; Rettig & Athreya, 1991; Sawyer et al., 1998; Schmidt, Herrmann-Garitz, Bomba, & Thyen, 2016; Sequeira et al., 2015; Shaw, Southwood, & McDonagh, 2007; Smith, Lewis, Whitworth, Gold, & Thornburg, 2011; Steinbeck et al., 2015; Steinkamp, Ullrich, Müller, Fabel, & Von Der Hardt, 2001; Styron et al., 2006; Van Walleghem, MacDonald, & Dean, 2008, 2011, 2012; Vanelli et al., 2004; Vidal et al., 2004; Weitz, Heeringa, Neuhaus, Fehr, & Laube, 2015; Wiener, Battles, Ryder, & Zobel, 2007). Eligible primary studies contained a wide range of participants (range: 6 to 3613, median: 67).
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