Predicting Suboptimal Transitions in Adolescents With Inflammatory Bowel Disease.
Journal
Journal of pediatric gastroenterology and nutrition
ISSN: 1536-4801
Titre abrégé: J Pediatr Gastroenterol Nutr
Pays: United States
ID NLM: 8211545
Informations de publication
Date de publication:
01 04 2021
01 04 2021
Historique:
pubmed:
3
12
2020
medline:
10
7
2021
entrez:
2
12
2020
Statut:
ppublish
Résumé
Adolescents and young adults (AYAs) are at risk for disease exacerbations and increased health care utilization around the time of transition to adult care. Our aim was to identify risk factors predictive of a suboptimal transition for AYA with inflammatory bowel disease. We performed a retrospective chart review of patients with pediatric inflammatory bowel disease transferred to adult care from our institution in 2016 and 2017, recording demographic, psychosocial, and disease-specific data. Post-transfer data were obtained via the health care information exchange from the adult provider within our electronic medical record. We defined suboptimal transition as either a return to pediatric care or requiring care escalation within 1 year of transfer. Out of 104 subjects 37 (36%) were found to have had a suboptimal transition. Our models suggest that a suboptimal transition is associated with several risk factors including any mental health diagnosis (odds ratio [OR] = 4.15; 95% confidence interval [95% CI]: 1.18-14.59), history of medication nonadherence (OR = 5.15 [95% CI: 1.52-17.42]), public insurance (OR = 6.60 [95% CI: 1.25-34.96]), higher Physician Global Assessment score at time of transition (OR = 6.64 [95% CI: 1.60-27.58], and short Pediatric Crohn Disease Activity Index scores (OR = 1.17 [95% CI: 1.03-1.33]). Higher hemoglobin levels at transition were protective (OR = 0.69 [95% CI: 0.48-0.98]). Age at time of transition, disease duration, and medication type at transition were not found to be associated with transition outcomes. AYA with public insurance, a mental health history, medication nonadherence, and evidence of active disease may be at greater risk for suboptimal and poor health outcomes at transition.
Identifiants
pubmed: 33264185
pii: 00005176-202104000-00017
doi: 10.1097/MPG.0000000000003013
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
563-568Informations de copyright
Copyright © 2020 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.
Références
Blum RW, Garell D, Hodgman CH, et al. Transition from child-centered to adult health-care systems for adolescents with chronic conditions. A position paper of the Society for Adolescent Medicine. J Adolesc Health 1993; 14:570–576.
Gurvitz MZ, Inkelas M, Lee M, et al. Changes in hospitalization patterns among patients with congenital heart disease during the transition from adolescence to adulthood. J Am Coll Cardiol 2007; 49:875–882.
Remorino R, Taylor J. Smoothing things over: the transition from pediatric to adult care for kidney transplant recipients. Prog Transplant 2006; 16:303–308.
Stollon NB, Paine CW, Lucas MS, et al. Transitioning adolescents and young adults with sickle cell disease from pediatric to adult health care: provider perspectives. J Pediatr Hematol Oncol 2015; 37:577–583.
Lawrence ZE, Martinez M, Lobritto S, et al. Adherence, medical outcomes, and health care costs in adolescents/young adults following pediatric liver transplantation. J Pediatr Gastroenterol Nutr 2020; 70:183–189.
Brousseau DC, Owens PL, Mosso AL, et al. Acute care utilization and rehospitalizations for sickle cell disease. JAMA 2010; 303:1288–1294.
White PH, Cooley WC. American Academy of Pediatrics, American Academy of Family Physicians, American College of Physicians, Transitions Clinical Report Authoring Group,Supporting the health care transition from adolescence to adulthood in the medical home. Pediatrics 2018; 142:e20182587.
Bollegala N, Nguyen GC. Transitioning the adolescent with IBD from pediatric to adult care: a review of the literature. Gastroenterol Res Pract 2015; 2015:853530.
Philpott JR, Kurowski JA. Challenges in transitional care in inflammatory bowel disease: a review of the current literature in transition readiness and outcomes. Inflamm Bowel Dis 2019; 25:45–55.
Gray WN, Maddux MH. Current transition practices in pediatric IBD: findings from a national survey of pediatric providers. Inflamm Bowel Dis 2016; 22:372–379.
Bensen R, McKenzie RB, Fernandes SM, et al. Transitions in pediatric gastroenterology: results of a national provider survey. J Pediatr Gastroenterol Nutr 2016; 63:488–493.
Gray WN, Resmini AR, Baker KD, et al. Concerns, barriers, and recommendations to improve transition from pediatric to adult IBD care: perspectives of patients, parents, and health professionals. Inflamm Bowel Dis 2015; 21:1641–1651.
Eros A, Soos A, Hegyi P, et al. Spotlight on transition in patients with inflammatory bowel disease: a systematic review. Inflamm Bowel Dis 2020; 26:331–346.
El-Matary W. Transition of children with inflammatory bowel disease: big task, little evidence. World J Gastroenterol 2009; 15:3744–3747.
Paine CW, Stollon NB, Lucas MS, et al. Barriers and facilitators to successful transition from pediatric to adult inflammatory bowel disease care from the perspectives of providers. Inflamm Bowel Dis 2014; 20:2083–2091.
Shapiro JM, El-Serag HB, Gandle C, et al. Recommendations for successful transition of adolescents with inflammatory bowel diseases to adult care. Clin Gastroenterol Hepatol 2020; 18:276–289.
Rosen D, Annunziato R, Colombel JF, et al. Transition of inflammatory bowel disease care: assessment of transition readiness factors and disease outcomes in a young adult population. Inflamm Bowel Dis 2016; 22:702–708.
Whitfield EP, Fredericks EM, Eder SJ, et al. Transition readiness in pediatric patients with inflammatory bowel disease: patient survey of self-management skills. J Pediatr Gastroenterol Nutr 2015; 60:36–41.
Gray WN, Holbrook E, Morgan PJ, et al. Transition readiness skills acquisition in adolescents and young adults with inflammatory bowel disease: findings from integrating assessment into clinical practice. Inflamm Bowel Dis 2015; 21:1125–1131.
Heyman MB, LaBerge JM, Somberg KA, et al. Transjugular intrahepatic portosystemic shunts (TIPS) in children. J Pediatr 1997; 131:914–919.
Plevinsky JM, Gumidyala AP, Fishman LN. Transition experience of young adults with inflammatory bowel diseases (IBD): a mixed methods study. Child Care Health Dev 2015; 41:755–761.
Gumidyala AP, Greenley RN, Plevinsky JM, et al. Moving on: transition readiness in adolescents and young adults with IBD. Inflamm Bowel Dis 2018; 24:482–489.
R: A Language and Environment for Statistical Computing. 2019; Vienna, Austria: R Foundation for Statistical Computing, [Computer program].
Wojtowicz AA, Plevinsky JM, Poulopoulos N, et al. Examining predictors of healthcare utilization in youth with inflammatory bowel disease. Eur J Gastroenterol Hepatol 2016; 28:469–474.
Arnett JJ. Emerging adulthood. A theory of development from the late teens through the twenties. Am Psychol 2000; 55:469–480.
Rao U, Hammen C, Daley SE. Continuity of depression during the transition to adulthood: a 5-year longitudinal study of young women. J Am Acad Child Adolesc Psychiatry 1999; 38:908–915.
Newman DL, Moffitt TE, Caspi A, et al. Psychiatric disorder in a birth cohort of young adults: prevalence, comorbidity, clinical significance, and new case incidence from ages 11 to 21. J Consult Clin Psychol 1996; 64:552–562.
Luyckx K, Seiffge-Krenke I, Schwartz SJ, et al. Identity development, coping, and adjustment in emerging adults with a chronic illness: the sample case of type 1 diabetes. J Adolesc Health 2008; 43:451–458.
Johnston-Brooks CH, Lewis MA, Garg S. Self-efficacy impacts self-care and HbA1c in young adults with Type I diabetes. Psychosom Med 2002; 64:43–51.
Monaghan M, Helgeson V, Wiebe D. Type 1 diabetes in young adulthood. Curr Diabetes Rev 2015; 11:239–250.
Luyckx K, Seiffge-Krenke I. Continuity and change in glycemic control trajectories from adolescence to emerging adulthood: relationships with family climate and self-concept in type 1 diabetes. Diabetes Care 2009; 32:797–801.
Luyckx K, Moons P, Weets I. Self-classification as an adult in patients with type 1 diabetes: relationships with glycemic control and illness coping. Patient Educ Couns 2011; 85:245–250.
Thavamani A, Umapathi KK, Khatana J, et al. Burden of psychiatric disorders among pediatric and young adults with inflammatory bowel disease: a population-based analysis. Pediatr Gastroenterol Hepatol Nutr 2019; 22:527–535.
Pai A, Ostendorf H. Treatment adherence in adolescents and young adults affected by chronic illness during the health care transition from pediatric to adult health care: a literature review. Child Health Care 2011; 40:16–33.
Javalkar K, Johnson M, Kshirsagar AV, et al. Ecological factors predict transition readiness/self-management in youth with chronic conditions. J Adolesc Health 2016; 58:40–46.
Ayanian JZ, Weissman JS. Teaching hospitals and quality of care: a review of the literature. Milbank Q 2002; 80:569–593.
Retchin SM, Xu WY. Medicaid innovations and the role of academic health centers. Acad Med 2018; 93:1454–1456.
De Silva PS, Fishman LN. Transition of the patient with IBD from pediatric to adult care-an assessment of current evidence. Inflamm Bowel Dis 2014; 20:1458–1464.