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Impact of Paediatric Versus Adult Care Setting on Health Care Utilization in Adolescents With Inflammatory Bowel
Renske W B Bottema1,2, Han de Vries3, Roderick H J Houwen1
1Department of Paediatric Gastroenterology, Hepatology and Nutrition, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht.
Insights
Adolescents with inflammatory bowel disease (IBD) treated in pediatric care settings experienced lower use of corticosteroids and biologics without increased hospital admissions. This suggests pediatric care may optimize treatment for young IBD patients.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Health Services Research
Background:
- Paediatric-onset inflammatory bowel disease (IBD) presents unique challenges in growth and development compared to adult-onset IBD.
- Care for paediatric IBD patients is often fragmented between pediatric and adult healthcare providers, potentially impacting outcomes.
- Adolescence is a critical transition period for IBD management.
Purpose of the Study:
- To evaluate the impact of care setting (pediatric vs. adult-oriented) on healthcare utilization among adolescent IBD patients.
- To compare treatment patterns and outcomes in different care settings for young IBD patients.
- To provide evidence for optimizing clinical care pathways for adolescents with IBD.
Main Methods:
- A Dutch population-based cohort study utilizing an insurance claims database of 4.2 million individuals.
- Identification of IBD patients aged 16-18 years, followed until age 19 or transfer to adult care.
- Categorization into pediatric or adult-oriented care settings, with outcomes including corticosteroid, biological use, hospital admissions, and surgeries. Cox proportional hazards regression was used for analysis.
Main Results:
- Of 626 patients, 61% received pediatric care and 39% adult-oriented care.
- Patients in pediatric care showed significantly lower rates of corticosteroid use (HR 0.72, 95% CI 0.52-0.99) and biologicals (HR 0.57, 95% CI 0.34-0.97).
- Pediatric care was also associated with fewer IBD-related hospital admissions (HR 0.58, 95% CI 0.37-0.92).
Conclusions:
- Treatment within a pediatric care setting for adolescents with IBD is linked to reduced use of steroids and biologics.
- This approach did not result in an increased rate of hospital admissions.
- Findings suggest that pediatric-focused care models can effectively manage adolescent IBD, potentially optimizing treatment strategies.
Objective:
Paediatric-onset inflammatory bowel disease (IBD) is different from adult-onset IBD with respect to disease severity and its effect on growth and development. Care of paediatric IBD patients in some countries is dispersed among paediatricians and adult care providers, which may result in different outcomes. This study aims to assess the effect of care setting (paediatric vs adult-oriented) on health care utilization in adolescent IBD patients.
Methods:
This is a Dutch population-based cohort study based on an insurance claims database covering 4.2 million insurees (approximately 25% of the Dutch population). We identified IBD patients ages 16 to 18 years and followed them until the age of 19 years or transfer to adult care, whichever came first. We categorized patients according to care setting: paediatric versus adult-oriented. We defined outcomes as corticosteroid use, IBD-related hospital admission, IBD-related surgery, and biological use. We estimated Cox proportional hazards regression models to control for confounding by indication.
Results:
Among 626 patients, 380 (61%) were in paediatric and 246 (39%) in adult-oriented care. In paediatric care, patients were less likely to be treated with corticosteroids (hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.52-0.99) or biologicals (HR 0.57, 95% CI 0.34-0.97), and had fewer IBD-related hospital admissions (HR 0.58, 95% CI 0.37-0.92).
Conclusion:
In a large and representative community cohort of adolescents with IBD, treatment in paediatric care setting was associated with significantly lower steroid and biological use, without increase in hospital admissions. These results might be used to optimize clinical care for adolescents with IBD.
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