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Value of an outpatient transition clinic for young people with inflammatory bowel disease: a mixed-methods evaluation
Jane N T Sattoe1, Mariëlle A C Peeters1,2, Jannie Haitsma1
1Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands.
Insights
Transition clinics (TCs) improve care for young people with inflammatory bowel disease (IBD), offering better experiences and satisfaction. Addressing organizational and financial barriers is key to widespread implementation of effective IBD transition interventions.
Area of Science:
- Pediatric Gastroenterology
- Adult Gastroenterology
- Health Services Research
Background:
- Effective transition interventions for young people (16-25 years) with inflammatory bowel disease (IBD) are crucial.
- Transition clinics (TCs) are recommended, but their operational structures and outcomes require further investigation.
- This study compares the value of TCs versus direct handover care for IBD patient transition.
Purpose of the Study:
- To gain insight into the value of a transition clinic (TC) compared with direct handover care for young people with IBD.
- To evaluate process, clinical, and patient-reported outcomes of transitional care models.
- To identify barriers and facilitators in implementing TCs for IBD patients.
Main Methods:
- Controlled mixed-methods evaluation conducted in two Dutch outpatient IBD clinics.
- Data collection involved semistructured interviews with professionals, observations, medical chart reviews (n=110), and patient questionnaires (n=33).
- Analysis focused on service structures, daily routines, barriers, facilitators, healthcare utilization, clinical outcomes, and patient experiences.
Main Results:
- TCs incorporated multidisciplinary team meetings and aligned pediatric and adult care, with greater attention to non-medical topics.
- Young people in TCs had more planned consultations pre-transfer and reported better transfer experiences and satisfaction.
- Direct handover care was associated with more relapses pre-transfer and missed consultations post-transfer.
Conclusions:
- Transition clinics offer significant opportunities to enhance transitional care for IBD patients.
- Organizational and financial barriers must be addressed for effective implementation of TC guidelines and consensus statements.
- Further research and policy development are needed to optimize TC models in IBD care.
Objective:
Developing and evaluating effective transition interventions for young people (16-25 years) with inflammatory bowel disease (IBD) is a high priority. While transition clinics (TCs) have been recommended, little is known about their operating structures and outcomes. This study aimed to gain insight into the value of a TC compared with direct handover care.
Design:
Controlled mixed-methods evaluation of process outcomes, clinical outcomes and patient-reported outcomes.
Setting:
Two outpatient IBD clinics in the Netherlands.
Participants:
Data collection included: semistructured interviews with professionals (n=8), observations during consultations with young people (5×4 hours), medical chart reviews of patients transferred 2 to 4 years prior to data collection (n=56 in TC group; n=54 in control group) and patient questionnaires (n=14 in TC group; n=19 in control group).
Outcomes:
Data were collected on service structures and daily routines of the TC, experienced barriers, facilitators and benefits, healthcare use, clinical outcomes, self-management outcomes and experiences and satisfaction of young people with IBD.
Results:
At the TC, multidisciplinary team meetings and alignment of care between paediatric and adult care providers were standard practice. Non-medical topics received more attention during consultations with young people at the TC. Barriers experienced by professionals were time restrictions, planning difficulties, limited involvement of adult care providers and insufficient financial coverage. Facilitators experienced were high professional motivation and a high case load. Over the year before transfer, young people at the TC had more planned consultations (p=0.015, Cohen's d=0.47). They showed a positive trend in better transfer experiences and more satisfaction. Those in direct handover care more often experienced a relapse before transfer (p=0.003) and had more missed consultations (p=0.034, Cohen's d=-0.43) after transfer.
Conclusion:
A TC offer opportunities to improve transitional care, but organisational and financial barriers need to be addressed before guidelines and consensus statements in healthcare policy and daily practice can be effectively implemented.
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