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Benefits of Paediatric to Adult Transition Programme in Inflammatory Bowel Disease: The BUTTERFLY Study of GETECCU
Cristina Rubín de Célix1, Javier Martín-de-Carpi2, Gemma Pujol-Muncunill2
1Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), 28006 Madrid, Spain.
Insights
Structured transition care programs significantly improve outcomes for pediatric inflammatory bowel disease (IBD) patients moving to adult care. Patients without transition experienced worse clinical outcomes, including flares and hospitalizations.
Area of Science:
- Gastroenterology
- Pediatric Healthcare
- Transition Medicine
Background:
- Implementation of planned transition from pediatric to adult healthcare systems is inconsistent in inflammatory bowel disease (IBD) units.
- Evaluating the impact of transition on IBD patient outcomes is crucial for optimizing care pathways.
Purpose of the Study:
- To assess the effect of a structured transition process on clinical outcomes in pediatric patients with IBD after transfer to adult care.
- To identify factors predicting poor clinical outcomes in IBD patients during the transition period.
Main Methods:
- A multicenter, retrospective observational study compared outcomes of IBD patients transitioning (≥1 joint visit) versus not transitioning to adult care (2017-2020).
- Poor clinical outcome was defined as IBD flare, hospitalization, surgery, or treatment change due to a flare.
- Multivariable analysis identified predictive factors for poor clinical outcomes.
Main Results:
- 278 IBD patients from 34 Spanish hospitals were analyzed; 67% underwent structured transition.
- The transition group showed a significantly lower rate of poor clinical outcome (27% vs. 43%, p=0.005) at one year post-transfer.
- No-transition patients had higher rates of IBD flares (36% vs. 22%) and hospitalizations (10% vs. 3%).
Conclusions:
- Transition care programs demonstrably improve patient outcomes following transfer from pediatric to adult IBD services.
- Active IBD at the time of transfer is a significant predictor of adverse outcomes.
- Structured transition care minimizes loss to follow-up and enhances long-term management of IBD.
Abstract:
(1) Background: Transition is a planned movement of paediatric patients to adult healthcare systems, and its implementation is not yet established in all inflammatory bowel disease (IBD) units. The aim of the study was to evaluate the impact of transition on IBD outcomes. (2) Methods: Multicentre, retrospective and observational study of IBD paediatric patients transferred to an adult IBD unit between 2017-2020. Two groups were compared: transition (≥1 joint visit involving the gastroenterologist, the paediatrician, a programme coordinator, the parents and the patient) and no-transition. Outcomes within one year after transfer were analysed. The main variable was poor clinical outcome (IBD flare, hospitalisation, surgery or any change in the treatment because of a flare). Predictive factors of poor clinical outcome were identified with multivariable analysis. (3) Results: A total of 278 patients from 34 Spanish hospitals were included. One hundred eighty-five patients (67%) from twenty-two hospitals (65%) performed a structured transition. Eighty-nine patients had poor clinical outcome at one year after transfer: 27% in the transition and 43% in the no-transition group (p = 0.005). One year after transfer, no-transition patients were more likely to have a flare (36% vs. 22%; p = 0.018) and reported more hospitalisations (10% vs. 3%; p = 0.025). The lack of transition, as well as parameters at transfer, including IBD activity, body mass index < 18.5 and corticosteroid treatment, were associated with poor clinical outcome. One patient in the transition group (0.4%) was lost to follow-up. (4) Conclusion: Transition care programmes improve patients' outcomes after the transfer from paediatric to adult IBD units. Active IBD at transfer impairs outcomes.
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