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Original research
Value of an outpatient transition clinic for young people with inflammatory bowel disease: a mixed-methods evaluation
  1. Jane N T Sattoe1,
  2. Mariëlle A C Peeters1,2,
  3. Jannie Haitsma1,
  4. AnneLoes van Staa1,2,
  5. Victorien M Wolters3,
  6. Johanna C Escher4
  1. 1 Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
  2. 2 Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
  3. 3 Department of Pediatric Gastroenterology, University Medical Center Utrecht, Utrecht, The Netherlands
  4. 4 Department of Pediatric Gastroenterology, Erasmus Medical Centre - Sophia Children's Hospital, Rotterdam, The Netherlands
  1. Correspondence to Dr AnneLoes van Staa; vanstaa{at}eshpm.eur.nl

Abstract

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.

  • inflammatory bowel disease
  • transitional care
  • self-management
  • young adults
  • adolescents
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Footnotes

  • Contributors JNTS: conception and design of the study, acquisition of data, analysis and interpretation of data, drafting the article, revision of the article and final approval of the version submitted. MACP: acquisition of data, analysis and interpretation of the data, revising the article critically for important intellectual content and final approval of the version to be submitted.JH: acquisition of data, revising the article critically for important intellectual content and final approval of the version to be submitted. AvS: conception and design of the study, interpretation of the data, revising the article critically for important intellectual content and final approval of the version to be submitted.VMW: acquisition and interpretation of data, revising the article critically for important intellectual content and final approval of the version to be submitted.JCE: design of the study, acquisition and interpretation of data, revising the article critically for important intellectual content and final approval of the version to be submitted.

  • Funding This work was supported by Foundation Innovation Alliance (SIA-RAAK) with funding from the Dutch Ministry of Education, Culture and Science (Grant no: PRO-02-025). The funding organisation had no role in the design, implementation, interpretation and reporting of this study.

  • Competing interests JCE received research support from MSD and has served as advisory board member for Janssen and Abbvie. AvS has served as advisory board member for professional education in diabetes care for Medtronic.

  • Patient consent for publication Not required.

  • Ethics approval The Medical Ethical Committees of the Erasmus Medical Center (MEC-2014-246) and University Medical Center Utrecht (METC-15-123/C) approved the study protocol.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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