P628 Transfer of care of adolescent IBD patients without longitudinal transition: Lesson from 10-year experiences. (16th January 2018)

• Record Type: Journal Article
• Authors: Szántó, K; Farkas, K; Rutka, M; Bálint, A; Bor, R; Milassin, Á; Fábián, A; Szepes, Z; Nagy, F; Vass, N; Szűcs, D; Molnár, T
• Is Part Of: Journal of Crohn's and colitis. Volume 12:Number 1(2018:Jan.)Supplement 1
• Page Start: S427
• Page End: S427
• Publication Date: 2018-01-16
• Subjects: Inflammatory bowel diseases -- Periodicals; 616.344005
• DOI: 10.1093/ecco-jcc/jjx180.755
• Languages: English
• ISSNs: 1873-9946

Abstract

Abstract: Background: inflammatory bowel disease s (IBD-Crohn's disease [CD], ulcerative colitis [UC]) are usually diagnosed in adolescence or young adulthood. Transfer, which is a planned movement of patient and their medical records from one provider to another, is the final, single event of a transition process. Only a few data are available from real life about the outcome of transfer and transition of care in IBD. Our aim was to retrospectively evaluate the results of the transfer of our IBD patients from paediatric to adult care without longitudinal transition. Methods: Data on demographic and clinical characteristics of the transferred patients at the University of Szeged were analysed. Patients were diagnosed with IBD in paediatric care based on the ECCO-ESPGHAN consensus. Transfer strategy at our departments was detailed medical summary. Results: Data of 59 IBD patients (39 CD, 16 UC, 4 indeterminate colitis) were analysed. Patients spent an average of 4.8 years at the paediatric and an average of 3.9 years in the adult care at the time of analysis. In 27 cases (45.7%) endoscopy was performed connected to the transfer. Twenty-eight per cent of the patients had mild-to-moderate disease activity and 71.2% was in remission at the time of transfer. The number of endoscopies per patient per year were 0.40 during the paediatric care and 0.44 during the adult care. After the transfer, medical therapy was escalated in 26 patients. Steroid therapy was initiated in 58 % of the patients within an average of 9.1 months after the transfer. Seventeen per cent of the patients received the first steroid shot in the adult care. Anti TNF therapy was given for 24% of the patients during the paediatric care and for an additional 23% in the adult care within an average of 28 months. Seventy per cent of patients received immunosuppressive therapy during paediatric care. Azathioprine was newly initiated in 12% of patients at the adult care. Surgery was required in 17% of the patients within an average 10.7 months after the transfer. Conclusions: Our results revealed that one-third of the paediatric patients have been transferred to adult care in active stage of disease. Fifty-eight per cent of young patients required corticosteroids and 17% required surgery shortly after transferring to the adult care. Every fifth patient needed biological therapy to be initiated after the transfer. Our results revealed that the transfer of the patients in this vulnerable age is associated with a higher risk of adverse outcome. Longitudinal transition may have a potential to decrease the need for therapeutic change and the relatively high rate of surgery.