TY - JOUR
T1 - Value of an outpatient transition clinic for young people with inflammatory bowel disease
T2 - A mixed-methods evaluation
AU - Sattoe, Jane N.T.
AU - Peeters, Mariëlle A.C.
AU - Haitsma, Jannie
AU - Van Staa, Anne Loes
AU - Wolters, Victorien M.
AU - Escher, Johanna C.
N1 - Funding Information:
Barriers for the organisation of a TC were: (1) lack of service structure and alignment in content of care between paediatric and adult care, and little attention given to transition-specific topics; (2) time restrictions and planning difficulties; (3) limited involvement of professionals from adult care; (4) lack of financial coverage of the provided joint care. Professionals from both paediatric and adult care mentioned that they did not really coordinate who would discuss which topic with the young person (and his/her parents). Coordination could provide more structure in discussing important topics and preparing young persons for transition, but they feel that time is too short. The paediatric gastroenterologist explained: “So many things have to be done in so little time that often you don’t find the time to address all important topics. […] We need to bring more structure into the content discussed, because it can be valuable to discuss certain topics repeatedly”. The adult gastroenterologist also explained: “Being involved in transitional care takes time, and that is always the big problem. We do not have time”. In the control setting, time restrictions were an important reason for not organising a TC and the TC time restrictions were also the reason that only one dedicated adult gastroenterologist was involved at the TC: the young people did not get to know the other adult providers before transfer. Another important barrier was related to financial coverage. The adult gastroenterologist clarified: “The only reason [the TC] is organised is because both the paediatric gastroenterologist and I want to do this. We think this is important, but I think others don’t find it as important as we do. No time and extra money are reserved for the TC. Although we provide joint care, my department doesn’t get paid for this. I’m doing a lot of voluntary work and have done so for years now. Now I don’t care, but my department doesn’t get paid. That means that there is no incentive to do this”. Financial support was also an issue according to the paediatric care professionals. A paediatric gastroenterologist explained: “The transition clinic is not financially supported by the hospital. All the extra work we do, is voluntary”. Lack of reimbursement was also mentioned in the control setting as an important reason for not having a TC.
Publisher Copyright:
© 2020 Author(s) (or their employer(s)).
PY - 2020/1/6
Y1 - 2020/1/6
N2 - 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.
AB - 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.
KW - adolescents
KW - inflammatory bowel disease
KW - self-management
KW - transitional care
KW - young adults
UR - http://www.scopus.com/inward/record.url?scp=85077724043&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2019-033535
DO - 10.1136/bmjopen-2019-033535
M3 - Article
C2 - 31911522
AN - SCOPUS:85077724043
SN - 2044-6055
VL - 10
JO - BMJ Open
JF - BMJ Open
IS - 1
M1 - e033535
ER -