Resource utilization during pediatric to adult transfer of care in IBD.
BACKGROUND
The transition from pediatric to adult care for inflammatory bowel disease (IBD) is poorly understood.


OBJECTIVE
To characterize this transfer of care, health resource utilization was assessed.


METHODS
Patients transferred between 1999 and 2008 were studied. Utilization of health resources one year before transfer and one year after transfer was compared. Resource units assessed included: i) emergency department (ED) visits; ii) hospitalizations; iii) clinic visits; iv) surgical procedures; and v) endoscopies. Secondary outcomes included: i) documentation of patient non-compliance; ii) reason(s) for ED visit; iii) diagnoses most responsible for hospital admission; iv) medications; v) indications for surgery; vi) endoscopic findings; vii) and disease activity.


RESULTS
95 subjects were identified (48 female), of whom 69 had Crohn's disease (CD) and 26 had ulcerative colitis (UC). The average age of diagnosis was 12.9 years. Over their adult care interval, subjects had fewer clinic visits (2.56 versus 3.05 (p = 0.01)) and more documented non-compliance (43% versus 29% (p = 0.01)). No differences in ED visits (0.15 versus 0.18 (p = 0.71)), hospitalizations (0.13 versus 0.13 (p = 0.23)), surgical intervention (0.03 versus 0.05 (p = 0.53)) or endoscopies (0.37 versus 0.25 (p = 0.11)) were observed. IBD was active 66.7% of endoscopies under pediatric care versus only 23.8% under adult care (p = 0.003). The average activity of CD was also higher during the last year of pediatric care.


CONCLUSIONS
Understanding the transition process can help to develop strategies needed to support patients and their families.
Internal Medicine, McMaster University, Canada. natasha.bollegala@medportal.ca
Natasha
N
Bollegala
Herbert
H
Brill
John K
JK
Marshall
D000293:Adolescent; D000553:Ambulatory Care / Q000706:statistics & numerical data; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000601:surgery / Q000628:therapy*; D003424:Crohn Disease / Q000601:surgery / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D016099:Endoscopy, Gastrointestinal / Q000706:statistics & numerical data; D005260:Female; D005774:Gastrostomy / Q000706:statistics & numerical data; D006295:Health Resources / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D000069285:Infliximab; D010535:Laparoscopy / Q000706:statistics & numerical data; D008297:Male; D019804:Mesalamine / Q000627:therapeutic use; D010349:Patient Compliance; D012189:Retrospective Studies; D012720:Severity of Illness Index; D060305:Transition to Adult Care / Q000706:statistics & numerical data*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D019804:Mesalamine; D000069285:Infliximab; D001379:Azathioprine