Fishman Laurie N, Ziniel Sonja I, Adrichem Max E, Fernandes Susan M, Arnold Janis
*Center for Inflammatory Bowel Disease and Division of Gastroenterology and Nutrition, Boston Children's Hospital †Department of Pediatrics, Harvard Medical School, Boston, MA ‡University of Amsterdam, Amsterdam, The Netherlands §Division of Pediatric Cardiology, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA.
J Pediatr Gastroenterol Nutr. 2014 Aug;59(2):221-4. doi: 10.1097/MPG.0000000000000405.
Adolescent patients with chronic health conditions must gradually assume responsibility for their health. Self-management skills are needed for a successful transfer from adolescent to adult health care, but the development of these skills could be resource intensive. Pediatric providers are already instrumental in teaching patients about their health and may improve these skills. The aim of the study was to evaluate whether informal education of pediatric providers regarding transition improves inflammatory bowel disease (IBD) patient self-management skills.
Consecutive patients with IBD older than 10 years who presented to the outpatient setting were administered a survey regarding self-management behaviors in 2008 and 2011. During this time, several conferences on transition were presented to the providers.
In 2008, 294 patients completed the survey (82%) compared with 121 patients (89%) in 2011. The patient groups were comparable with respect to sex (boys 50% vs 42%), mean age (16.7 vs 16.2 years), and type of IBD (Crohn 68% vs 66%). The 13- to 15-year-olds reported calling in refills (11%, 8%, respectively), scheduling clinic appointment (0, 1%), preparing questions (13%, 5%), and taking the main role in talking during clinic visits (15%, 24%). The 16- to 18-year-olds reported calling in refills (13%, 27%), scheduling clinic appointments (9%, 6%), preparing questions (9%, 16%), and taking the main role in talking in clinic visits (36%, 45%). Responsibility for behaviors gradually increases with age, but did not differ significantly between 2008 and 2011.
Increasing awareness around transition readiness for pediatric providers had an insignificant effect on the self-management skills of patients with IBD. A more formal or structured approach is likely required to improve transition skills in adolescent patients.
患有慢性健康问题的青少年患者必须逐渐对自己的健康负责。从青少年医疗保健成功过渡到成人医疗保健需要自我管理技能，但这些技能的培养可能需要大量资源。儿科医疗服务提供者在教导患者了解自身健康方面已经发挥了作用，并且可能会提高这些技能。本研究的目的是评估对儿科医疗服务提供者进行关于过渡的非正式教育是否能提高炎症性肠病（IBD）患者的自我管理技能。
2008年和2011年，对到门诊就诊的10岁以上连续性IBD患者进行了一项关于自我管理行为的调查。在此期间，向医疗服务提供者举办了几次关于过渡的会议。
2008年，294名患者完成了调查（82%），2011年为121名患者（89%）。患者组在性别（男孩分别为50%和42%）、平均年龄（16.7岁和16.2岁）以及IBD类型（克罗恩病分别为68%和66%）方面具有可比性。13至15岁的患者报告称打电话要求续开药方（分别为11%、8%）、安排门诊预约（0、1%）、准备问题（13%、5%）以及在门诊就诊时主要负责交谈（15%、24%）。16至18岁的患者报告称打电话要求续开药方（13%、27%）、安排门诊预约（9%、6%）、准备问题（9%、16%）以及在门诊就诊时主要负责交谈（36%、45%）。行为责任随着年龄逐渐增加，但在2008年和2011年之间没有显著差异。
提高儿科医疗服务提供者对过渡准备的认识对IBD患者的自我管理技能影响不大。可能需要一种更正式或结构化的方法来提高青少年患者的过渡技能。
