Clarke Tilean, Lusher Joanne
School of Psychology, Faculty of Life Sciences and Computing, London Metropolitan University, London, UK.
Frontline Gastroenterol. 2016 Oct;7(4):264-270. doi: 10.1136/flgastro-2015-100575. Epub 2015 Jun 16.
Approximately a quarter of patients with inflammatory bowel disease (IBD) are diagnosed before 20 years of age, presenting with more extensive distribution and severity of disease than adult onset. The purpose of this review was to determine facilitators of, and barriers to, successful transition of patients with IBD from adolescent to adult services. A systematic review of IBD transition research was conducted in March 2014 searching PubMed, MEDLINE, PsycINFO, Web of Science and the Cochrane Database of Systematic Reviews databases. A hand search of reference lists and narrative reviews was carried out to maximise the potential for retrieving all relevant manuscripts. Primary studies written in English of full-length peer-reviewed journal articles that investigated transition of paediatric patients with IBD to adult services were included. Studies were excluded if the primary focus was not IBD. The search produced 283 potentially relevant studies. After removing duplicates and screening for suitability, six met our inclusion criteria. Barriers to transition included system inadequacies and a lack of resources, clinical time and training. Successful transition involved joint medical visits, structured transition services, improved communication between paediatric and adult services and improved education for patients and staff. If the transition process for adolescents suffering with IBD is to improve then it is vital that more research is conducted to better our understanding of ways in which we can ensure that defined protocols are in place for a smooth transition for every adolescent, leading to improved standards and minimal disruption to care.
大约四分之一的炎症性肠病（IBD）患者在20岁之前被诊断出来，与成人发病相比，其疾病分布范围更广、病情更严重。本综述的目的是确定IBD患者从青少年服务顺利过渡到成人服务的促进因素和障碍。2014年3月，我们对IBD过渡研究进行了系统综述，检索了PubMed、MEDLINE、PsycINFO、科学网和Cochrane系统评价数据库。我们还对参考文献列表和叙述性综述进行了手工检索，以最大限度地检索所有相关手稿。纳入了以英文撰写的、经同行评审的全长期刊文章的原创性研究，这些研究调查了IBD儿科患者向成人服务的过渡情况。如果主要关注点不是IBD，则排除相关研究。检索共得到283项潜在相关研究。在去除重复项并筛选适用性后，有6项符合我们的纳入标准。过渡障碍包括系统不完善以及缺乏资源、临床时间和培训。成功过渡涉及联合医疗就诊、结构化过渡服务、改善儿科和成人服务之间的沟通以及加强对患者和工作人员的教育。如果要改善IBD青少年的过渡过程，那么至关重要的是要进行更多研究，以更好地了解如何确保为每个青少年制定明确的方案，实现平稳过渡，从而提高标准并尽量减少对护理的干扰。
