The Ohio State University Inflammatory Bowel Disease Center, Columbus, Ohio, USA.
Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
Am J Gastroenterol. 2019 Sep;114(9):1432-1440. doi: 10.14309/ajg.0000000000000222.
The growing need for transitional care is quickly becoming apparent in the medical community because children with chronic illnesses are surviving into adulthood. Transitional care is the coordinated movement of young adults with chronic conditions from the pediatric to adult health care setting. This transition period is associated with poorer health outcomes due to differences in pediatric and adult health care models, reluctance to change providers, and transfer of disease ownership. These factors must be considered in inflammatory bowel disease (IBD), in which 25% of patients are diagnosed before adulthood and there is an increasing incidence in the pediatric population. Additionally, those with childhood IBD tend to have more severe disease, making structured transition programs imperative to ensure continuity of care and promote self-advocacy. Recommended models for transition have been based on descriptive data rather than on prospective or randomized studies, but the recent IBD literature supports a need for transitional care. Regardless, a great deal of variability in clinical practice remains because there is no agreed upon optimal transition model. This review addresses the status of transitional care in IBD and provides helpful resources to assess patient readiness for transition and to assist in the care of the young transitioning adult.
由于患有慢性病的儿童能够存活至成年,因此医疗界越来越需要过渡护理。过渡护理是指将患有慢性病的青年从儿科医疗保健环境协调转移到成人医疗保健环境。由于儿科和成人医疗保健模式的差异、不愿更换提供者以及疾病所有权的转移,这一过渡时期与较差的健康结果有关。在炎症性肠病(IBD)中必须考虑这些因素,其中 25%的患者在成年前被诊断出,而且儿科人群中的发病率也在增加。此外,那些患有儿童 IBD 的患者往往病情更严重,因此需要有结构化的过渡计划,以确保护理的连续性并促进自我倡导。过渡的推荐模式是基于描述性数据,而不是基于前瞻性或随机研究,但最近的 IBD 文献支持过渡护理的必要性。尽管如此,由于没有达成共识的最佳过渡模式,临床实践仍然存在很大的差异。这篇综述讨论了 IBD 中的过渡护理现状,并提供了有用的资源来评估患者过渡的准备情况,并帮助过渡中的年轻成年患者进行护理。