Department of Medicine, Baylor College of Medicine, Houston, Texas; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
Department of Medicine, Baylor College of Medicine, Houston, Texas; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
Clin Gastroenterol Hepatol. 2020 Feb;18(2):276-289.e2. doi: 10.1016/j.cgh.2019.04.063. Epub 2019 May 8.
Adolescents and young adults diagnosed with inflammatory bowel diseases (IBDs) in pediatric care are vulnerable during their transition to adult care. There are 6 core elements of transition from pediatric to adult IBD care. We identified gaps in this transition and make recommendations for clinical practice and research. There have been few studies of transition policy (core element 1) or studies that tracked and monitored patients through the transition (core element 2). Several studies have assessed transition readiness (core element 3), but instruments for assessment were not validated using important outcomes such as disease control, health care use, adherence, quality of life, or continuity of care. There have been no studies of best practices for transition planning (core element 4), including how to best educate patients and facilitate gradual shifts in responsibility. A small number of longitudinal studies have investigated transfer of care (core element 5), but these were conducted outside of the United States; these studies found mixed results in short- and intermediate-term outcomes after transition completion (core element 6). We discuss what is known about the transition from pediatric to adult care for IBD, make recommendations to improve this process, and identify areas for additional research.
在儿科接受诊断的青少年和年轻成年人患有炎症性肠病(IBD),在向成人护理过渡期间容易受到影响。从儿科 IBD 护理过渡到成人护理有 6 个核心要素。我们发现了这一过渡中的差距,并为临床实践和研究提出了建议。关于过渡政策(核心要素 1)或跟踪和监测患者过渡情况的研究(核心要素 2)很少。有几项研究评估了过渡准备情况(核心要素 3),但评估工具并未使用疾病控制、医疗保健使用、依从性、生活质量或护理连续性等重要结果进行验证。没有关于过渡计划最佳实践(核心要素 4)的研究,包括如何最好地教育患者并促进责任的逐步转变。少数纵向研究调查了护理的转移(核心要素 5),但这些研究是在美国境外进行的;这些研究发现,过渡完成后短期和中期结果的结果喜忧参半(核心要素 6)。我们讨论了关于 IBD 从儿科到成人护理的过渡的已知情况,提出了改进这一过程的建议,并确定了进一步研究的领域。