{
  "abstract": "Transition from paediatric to adult care is a critical phase for adolescents with inflammatory bowel disease (IBD). 20–30% of patients are diagnosed with IBD before the age of 20, and paediatric-onset illness has shown to be associated with greater disease severity. 1–3 It is essential to optimise management prior to transfer to adult services. Transition services provide pivotal opportunities to empower patients with greater responsibility and autonomy within a well-supported environment. There is limited literature regarding the transition process, particularly from a patient-centred view, and a lack of standardised approach to transition services.4–6 This study aimed to evaluate the current IBD transition service at a single tertiary centre and identify any recurring themes and targets for improvement within service delivery.50 patients aged 16–18 were selected retrospectively from the departmental IBD database. Electronic patient notes were evaluated and data collected on age, sex, diagnosis and treatment. Thematic analysis using open coding was performed on consult notes and letters to identify transition-related themes.Mean age was 16.5 years, 26/50 (52%) were male and 24/50 (48%) female. 35/50 (70%) had Crohn’s disease, 10/50 (20%) had IBD-unclassified and 5/50 (10%) had ulcerative colitis. 34/50 (68%) were on thiopurines, 31/50 (62%) were on aminosalicylates and 19/50 (38%) were on biologics. 2/50 (4%) were on no maintenance therapy. 32/50 (64%) were in clinical remission.31/50 (60%) had a completed transition clinic appointment. In 4/31 (13%) the parent was present without the patient. 6/50 (12%) had failed to attend at least 1 transition appointment. 4/50 (8%) explicitly expressed they did not feel ready for transition, most commonly due to active disease.Mental health issues affected 12/50 (24%); 5/50 (10%) reported anxiety, 3/50 (6%) reported eating disorder/poor self-image behaviours and 4/50 (8%) reported autism as having a significant effect on their well-being and disease management. 9/50 (18%) reported school absences having a substantial effect upon their work and examinations. Future education or work was discussed in 36% of consultations.When prompted, 8/13 (62%) had medication compliance issues with reasons including poor understanding and forgetfulness quoted.Menstrual cycles were broached in 25% of female consultations, with 80% of these patients reporting irregular periods. 1/50 recorded discussion of smoking. Sex, relationships, alcohol and substance use were not discussed.20/50 (40%) wanted to continue care within the Trust’s adult services, 10/50 (20%) at a local district general hospital (DGH) oand 20/50 (40%) had not indicated a preference yet.Key issues at the time of transition to adult IBD services include mental health, school and education, and medication. Particular consideration should be given to these in clinic. Prevalence of mental health issues is comparable to reported rates of 22% in the general adolescent population.7 Relationships, sex, substance use, alcohol and smoking were rarely discussed. Incorporating a structured tool into clinic review such as the HEADSSS assessment8 can help clinicians structure discussion of these and mental health issues. Barriers to patient attendance at clinic and patients’ views on service design should be sought to ensure young people attend key clinic appointments.References Kelsen J, Baldassano RN. Inflammatory bowel disease: the difference between children and adults. Inflamm Bowel Dis. 2008;14 Suppl 2:S9–11.Massouille G, Balde M, Salleron J, et al. Natural history of pediatric Crohn’s disease: a population-based cohort study. Gastroenterology 2008;357:1106–13.Pigneur B, Seksik P, Viola S, et al. Natural history of Crohn’s disease: comparison between childhood- and adult-onset disease. Inflamm Bowel Dis. 2010;357:953–61.Afzali A, Wahbeh G. Transition of pediatric to adult care in inflammatory bowel disease: is it as easy as 1, 2, 3? World J Gastroenterol. 2017;23(20):3624–3631.Wright EK, Williams J, Andrews JM, et al. Perspectives of paediatric and adult gastroenterologists on transfer and transition care of adolescents with inflammatory bowel disease. Intern Med J. 2014 May;44(5):490–6.Zeisler B, Hyams JS. Transition of management in adolescents with IBD. Nat Rev Gastroenterol Hepatol. 2014 Feb;11(2):109–15.Newlove-Delgado T, Marcheselli F, Williams T, et al. (2022) Mental Health of Children and Young People in England, 2022. NHS Digital, Leeds.Cohen E, MacKenzie RG, Yates GL. HEADSS, a psychosocial risk assessment instrument: implications for designing effective intervention programs for runaway youth. Journal of Adolescent Health 1991;12(7):539–544.",
  "authors": [
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Priyanka Kamath"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Rebecca Foulkes"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Lisa Charlton"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Maureen Lawson"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Adnaan Kala"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Loveday Jago"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Virginia Chatzidaki"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Chai Lee"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Andrew Fagbemi"
    },
    {
      "affiliations": [
        "Royal Manchester Children’s Hospital"
      ],
      "name": "Sian Copley"
    }
  ],
  "title": "OC58 Transition services in paediatric inflammatory bowel disease: a single tertiary centre experience",
  "uid": "eea7cbbc-9225-599b-85cd-2152b84897a4"
}