Transition of care programme and treatment adherence in adolescents with inflammatory bowel disease

Abstract

Transition of care clinic attendance and readiness have been studied due to their impact on the lifelong management of chronic illnesses. Inflammatory bowel disease (specifically Crohn’s Disease and Ulcerative Colitis) is a chronic, idiopathic, immune-mediated illness. Paediatric onset accounts for 25% of all IBD cases. Adolescents face a critical period of cognitive, physical, and emotional nature, therefore studies contributing to research would ultimately provide aid in successful management. Nonadherence to treatment amongst adolescents ranges between 50% to 75%. This instigated the objective of this dissertation in the search for the effectiveness of the transition of care in the treatment adherence of IBD adolescent patients. The PICO question “In Adolescents with Inflammatory Bowel Disease is participation in a formal Transition of Care Programme versus no Transition of Care Programme associated with better treatment adherence?” was fostered to generate focal research studies. To minimise selection bias, inclusion and exclusion criteria were developed. Such criteria involved adolescents to adults suffering from IBD, disregarding undiagnosed patients above or below the transition of care age gap. A methodological search was conducted using the EBSCO Host and relevant keywords were utilised in various combinations to generate suitable studies. The latter deduced 1 cohort study, 3 cross-sectional studies and 1 multi-site comparison study. Appraisal for quality was conducted using both the CASP and AXIS tool. Review of the literature led to the conclusion that attendance at dedicated IBD transition clinics leads to improved medication adherence and overall self-management of IBD. Increasing age was associated with the improvement of said skills and therefore, transition should be conducted once the patient is verified for readiness. Additionally, the local context was analysed and recommendations for practice, education, management, and further research such as the development and implementation of practical protocols, the involvement of a well-trained multidisciplinary and the latency in transition till post readiness assessment were formulated.