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Transitions in IBD Care: Ensuring Young Adults Are Prepared
How do you successfully transition a pediatric patient with IBD to adult care? Maureen Kelly, APN, DNP, CPNP, from the department of pediatrics, division of gastroenterology, at UNC-Chapel Hill Hospitals School of Nursing, addressed this question at the 2018 AIBD Meeting.
A recent study reported that only 17% of young adult patients had received adequate preparation to transition to adult care, defined as: 1) the patient being seen by the provider alone; 2) the patient being prepared with the necessary information to manage their care on their own; and 3) the patient having discussed their care transition with their provider.
The most successful transition experiences, Kelly said, are ones in which the parent is involved, the patient has sufficient maturity to handle their care independently, and treatment adherence is taught early on. Transition steps should include clearly outlining expectations for the adolescent, having the adolescent practice some independence, and, finally, having the patient take more responsibility for their own care.
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Though it can be a challenge to determine when a pediatric patient is ready to transition to adult care, Kelly said, the transition process ideally should start at age 12 to 14 years and should happen gradually. She also noted several tools and resources that are currently available to help providers assess transition readiness:
- Six Core Elements of Health Care Transition 2.0, a basic tool defining the main elements of transition support;
- TRxANSITION Readiness Assessment (TRAQ) questionnaire, a disease-neutral, adolescent self-report questionnaire to assess the patient’s involvement in maintaining their own care;
- UNC Transition Index, a disease-neutral, validated tool that includes patient self-report but with confirmation by health care team; and
- STARx Questionnaire, a tool for the provider to answer questions regarding the patient’s communication, disease knowledge, and self-management.
Kelly noted that, at age 18, patients must be asked whether they want their parents to continue being involved in their care, and providers should be sure that this decision is documented. She also reminded providers that billing codes can be used to ensure providers are compensated for time spent on transition activities; providers can refer to gottransition.org for a full list of these codes.
—Kara Rosania
Reference:
Kelly M. Ready, Set, Go! Or Not? Transition of the Pediatric Patient to Adult Care. Presented at: Advances in Inflammatory Bowel Diseases; December 13-15, 2018; Orlando, FL. https://www.consultant360.com/meetings/aibd.
