Abstract

Transition of Inflammatory Bowel Disease Care: Assessment of Transition Readiness Factors and Disease Outcomes in a Young Adult Population

Rosen D1, Annunziato R, Colombel JF, Dubinsky M, Benkov K. Inflamm Bowel Dis. 2016 Feb 2. [Epub ahead of print]
 
     
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1*Division of Pediatric Gastroenterology and Hepatology, Yale University School of Medicine, New Haven, Connecticut; †Departments of Pediatrics and Psychiatry, Icahn School of Medicine at Mount Sinai, Fordham University, New York, New York; ‡Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York; and §Division of Pediatric Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, New York.

Abstract

BACKGROUND: Limited data exist on what factors impact transition readiness and how readiness impacts short-term disease outcomes.

METHODS: Patients between the ages of 18 and 25 with an established inflammatory bowel disease diagnosis completed questionnaires at the time of an outpatient visit in the pediatric or adult setting, which included the Transition Readiness Assessment Questionnaire (TRAQ). After 6 months, electronic medical records were reviewed.

RESULTS: A total of 95 patients were enrolled, 46 in the adult care setting and 49 in the pediatric care setting. Patients in the adult setting had a significantly higher overall TRAQ score compared with the pediatric setting (median: 4.42 [IQR: 3.9-4.6] versus 4.06 [IQR: 3.4-4.4], P < 0.001). Logistic regression analysis demonstrated that age was independently associated with higher TRAQ scores (odds ratio: 1.49; 95 confidence interval%, 1.1-2.02). Nonadherent patients scored lower on the Managing Medications subscale (median: 4.25 [IQR: 3.3-4.8] versus 4.75 [IQR: 4.3-5.0], P < 0.01). Logistic regression showed that patients who scored <4.75 on the Medication Management subscale were 3.8 times more likely to be nonadherent than patients who scored ≥4.75 (95% confidence interval, 1.4-10.3). This remained significant after adjusting for gender and age. During the 6-month follow-up period, 9/95 patients (10%) had hospitalizations or ED visits related to inflammatory bowel disease. There were no associations between TRAQ scores and hospitalizations/ED visits.

CONCLUSIONS: Age is the primary factor that drives transition readiness. Our findings suggest that administering the medication management portion of the TRAQ can be used to identify patients at risk for nonadherence. Follow-up studies are needed to determine how readiness impacts long-term disease outcomes.

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