Impact of the Transition from Pediatric to Adult Medical Care on Health Service Utilization in Inflammatory Bowel Disease (IBD)

Title: Impact of the Transition from Pediatric to Adult Medical Care on Health Service Utilization in Inflammatory Bowel Disease (IBD)
Authors: Zhao, Xinbei
Date: 2017
Abstract: OBJECTIVES: Inflammatory bowel disease (IBD) is a chronic condition with increasing pediatric incidence. Transition from pediatric to adult care is associated both with disruption of links with familiar caregivers and differences in health care delivery. This study explored the impact of the transfer from pediatric to adult care on health services utilization for pediatric-onset IBD patients. APPROACH: A population-based retrospective cohort study identified all children diagnosed with IBD 1994-2008 and treated by pediatric gastroenterologists from within Ontario health administrative data. Self-controlled case series analyses compared health services utilization in the 2 years before and after transfer to adult gastroenterologists, with a 6-month washout period at transfer. Outcome evaluated included IBD related/specific hospitalization, emergency department (ED) utilization, outpatient visits, and laboratory utilization. Relative incidence (RI) in the post-transfer was compared to pre-transfer periods using Poisson regression analysis controlling for transfer starting age. Analyses were stratified by IBD types: Crohn’s disease (CD) and ulcerative colitis (UC). RESULTS: 536 patients were included in the study (388 CD, 148 UC). ED utilization rate was higher after transfer for both CD (RI 2.12, 95% CI 1.53-2.93) and UC (RI 2.34, 95% CI 1.09-5.03). Other increases in health care provision included outpatients visits (CD: RI 1.56, 95% CI 1.42-1.72; UC: RI 1.48, 95% CI 1.24-1.76), and laboratory investigations (CD: RI 1.43, 95% CI 1.26-1.63; UC: 1.38, 95% CI 1.13-1.68). There was no statistically significant change in hospitalization (CD: RI 0.70, 95% CI 0.42-1.18; UC: RI 2.41, 95% CI 0.62-9.40). Sensitivity analysis revealed similar results when only the first year post-transfer period was assessed. CONCLUSIONS: In the largest study to date examining the transfer from pediatric to adult IBD care, health services utilization increased significantly in the two years after transfer for measures of access to health care providers. Understanding causation and rigorously evaluated transition programs may help to better manage the resources and meet the needs of pediatric-onset IBD patients.
CollectionThèses, 2011 - // Theses, 2011 -