Inflamm Bowel Dis. 2024 Aug 28:izae190. doi: 10.1093/ibd/izae190. Online ahead of print.

Patrick Chan ^1 2, Jack McNamara ^1 3, Angharad Vernon-Roberts ⁴, Edward M Giles ^5 6, Rachael Havrlant ⁷, Britt Christensen ⁸, Amanda Thomas ⁹, Astrid-Jane Williams ^1 2 3 10

Author information

¹Department of Gastroenterology and Hepatology, Liverpool Hospital, Liverpool, New South Wales, Australia.

²South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia.

³Ingham Institute for Applied Medical Research, Gastroenterology and Hepatology, Liverpool, New South Wales, Australia.

⁴Department of Paediatrics, University of Otago, Christchurch, New Zealand.

⁵Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.

⁶Centre for Innate Immunity and Infectious Disease, Hudson Institute of Medical Research, Melbourne, Victoria, Australia.

⁷Agency for Clinical Innovation, NSW Health, Sydney, New South Wales, Australia.

⁸Gastroenterology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia.

⁹Department of Gastroenterology, Fiona Stanley Hospital, Perth, Western Australia, Australia.

¹⁰IBD Centre of BC, Vancouver, British Columbia, Canada.

Abstract

Background: Adolescents with inflammatory bowel disease (IBD) transitioning to adult care is often deemed a challenging period for patients, their carers, and practitioners. The use of structured transition programs is increasingly incorporated into standards of care, yet the optimal format remains unknown. The aim of this study is to carry out a systematic review of structured transition programs and their components to assess the impact on disease-specific and transition-related outcomes.

Methods: A systematic review (PROSPERO ID: CRD42023380846) was performed across 4 databases (PubMed, CINAHL, CENTRAL, and EMBASE) and relevant publications up to March 2023 were reviewed. Studies evaluating either a structured transition program or targeted intervention which also measured a transition- and/or disease-related outcomes were included for evaluation in accordance with the PRISMA statement.

Results: Three thousand four hundred and thirty-two articles were identified and 29 included in the final review. A structured transition program was reported in 21 studies and 8 investigated discrete transition-related interventions. The key transition-related outcomes included knowledge, self-efficacy, adherence, clinic attendance, and transition readiness which overall improved with the use of structured transition programs. Similarly, interventions consistently improved relapse/admission rates and corticosteroid use across most studies, although the benefit in hospitalization and surgical rates was less evident. Methodological limitations alongside heterogeneity in study design and outcome measures impacted on the quality of the evidence as assessed by the GRADE rating.

Conclusions: Transition- and medical-related outcomes for adolescents with IBD have been shown to benefit from structured transition programs but practices vary greatly between centers. There is no current standardized transition model for patients with IBD prompting further research to guide future development of guidelines and models of care.