A newly established young adult inflammatory bowel disease transition clinic: An assessment of clinical outcomes and patient satisfaction.

Abstract

Background and Aim: The rapid transition from adolescence to adulthood challenges many young patients with chronic conditions, such as inflammatory bowel disease (IBD), to suddenly adapt to a more independent model of care. Up to 25% of IBD diagnoses in Australia are now being made in the pre-adulthood period.1 The Young Adult (YA) IBD Clinic is a newly developed clinic aimed primarily at smoothing the transition from pediatric to adult services. We aimed to demonstrate the impact of this clinic on improving IBD clinical outcomes and patient satisfaction. Method(s): All patients who attended the YA IBD clinic between November 2016 and June 2018 were identified. For comparison, young patients from the Adult IBD clinic were also recruited. To assess clinical outcomes, we compared IBD-related emergency department (ED) presentations from each group before and after their first respective IBD clinic attendance, using a search of electronic medical records. To assess patient satisfaction, a subset of patients from the YA IBD clinic and all patients from the Adult IBD clinic were recruited to complete our IBD-Patient Satisfaction Questionnaire (IBD-PSQ), a tool developed for this project. On the IBD-PSQ, participants from each group expressed their satisfaction with their respective clinic by answering 27 questions in seven different clinical domains using a 5-point Likert scale, with a response scoring 4 or greater indicating satisfactory performance in that domain. Result(s): We recruited 64 and 33 patients from the YA and Adult IBD Clinics, respectively. Average ages of the YA and Adult IBD Clinic groups were 18.9 and 20.0 years, respectively. Patients in the YA Clinic group had a total of 21 ED presentations before their first clinic attendance, with an average of 0.63 ED presentations per person. After attending the clinic, there were a total of 11 ED presentations during the study period, with an average of 0.25 ED presentations per person, showing a 47.6% reduction in absolute ED presentations (P = 0.08). In the Adult Clinic group, there were a total of 33 ED presentations before their first clinic attendance, with an average of 0.97 ED presentations per person. After attending the clinic, there were a total of 24 ED presentations during the study period, with an average of 0.71 presentations per person, showing a 27.3% reduction in absolute ED presentations (P = 0.09). There were 24 patients from the YA IBD Clinic and all 33 patients from the Adult IBD Clinic who completed the IBD-PSQ. In general, both clinic groups similarly responded that they were receiving satisfactory service throughout multiple domains, except the transition domain. The score +/- 95% confidence interval of thisdomain was 3.69 +/- 0.0196 for the YA Clinic group and 3.32 +/- 0.216 for the Adult Clinic group, with both confidence intervals falling under 4. Notably, the transition domain was also where there was the biggest difference in average IBD-PSQ scores between the YA Clinic group and Adult Clinic group, with a difference of 0.37 favoring the YA clinic group indicating they had a more positive experience in this domain. Conclusion(s): The YA IBD Clinic has shown a higher reduction in absolute IBD-related ED presentations after first clinic attendance compared with the Adult IBD Clinic. This was not statistically significant, possibly due to the small time frame of the study. IBD-PSQ has also shown that patients from the YA IBD Clinic are generally satisfied with the services provided, but there are still areas for improvement to provide a more positive clinic experience.