Barriers to transition care in inflammatory bowel disease: a survey of adult and paediatric gastroenterologists in the UK

Abstract

Introduction and Aim: There is paucity of data on the transition of adolescents and young adults with inflammatory bowel disease from paediatric to adult services. IBD nurses play a crucial role in co-ordinating transition care. However, transition services are variable throughout the UK, which may represent differences in the perception of barriers to transition. Understanding these may help the development of a successful service. We aimed to survey IBD nurses on their views and experiences of barriers to transition care. Materials and Methods: Both adult and paediatric IBD nurses were sent a structured postal questionnaire on barriers to transition care. The importance of patient related and health care organisation related issues were ranked on a Likert scale of 1 to 5 and the mean (+/-SD) scores were calculated. Personal experiences of barriers to service development were ranked from 1 to 5 and the proportion of those ranking I was calculated. Differences in relation to geography, hospital setting and paediatric and adult IBD nurses were compared with chi-square test. Results: A total of 167 IBD nurses were contacted and 92 (55%) responded which included 9 paediatric IBD nurses. A majority of respondents (n = 56, 69%) work in a teaching hospital setting. 48.9% of respondents were involved in transition care. The main reasons stated for not being involved in transition care included lack of service (n = 25) and too few patients for a viable service (n = 16).The mean scores for patient related factors and organisational factors that prevent successful transition are summarised in table 1 and table 2 respectively. The 3 highest ranked barriers to a successful transition service were lack of dedicated time (20% respondents), lack of demand (19%) and lack of training (13%). There were statistically significant differences in responses of barriers and ranking based on the hospital setting (p = 0.001) and paediatric and adult IBD nurses (p = 0.02) but no significant regional difference was recorded. (Table presented) Conclusion: A number of organisational and patient related barriers for development of a successful transition were identified in the survey of IBD nurses. Identification of these in individual situations may help in tackling these when developing the service.