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5 WORLD GASTROENTEROLOGY NEWS NOVEMBER 2016 Editorial | Expert Point of View | Gastro 2016: EGHS-WGO | WDHD News | WGO & WGOF News | WGO Global Guidelines | Calendar of Events tured transition process compared to adult providers (80% versus 47% respectively, p=0.001). Barriers to a Successful Transition of Care Program: The Social-ecological Model of Ado-lescent and Young Adult Readiness to Transition (SMART) developed and validated by Schwartz and col-leagues23,24 have identified seven major inter-related components of patients, parents and providers which impacts transition readiness and potential targets of intervention: patient devel-opment, knowledge, skills/efficacy to managing health, beliefs/expectations of the transition process, transition goals, relationships among patients, parents and providers, and psychoso-cial functioning regarding conditions and emotions related to the transition process; as well as pre-existing factors which are less modifiable but may still influence the transition process including socio-demographics/cul-ture, insurance/access, health status, risks and problems due to complica-tions of disease, and neurocognition/ IQ. These components can either be barriers or potential facilitators for a successful transition of care. Clini-cians are encouraged to review these components early and regularly. Achieving the goals of a successful transition of care program may be dif-ficult due to limitations of resources or access to clinics with a structured pro-gram, poor readiness or preparation for the young adult to transition, limited communication between the pediatric gastroenterologists to referring adult providers, and suboptimal training in adolescent medicine for adult gastro-enterologists22,25,26. Other barriers to the success of a transition includes the reluctance or inability to ‘let go’ by other key players involved in this process aside from the EAI, such as the parent or pediatric provider. There are also inherent differences in treatment goals and health priorities from patient and pediatric provider to an adult provider3,27. Sebastian and colleagues22 reported lack of funding, time, support of services, training and too few of patients as the top five obstacles experi-enced among local pediatric and adult gastroenterologists for ability to deliver transition of care services. Conclusions: To date, although a number of tran-sition clinic models currently exists, there is no standardized transition program in IBD. Future data-driven studies are needed to evaluate the tools and strategies currently used to help evaluate early readiness of the young adult, implement improved communication by the pediatric gastroenterologists and provide expan-sion in training for the adult providers in order to achieve a smooth transi-tion and best outcomes for the EAI. References: 1. Kelsen J and Baldassano RN. Inflammatory bowel disease: the difference between children and adults. Inflammatory Bowel Dis-eases 2009; 15:1438-1447. 2. Blum RW, Dale Garrell D, Hodg-man CH, et al. Transition from child-centered to adult health-care systems for adolescents with chronic conditions. A position paper of the Society for Adolescent Medicine. Journal of Adolescent Health 1993; 14:570-576. 3. Trivedi I, Keefer L. The emerg-ing adult with inflammatory bowel disease: Challenges and recommendations for the adult gastroenterologist. Gas-troenterology Research and Practice. 2015; 2015:260807. doi:10.1155/2015/260807. 4. Bollegala N and Nguyen GC. Transitioning the Adolescent with IBD from Pediatric to Adult Care: A review of the literature. Gastro-enterology Research and Practice. Volume 2015: 7 pages. 5. Hait EJ, Barendse RM, Arnold JH, et al. Transition of adolescents with inflammatory bowel disease from pediatric to adult care: a survey of adult gastroenterologists. Journal of Pediatric Gastroenterol-ogy and Nutrition 2008; 48:61- 65. 6. Goodhand J, Dawson R, Hefferon M, et al. Inflammatory bowel disease in young people: the case for transitional clinics. Inflamm Bowel Dis 2010; 16:947-952. 7. Vernier-Massouille G, Balde M, Salleron J, et al. Natural history of pediatric Crohn’s disease: a population-based cohort study. Gastroenterology 2008; 135:1106- 1113. 8. Hartman C, Eliakim R, Shamir R. Nutritional status and nutritional therapy in inflammatory bowel diseases. World J Gastroenterol 2009; 15:2570-2578. 9. Greenley RN, Hommel KA, Nebel J, et al. A meta-analytic review of the psychosocial adjustment of youth with inflammatory bowel disease. J Pediatr Psychol 2010; 35:857-869. 10. Louis E. Epidemiology of the transition for early to late Crohn’s disease. Digestive Diseases 2012; 30:376-379. 11. Bickston SJ, Waters HC, Dabbous O, et al. Administrative claims analysis of all –cause annual costs of care and resource utilization by age category for ulcerative colitis patients. Journal of Managed Care Pharmacy 2008; 14:352-362. 12. Kappelman MD, Rifas-Shiman SL, Porter CQ, et al. Direct health care costs of Crohn’s disease and ulcerative colitis in US chil-dren and adults. Gastroenterology 2008; 135:1907-1913. 13. Ananthakrishnan AN, McGinley EL, Saeian K, et al. Trends in am-bulatory and emergency room vis-its for inflammatory bowel diseases


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