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Impact of Paediatric Versus Adult Care Setting on Health Care Utilization in Adolescents With Inflammatory Bowel Disease

Bottema, Renske W.B.*,†; de Vries, Han; Houwen, Roderick H.J.*; van Rheenen, Patrick F.§

Journal of Pediatric Gastroenterology and Nutrition: September 2019 - Volume 69 - Issue 3 - p 310–316
doi: 10.1097/MPG.0000000000002399
Original Articles: Gastroenterology: Inflammatory Bowel Disease
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Objective: Paediatric-onset inflammatory bowel disease (IBD) is different from adult-onset IBD with respect to disease severity and its effect on growth and development. Care of paediatric IBD patients in some countries is dispersed among paediatricians and adult care providers, which may result in different outcomes. This study aims to assess the effect of care setting (paediatric vs adult-oriented) on health care utilization in adolescent IBD patients.

Methods: This is a Dutch population-based cohort study based on an insurance claims database covering 4.2 million insurees (approximately 25% of the Dutch population). We identified IBD patients ages 16 to 18 years and followed them until the age of 19 years or transfer to adult care, whichever came first. We categorized patients according to care setting: paediatric versus adult-oriented. We defined outcomes as corticosteroid use, IBD-related hospital admission, IBD-related surgery, and biological use. We estimated Cox proportional hazards regression models to control for confounding by indication.

Results: Among 626 patients, 380 (61%) were in paediatric and 246 (39%) in adult-oriented care. In paediatric care, patients were less likely to be treated with corticosteroids (hazard ratio [HR] 0.72, 95% confidence interval [CI] 0.52–0.99) or biologicals (HR 0.57, 95% CI 0.34–0.97), and had fewer IBD-related hospital admissions (HR 0.58, 95% CI 0.37–0.92).

Conclusion: In a large and representative community cohort of adolescents with IBD, treatment in paediatric care setting was associated with significantly lower steroid and biological use, without increase in hospital admissions. These results might be used to optimize clinical care for adolescents with IBD.

*Department of Paediatric Gastroenterology, Hepatology and Nutrition, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht

Department of Paediatrics, Gelderse Vallei Hospital, Ede

Research for Decisions, Hoflaan, Bilthoven

§Department of Paediatric Gastroenterology, Hepatology and Nutrition, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Address correspondence and reprint requests to Renske W.B. Bottema, MD, PhD, Department of Paediatrics, Gelderse Vallei Hospital, PO Box 9025, 6710 HN, Ede, The Netherlands (e-mail: bottemar@zgv.nl).

Received 20 March, 2019

Accepted 28 April, 2019

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org).

The authors report no conflicts of interest.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,