Medical Summary Template for the Transfer of Patients with Inflammatory Bowel Disease from Pediatric to Adult Care

Eric I Benchimol; Waqqas Afif; Sophie Plamondon; Dennis Newhook; Stuart G Nicholls; Dominique Lévesque

doi:10.1093/jcag/gwab009

Medical Summary Template for the Transfer of Patients with Inflammatory Bowel Disease from Pediatric to Adult Care

J Can Assoc Gastroenterol. 2021 May 15;5(1):3-11. doi: 10.1093/jcag/gwab009. eCollection 2022 Feb.

Authors

Eric I Benchimol^{1

2

3

4

5}, Waqqas Afif⁶, Sophie Plamondon^{7

8}, Dennis Newhook⁴, Stuart G Nicholls⁹, Dominique Lévesque¹⁰

Affiliations

¹ SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children and Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada.
² Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
³ CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario (CHEO), Ottawa, Ontario, Canada.
⁴ Health Information Technology Program, CHEO Research Institute, Ottawa, Ontario, Canada.
⁵ Department of Pediatrics and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
⁶ Inflammatory Bowel Disease Centre, Division of Gastroenterology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
⁷ Division of Gastroenterology, Department of Medicine, Centre Hospitalier Universitaire de Sherbrooke, Hôtel-Dieu, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
⁸ Centre de Recherche Étienne-Lebel, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
⁹ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
¹⁰ Pediatric Gastroenterology Service, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.

Abstract

Background: The transfer of information is a key aspect of the transition of adolescent patients with inflammatory bowel disease (IBD) from pediatric to adult care. This is typically accomplished through the use of a consultation letter with a medical summary of the patient being transferred. To improve the quality and completeness of information included in a transfer letter, we developed a standardized medical summary template by integrating the feedback of adult and pediatric health care providers.

Methods: To develop the letter template, we purposively sampled gastroenterologists or nurse practitioners caring for patients with IBD in four Canadian cities and invited them to take part in focus group discussions. Using a semi-structured approach, we explored the items deemed essential for inclusion in a transfer summary. Using the conventional content analysis framework, the focus group discussions were inductively coded to identify areas of priority for inclusion in the template.

Results: Four focus groups were conducted, comprising 17 health care providers of 30 invited (56.7% participation). The resulting medical summary template included the following major headings: patient/disease characteristics, therapeutics history (including medications and surgeries), clinical history and current status, noteworthy investigations, history of complications (including hospitalizations), family history, immunization history and psychosocial history. The template also addressed health system process factors (i.e., urgency of transfer, mode of delivery and confidentiality) to ensure a seamless transfer to adult care.

Conclusions: The standardized medical summary template should be used by pediatric providers to ensure that essential patient information and disease characteristics are sent to an adult provider.

Keywords: Crohn’s disease; Health services research; Inflammatory bowel disease; Pediatrics; Qualitative research; Transition from pediatric to adult care; Ulcerative colitis.