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Transitions in care from pediatric to adult general surgery in patients with anorectal malformation.

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eMediNexus    13 February 2018

The findings of a recent study published in the Journal of Pediatric Surgery indicated that patients undergoing childhood procedures for anorectal malformation (ARM) or Hirschsprung’s Disease (HD) have a high prevalence of ongoing symptoms related to bowel function, but very few have had conversations regarding transitions in care. The aim of this study was to understand the barriers to transition of care from pediatric to adult surgical providers for patients who have undergone childhood operations, from a patient and family perspective. This cross-sectional survey enrolled patients with a history of ARM or HD, and their families. The patients belonged to the age-range of 12-15 years, 64.5% being below 15 years of age. The primary diagnosis comprised HD in 29.0%; ARM in 61.3%; and cloaca in 9.7% of the patients. The average distance traveled for ongoing care was 186.6miles with 40.9% of the patients traveling ≥30miles. While the distance travelled was statistically significantly greater for patients with ARM. With regard to ongoing symptoms, 44.1% of the patients reported constipation, 40.9% reported diarrhea, and approximately 40.9% required chronic medication for management of bowel symptoms; whereas 3.2% respondents reported fecal incontinence. In addition, 52.7% patients reported being attended by a provider at least twice a year and a majority continued to be followed by a pediatric provider. It was also disclosed that discussions with providers regarding transitioning to an adult physician had occurred in fewer than 13% of the cases. The most commonly cited barrier to transition was the perception that adult providers would be ill-equipped to manage the persistent bowel symptoms. Therefore, it was stated that early implementation of transitional care plans and engagement of adult providers are essential to transitions and may facilitate long-term health benefits in this patient population.

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