Table 4

Differences in service structures and daily routines between the two settings

Characteristics of care	TC setting	Control setting (direct handover care)
Setting	Adult gastroenterology department	Paediatric gastroenterology department
Team of professionals	Paediatric IBD nurse specialist (n=1), paediatric gastroenterologists (n=2), adult gastroenterologist (n=1) and one family counsellor working in paediatric care (n=1)	Paediatric gastroenterologist (n=1)
Visitors	Young people with IBD aged 16–18 years with or without their parents	Young people with IBD with or without their parents until age of 18
Visits TC	Every 3 months	–
Follow-up after transfer within the same hospital	By an adult gastroenterologist, but not necessarily the one involved at the TC	By an adult gastroenterologist or IBD nurse
Structure of care before transfer	Each clinic starts with 1-hour multidisciplinary team meeting of professionals, usually lead by the paediatric nurse specialist Consultation with paediatric gastroenterologist or paediatric nurse Consultation with adult gastroenterologist for selected young people who will soon transfer to adult care; all young people treated at the TC will see the adult care gastroenterologist at least once before actual transfer to adult care, and preferable once every year	No multidisciplinary team or nurse involved Measurements of weight and length by a medical assistant Consultation with paediatric gastroenterologist
Topics discussed (content of care)	During team meeting: medical history and status, treatment and lifestyle of patients (eg, smoking behaviour); when paediatric nurse is in the lead extra topics are discussed: psychosocial topics (social participation, family situation, psychological counselling), treatment adherence, transfer to adult care (to which department/hospital) During consultation of paediatric healthcare professional with young person (with or without parents): how is your IBD, do you have complaints or symptoms you want to discuss, which medication do you use (directed to patient), how is this going, what are side effects, how is your eating behaviour, smoking behaviour, limitations in daily living (sports, hobby’s, leisure, school, holidays), future plans, medication adherence, transfer to adult care, explaining TC, importance of becoming independent and own responsibility During consultation of adult gastroenterologist with young person (and/or parents): how is it going with the condition, do you have complaints or symptoms you want to discuss, which medication do you use (directed to patient), how is this going, what are side effects, importance of own responsibility (when taking medication), further treatment, explanation about TC, differences between paediatric and adult care, choice of department young person will be transferred to, activities of young person (school, work, living)	During consultation of paediatric gastroenterologist with young person: physical examination by healthcare professional, how is it going with the condition, do you have complaints or symptoms you want to discuss, how is it going with taking your medication (how will you do this during holidays), how are things going at school, school absenteeism, further treatment (endoscopy and important of own voice in healthcare from 16 years and older, including transfer)

IBD, inflammatory bowel disease; TC, transition clinic.