MULTIDISCIPLINARY SPECIALTY CLINIC DECREASES HEALTHCARE UTILIZATION IN CHILDREN WITH FUNCTIONAL GASTROINTESTINAL DISORDERS

ABSTRACT

Introduction: The biopsychosocial model has been used to describe the complex pathophysiology of functional gastrointestinal disorders (FGIDs), and the literature is clear that conventional medical treatment alone is often inadequate and should be supplemented with behavioral and/or dietary treatment. We hypothesized that the implementation of a multidisciplinary clinic for children with FGIDs would lead to decreased healthcare utilization. Our objective was to compare healthcare utilization before and after the initial visit in a pediatric multidisciplinary FGID clinic. Methods: We performed a retrospective review of children seen in the FGID clinic at our institution for their initial visit from March 2018-November 2019 (to avoid any impact of the COVID-19 pandemic). Our FGID clinic sees patients referred from other gastroenterologists. The initial visit is a 60-minute visit with a pediatric gastroenterologist, psychologist, and at times a dietitian. We recorded baseline characteristics and clinic visit information. To evaluate impact on healthcare utilization, we compared phone calls, electronic messages, additional outpatient GI visits, emergency department (ED) or urgent care (UC) visits, and hospitalizations for GI symptoms three months before and after a patient's initial FGID clinic visit. Results: We included 49 patients (76% female, median age 16 years, range 5-19). Primary FGID diagnoses were functional abdominal pain (45%), irritable bowel syndrome (22%), functional dyspepsia (20%), rumination syndrome (6%), functional constipation (4%), and abdominal migraine (2%). Other diagnoses included anxiety (73%), depression (33%), and inflammatory bowel disease (2%). Prior testing included blood tests (86%), imaging (82%), esophagogastroduodenoscopy (78%), colonoscopy (35%), and manometry testing (31%). At the initial visit, 71% were on a medication for their GI symptoms, 76% were on a supplement or probiotic, and 35% were on a psychiatric medication. During their initial visit, 96% met with a psychologist and 18% met with a dietitian. Recommendations at the initial visit included new medications (76%), follow up with a GI psychologist (45%), dietary treatment (22%), imaging studies (16%), manometry testing (10%), psychiatry referral (10%), blood tests (8%), esophagogastroduodenoscopy (4%), and colonoscopy (2%). As shown in Table 1, total phone calls, electronic messages, and ED/UC visits for GI symptoms decreased after the FGID clinic visit (p<0.001, p<0.001, and p=0.02 respectively). Conclusion: Healthcare utilization decreased significantly after children with FGIDs were seen in a multidisciplinary FGID clinic. Our findings imply that establishing a multidisciplinary FGID clinic improves the care of children with these disorders and may also reduce the time and financial costs of caring for these disorders.(Table Presented)