Location: Children's Nutrition Research CenterTitle: Pediatric irritable bowel syndrome patient and parental characteristics differ by care management type
|HOLLIER, JOHN - Baylor College Of Medicine|
|CZYZEWSKI, DANITA - Texas Children'S Hospital|
|SELF, MARIELLA - Texas Children'S Hospital|
|WEIDLER, ERICA - Children'S Nutrition Research Center (CNRC)|
|SMITH, O'BRIAN - Baylor College Of Medicine|
|SHULMAN, ROBERT - Children'S Nutrition Research Center (CNRC)|
Submitted to: Journal of Pediatric Gastroenterology and Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/13/2016
Publication Date: 3/1/2017
Citation: Hollier, J.M., Czyzewski, D.I., Self, M.M., Weidler, E.M., Smith, O.E., Shulman, R.J. 2017. Pediatric irritable bowel syndrome patient and parental characteristics differ by care management type. Journal of Pediatric Gastroenterology and Nutrition. 65(3):391-395.
Interpretive Summary: Children with chronic abdominal pain often are referred to a specialist but it is not clear why some children are referred and others remain with their primary care provider. In this study we discovered that the duration of the abdominal pain, the unlikelihood of living in poverty, and how disabled the parent felt their child to be were predictors of referral to a specialist. Recognizing these factors will help in designing interventions to prevent unnecessary referrals to specialists.
Technical Abstract: This study evaluates whether certain patient or parental characteristics are associated with gastroenterology (GI) referral versus primary pediatrics care for pediatric irritable bowel syndrome (IBS). A retrospective clinical trial sample of patients meeting pediatric Rome III IBS criteria was assembled from a single metropolitan health care system. Baseline socioeconomic status (SES) and clinical symptom measures were gathered. Various instruments measured participant and parental psychosocial traits. Study outcomes were stratified by GI referral versus primary pediatrics care. Two separate analyses of SES measures and GI clinical symptoms and psychosocial measures identified key factors by univariate and multiple logistic regression analyses. For each analysis, identified factors were placed in unadjusted and adjusted multivariate logistic regression models to assess their impact in predicting GI referral. Of the 239 participants, 152 were referred to pediatric GI, and 87 were managed in primary pediatrics care. Of the SES and clinical symptom factors, child self-assessment of abdominal pain duration and lower percentage of people living in poverty were the strongest predictors of GI referral. Among the psychosocial measures, parental assessment of their child's functional disability was the sole predictor of GI referral. In multivariate logistic regression models, all selected factors continued to predict GI referral in each model. Socioeconomic environment, clinical symptoms, and functional disability are associated with GI referral. Future interventions designed to ameliorate the effect of these identified factors could reduce unnecessary specialty consultations and health care overutilization for IBS.