Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, OH.
Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center (UPMC) Children's Hospital of Pittsburgh, Pittsburgh, PA.
J Pediatr Gastroenterol Nutr. 2020 Jul;71(1):e28-e34. doi: 10.1097/MPG.0000000000002703.
Pediatric patients with inflammatory bowel diseases (IBD) require treatment, monitoring, and health maintenance services. We described patterns of primary, specialty, emergency department (ED) and urgent care delivery, and explored patient- and system-related variables that impact ED/urgent care utilization.
We conducted a cross sectional survey of parents of children with IBD at a large tertiary children's hospital.
One hundred sixty-one parents completed the survey (75% response). Mean patient age 13.9 years (51% boys); 80% Crohn disease, 16% ulcerative colitis, 4% IBD-unspecified. Mean disease duration 4 years (standard deviation [SD] 2.7). Thirty percent had at least 1 other chronic disease, 31% had a history of IBD-related surgery. Parents were predominantly Caucasian (94%), well-educated (61% bachelor's degree/higher), part of a 2-parent household (79%) living in a suburban setting (57%). Seventy-seven percent of patients had private insurance. In the past year, most children had 1 to 2 IBD-related office visits (54%) with their gastroenterology (GI) doctor and no IBD-related hospitalizations (79%). Eighty-eight percent (N = 141) had a primary care provider (PCP), and most (70%) saw their PCP 1 to 2 times. Even so, 86% (N = 139) received medical care from places other than their PCP or GI doctor; 27% in the ED and 45% at urgent care. Children of parents with less than a bachelor's degree, families that lived further from their GI doctor, and children who saw their PCP more often were more likely to utilize ED/urgent care.
ED/urgent care utilization in pediatric patients with IBD was greater than expected, potentially contributing to fragmented, costly care and worse outcomes.
患有炎症性肠病（IBD）的儿科患者需要接受治疗、监测和维持健康服务。我们描述了初级保健、专科、急诊部（ED）和紧急护理的提供模式，并探讨了影响 ED/紧急护理利用的患者和系统相关变量。
我们对一家大型三级儿童医院的 IBD 患儿的家长进行了横断面调查。
161 名家长完成了调查（75%的应答率）。患儿平均年龄 13.9 岁（51%为男性）；80%为克罗恩病，16%为溃疡性结肠炎，4%为 IBD 未特指。平均疾病病程为 4 年（标准差[SD]2.7）。30%的患儿至少有 1 种其他慢性病，31%有 IBD 相关手术史。家长主要为白种人（94%），教育程度较高（61%为学士及以上学历），来自双亲家庭（79%），居住在郊区（57%）。77%的患儿有私人保险。在过去的一年中，大多数患儿与胃肠病医生进行了 1 至 2 次 IBD 相关的门诊就诊（54%），没有 IBD 相关的住院治疗（79%）。88%（N=141）有初级保健提供者（PCP），大多数（70%）看 PCP 的次数为 1 至 2 次。即便如此，86%（N=139）仍从 PCP 或胃肠病医生以外的地方获得医疗服务；27%在 ED，45%在紧急护理。父母学历低于学士、家庭与胃肠病医生距离较远，以及患儿看 PCP 次数较多的患儿更有可能利用 ED/紧急护理。
IBD 儿科患者的 ED/紧急护理利用率高于预期，这可能导致医疗服务碎片化、费用增加和结局恶化。
