Pokarowski Martha, Rickard Mandy, Kanani Ronik, Mistry Niraj, Saunders Megan, Rockman Rebecca, Sam Jonathan, Varghese Abby, Malach Jessica, Margolis Ivor, Roushdi Amani, Levin Leo, Singh Manbir, Lopes Roberto Iglesias, Farhat Walid A, Koyle Martin A, Dos Santos Joana
Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Department of Pediatrics, North York General Hospital, North York, Ontario, Canada.
Pediatr Qual Saf. 2021 Mar 10;6(2):e383. doi: 10.1097/pq9.0000000000000383. eCollection 2021 Mar-Apr.
Lower urinary tract symptoms with constipation characterize bladder and bowel dysfunction (BBD). Due to high referral volumes to hospital pediatric urology clinics and time-consuming appointments, wait times are prolonged. Initial management consists of behavioral modification strategies that could be accomplished by community pediatricians. We aimed to create a network of community pediatricians trained in BBD (BBDN) management and assess its impact on care.
We distributed a survey to pediatricians, and those interested attended training consisting of lectures and clinical shadowing. Patients referred to a hospital pediatric urology clinic were triaged to the BBDN and completed the dysfunctional voiding symptom score and satisfaction surveys at baseline and follow-up. The Bristol stool chart was used to assess constipation. Results were compared between BBDN and hospital clinic patients.
Surveyed pediatricians (n = 100) most commonly managed BBD with PEG3350 and dietary changes and were less likely to recommend bladder retraining strategies. Baseline characteristics were similar in BBDN (n = 100) and hospital clinic patients (n = 23). Both groups had similar improvements in dysfunctional voiding symptom score from baseline to follow-up (10.1 ± 4.2 to 5.6 ± 3.3, = 0.01, versus 10.1 ± 4.2 to 7.8 ± 4.5, = 0.02). BBDN patients waited less time for their follow-up visit with 56 (28-70) days versus 94.5 (85-109) days for hospital clinic patients ( < 0.001). Both groups demonstrated high familial satisfaction.
Community pediatricians may require more knowledge of management strategies for BBD. Our pilot study demonstrates that implementing a BBDN is feasible, results in shorter wait times, and similar improvement in symptoms and patient satisfaction than a hospital pediatric urology clinic.
伴有便秘的下尿路症状是膀胱和肠道功能障碍（BBD）的特征。由于转诊至医院儿科泌尿外科门诊的患者数量众多且预约耗时，等待时间延长。初始治疗包括社区儿科医生可以完成的行为改变策略。我们旨在建立一个接受过BBD管理培训的社区儿科医生网络（BBDN），并评估其对治疗的影响。
我们向儿科医生发放了一份调查问卷，感兴趣的医生参加了由讲座和临床见习组成的培训。转诊至医院儿科泌尿外科门诊的患者被分诊至BBDN，并在基线和随访时完成排尿功能障碍症状评分和满意度调查。使用布里斯托大便分类法评估便秘情况。对BBDN患者和医院门诊患者的结果进行比较。
接受调查的儿科医生（n = 100）最常使用聚乙二醇3350和饮食改变来管理BBD，且不太可能推荐膀胱再训练策略。BBDN组（n = 100）和医院门诊患者（n = 23）的基线特征相似。两组从基线到随访时排尿功能障碍症状评分均有相似改善（10.1±4.2至5.6±3.3，P = 0.01，相比之下10.1±4.2至7.8±4.5，P = 0.02）。BBDN患者随访等待时间更短，为56（28 - 70）天，而医院门诊患者为94.5（85 - 109）天（P < 0.001）。两组患者的家庭满意度均较高。
社区儿科医生可能需要更多关于BBD管理策略的知识。我们的初步研究表明，实施BBDN是可行的，与医院儿科泌尿外科门诊相比，等待时间更短，症状改善和患者满意度相似。
