Yu Vanessa, Ballou Sarah, Hassan Rifu, Singh Prashant, Shah Eric, Rangan Vikram, Iturrino Johanna, Nee Judy, Lembo Anthony
Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Divison of Gastroenterology, Department of Medicine, University of Michigan Medical Center, Ann Arbor, Michigan, USA.
Am J Gastroenterol. 2021 Aug 1;116(8):1720-1726. doi: 10.14309/ajg.0000000000001306.
Patients with disorders of gut-brain interaction (DGBIs) are high users of health care. Past studies exploring predictors of utilization have lacked patient-level clinical data. The aim of the current study is to identify demographic, clinical, and psychological predictors of health care utilization in patients with irritable bowel syndrome (IBS), functional constipation (FC), and functional diarrhea (FDr).
Consecutive new patients diagnosed with IBS, FC, and FDr (using Rome IV criteria) completed questionnaires assessing health care utilization as well as clinical and psychological symptoms. Health care utilization was assessed using a 13-item measure inquiring about the previous 6 months. Patient-Reported Outcome Measures Information System (PROMIS) was used to assess severity of abdominal pain, constipation, diarrhea, anxiety, depression, and sleep disturbance.
Of the 507 patients diagnosed with IBS, FC, or FDr, 434 completed the health care utilization questionnaire (mean age of 44 years, 79.5% female, and 73.5% IBS). In the final multivariable models, more severe abdominal pain and higher depression scores were significantly associated with increased utilization of (i) total outpatient visits, (ii) outpatient visits for gastrointestinal (GI) symptoms, and (iii) number of medications for GI symptoms. More severe abdominal pain was also significantly predictive of GI-related emergency department visits. Altered bowel habits were not consistent predictors of health care utilization.
Severity of abdominal pain and depressive symptoms, but not bowel habits, is a primary driver of increased care-seeking behavior in patients with IBS, FC, and FDr.
肠道-脑互动障碍（DGBIs）患者是医疗保健的高使用者。过去探索医疗保健利用预测因素的研究缺乏患者层面的临床数据。本研究的目的是确定肠易激综合征（IBS）、功能性便秘（FC）和功能性腹泻（FDr）患者医疗保健利用的人口统计学、临床和心理预测因素。
连续诊断为IBS、FC和FDr（使用罗马IV标准）的新患者完成了评估医疗保健利用以及临床和心理症状的问卷。使用一项13项指标的测量方法评估前6个月的医疗保健利用情况。患者报告结局测量信息系统（PROMIS）用于评估腹痛、便秘、腹泻、焦虑、抑郁和睡眠障碍的严重程度。
在507例诊断为IBS、FC或FDr的患者中，434例完成了医疗保健利用问卷（平均年龄44岁，79.5%为女性，73.5%为IBS患者）。在最终的多变量模型中，更严重的腹痛和更高的抑郁评分与以下方面的利用增加显著相关：（i）门诊总就诊次数，（ii）胃肠道（GI）症状的门诊就诊次数，以及（iii）GI症状的用药数量。更严重的腹痛也是胃肠道相关急诊科就诊的显著预测因素。排便习惯改变并非医疗保健利用的一致预测因素。
腹痛和抑郁症状的严重程度而非排便习惯是IBS、FC和FDr患者寻求医疗行为增加的主要驱动因素。
