St Vincent's Hospital Melbourne, Melbourne, Australia; University of Melbourne, Melbourne, Australia.
St Vincent's Hospital Melbourne, Melbourne, Australia; University of Melbourne, Melbourne, Australia.
Clin Gastroenterol Hepatol. 2022 Sep;20(9):2102-2111.e9. doi: 10.1016/j.cgh.2021.12.005. Epub 2021 Dec 9.
BACKGROUND & AIMS: Functional gastrointestinal disorders are common and costly to the healthcare system. In the Multidisciplinary Treatment of Functional Gastrointestinal Disorders study, we demonstrated that multidisciplinary care resulted in superior clinical and cost outcomes, when compared with standard gastroenterologist-only care at end of treatment. In this study we evaluate the longer-term outcomes.
In a single-center, pragmatic trial patients with Rome IV criteria-defined functional gastrointestinal disorders were randomized 1:2 to a gastroenterologist-only standard care vs a multidisciplinary clinic comprising gastroenterologists, dietitians, gut hypnotherapists, psychiatrists, and biofeedback physiotherapists. Outcomes in this study were assessed 12 months after the end of treatment. Global symptom improvement was assessed by using a 5-point Likert scale. Symptoms, specific disorder status, psychological state, quality of life, and cost were additional outcomes. A modified intention-to-treat analysis was performed.
Of 188 randomized patients, 143 (46 standard care, 97 multidisciplinary) formed the longer-term modified intention-to-treat analysis. Sixty-two percent of multidisciplinary clinic patients saw allied clinicians. Sixty-five percent (30/46) standard care versus 76% (74/97) multidisciplinary clinic patients achieved global symptom improvement 12 months after end of treatment (P = .17), whereas 20% (9/46) versus 37% (36/97) rated their symptoms as "5/5 much better" (P = .04). A ≥50-point reduction in Irritable Bowel Syndrome Severity Scoring System occurred in 38% versus 66% (P = .02), respectively, for irritable bowel syndrome patients. Anxiety and depression were greater in the standard care than multidisciplinary clinic (12 vs 10, P = .19), and quality of life was lower in standard care than the multidisciplinary clinic (0.75 vs 0.77, P =·.03). An incremental cost-effectivness ratio found that for every additional 3555AUD spent in the multidisciplinary clinic, a further quality-adjusted life year was gained.
Twelve months after the completion of treatment, integrated multidisciplinary clinical care achieved a greater proportion of patients with improvement of symptoms, psychological state, quality of life, and cost, compared with gastroenterologist-only care.
gov: number NCT03078634.
功能性胃肠病较为常见，给医疗保健系统带来了沉重负担。在多学科治疗功能性胃肠病研究中，我们证实与治疗结束时仅接受胃肠病医生标准治疗相比，多学科治疗可带来更优的临床和成本结局。本研究评估了更长期的结局。
在一项单中心、实用型试验中，符合罗马 IV 标准的功能性胃肠病患者被随机分为 1:2 组，分别接受仅由胃肠病医生提供的标准治疗或由胃肠病医生、营养师、肠道催眠治疗师、精神科医生和生物反馈理疗师组成的多学科诊所治疗。本研究在治疗结束后 12 个月评估结局。采用 5 分 Likert 量表评估整体症状改善情况。其他结局包括症状、特定疾病状态、心理状态、生活质量和成本。采用改良意向治疗分析。
188 例随机患者中，143 例（标准治疗组 46 例，多学科治疗组 97 例）纳入更长期的改良意向治疗分析。多学科治疗组 62%的患者接受了其他临床医生的治疗。治疗结束后 12 个月，标准治疗组 65%（30/46）和多学科治疗组 76%（74/97）的患者达到整体症状改善（P=0.17），而标准治疗组 20%（9/46）和多学科治疗组 37%（36/97）的患者自述症状“5/5 明显改善”（P=0.04）。肠易激综合征严重程度评分系统（IBS-SSS）评分降低≥50 分的患者，标准治疗组为 38%，多学科治疗组为 66%（P=0.02）。标准治疗组的焦虑和抑郁评分高于多学科治疗组（12 分比 10 分，P=0.19），而标准治疗组的生活质量评分低于多学科治疗组（0.75 分比 0.77 分，P=0.03）。增量成本效果比发现，在多学科诊所每额外花费 3555 澳元，就能获得额外 1 个质量调整生命年。
与仅接受胃肠病医生治疗相比，治疗结束 12 个月后，综合多学科临床治疗使更多患者的症状、心理状态、生活质量和成本得到改善。
gov：编号 NCT03078634。
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