Faculties of Medicine and Health and Behavioural Sciences, University of Queensland/TRI, Brisbane, QLD, Australia.
Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia.
Dig Dis Sci. 2022 Dec;67(12):5593-5601. doi: 10.1007/s10620-022-07464-1. Epub 2022 Apr 1.
BACKGROUND: Functional gastrointestinal disorders (FGID) are linked to a variety of potential causes, and treatments include reassurance, life-style (including diet), psychological, or pharmacologic interventions. AIMS: To assess whether a multidisciplinary integrated treatment approach delivered in a dedicated integrated care clinic (ICC) was superior to the standard model of care in relation to the gastrointestinal symptom burden. METHODS: A matched cohort of 52 consecutive patients with severe manifestation of FGID were matched with 104 control patients based upon diagnosis, gender, age, and symptom severity. Patients in the ICC received structured assessment and 12-weeks integrated treatment sessions provided as required by gastroenterologist and allied health team. Control patients received standard medical care at the same tertiary center with access to allied health services as required but no standardized interprofessional team approach. Primary outcome was reduction in gastrointestinal symptom burden as measured by the Structured Assessment of Gastrointestinal Symptoms Scale (SAGIS). Secondary outcome was reduction in anxiety and depressive symptoms as measured by the Hospital Anxiety and Depression Scale (HADS). RESULTS: Mixed models estimated the within ICC change in SAGIS total as -9.7 (95% CI -13.6, -5.8; p < 0.0001), compared with -1.7 (95% CI -4.0, 0.6; p = 0.15) for controls. The difference between groups reached statistical significance, -7.6 (95% CI -11.4, -3.8; p < 0.0001). Total HADS scores in ICC patients were 3.4 points lower post-intervention and reached statistical significance (p = 0.001). CONCLUSION: This matched cohort study demonstrates superior short-term outcomes of FGID patients in a structured multidisciplinary care setting as compared to standard care.
背景:功能性胃肠病(FGID)与多种潜在病因相关,治疗方法包括安慰、生活方式(包括饮食)、心理或药物干预。
目的:评估在专门的综合护理诊所(ICC)中提供的多学科综合治疗方法是否优于标准护理模式,在胃肠道症状负担方面是否具有优势。
方法:对 52 例 FGID 严重表现的连续患者进行了匹配队列研究,根据诊断、性别、年龄和症状严重程度与 104 例对照患者进行了匹配。ICC 中的患者接受了结构化评估和 12 周的综合治疗,由胃肠病学家和联合健康团队根据需要提供。对照患者在同一三级中心接受标准医疗护理,并根据需要获得联合健康服务,但没有标准化的跨专业团队方法。主要结局是通过胃肠道症状结构化评估量表(SAGIS)测量的胃肠道症状负担的减少。次要结局是通过医院焦虑和抑郁量表(HADS)测量的焦虑和抑郁症状的减少。
结果:混合模型估计 ICC 内 SAGIS 总分的变化为-9.7(95%CI-13.6,-5.8;p<0.0001),而对照组为-1.7(95%CI-4.0,0.6;p=0.15)。组间差异具有统计学意义,-7.6(95%CI-11.4,-3.8;p<0.0001)。ICC 患者的总 HADS 评分在干预后降低了 3.4 分,具有统计学意义(p=0.001)。
结论:这项匹配队列研究表明,与标准护理相比,FGID 患者在结构化多学科护理环境中具有更好的短期结局。
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