Department of Pediatric surgery, All India Institute of Medical Sciences, Basni Phase 2 Industrial Area, Jodhpur, 342001, India.
Community and Family Medicine, All India Institute of Medical Sciences, Jodhpur, India.
Pediatr Surg Int. 2023 Feb 3;39(1):100. doi: 10.1007/s00383-023-05380-7.
Hospitalization is a nerve-wrecking experience for patients and their families (Lam et al. in Int J Nurs Stud 43:535-545, 2006). The financial burden of hospitalization is the prime perpetrator, however, multiple other factors also contribute significantly to the underlying problem which can be eliminated by efforts of the doctors and other healthcare workers and by modifying the hospital policies (Bassett et al. in J Hosp Med 15:652-658, 2020). We can reduce the number of outpatient visits and switch to telemedicine for rescheduling the cases. The pre-anaesthetic clearance and all the relevant investigations can be done on a single OPD visit thereby reducing the requirement of repeated commutes to the hospital. The free of charge category of the hospital can be extended to the patient requiring prolonged hospital stay or for solid tumor patients who require repeated hospital admissions for chemotherapy. Association with child welfare Non-government organizations (NGO's) can also solve major monetary issues for parents of patients suffering from complex congenital anomalies and solid tumors. The pre-operative NPO period can be shortened to 2-4 h, antibiotic use can be completely avoided or minimized in clean elective cases, children living in the same city requiring dressing/catheter removal after a few days (e.g. hypospadias, posterior sagittal anorectoplasty) can be discharged and called for a OPD visit after 5-7 days if the parents are willing to take care of the child at home. Patients undergoing minor elective surgeries can be followed up on telemedicine visits only. Parents of patients suffering from complex congenital anomalies should be referred to a clinical psychologist and receive periodic counseling sessions. A child psychologist should also be included in the management of cases which have social stigma attached as bladder exstrophy, anorectal malformations, spina bifida requiring lifelong follow-up and bowel washes or repeated clean intermittent catheterisation. Anxiety assessment questionnaires must be incorporated in the management of chronic patients and high-risk parents must be identified (Tiedeman in J Pediatr Nurs 12:110-119, 1997). We hereby propose adoption of family centric approach during the management of a patient as this may minimize the overall burden of the hospitalization of the family.
Hospital admission of a child leads to a myriad responses in the parents. Thus, we conducted a hospital-based cross-sectional study to determine the prevalence of anxiety and depression among the primary caregivers of hospitalized children and the factors causing it.
Parents of 228 children admitted in the pediatric surgery ward at a tertiary care hospital were interviewed using the HADS-A and Hamilton Anxiety Questionnaire to assess the prevalence of anxiety and depression during hospital admission. They were also subjected to a questionnaire comprising of 52 questions spread over 5 segments-demographic details, monetary burden, effect on siblings and other family members, practical problems faced, and surgery-specific concerns.
Thirty percent of the parents had severe anxiety and 20% developed depression due to the hospitalization of their child. We tested the association of this depression and anxiety against 56 variables in this study. Exorbitant loan amounts (r - 0.449, r- 0.557), repeated commute to the hospital (r - 0.274, r - 0.231), monetary burden (r - 0.193, r - 0.186), repetitive sampling (r - 0.248, r - 0.203), prolonged absence from work (r - 0.440, r - 0.424) were found to be the chief perpetrators of this anxiety and depression.
The burden of anxiety and depression in the primary caregivers of pediatric surgical patients is enormous. Identification of the implicating factors is essential. Simple reforms such as reduction in the number of OPD visits, extension of free of charge category, association with non-governmental organizations and involvement of a clinical psychologist can significantly meliorate the hospital journey of both the patients and their parents. (r-correlation coefficient of for depression, r-correlation coefficient of for anxiety).
住院对患者及其家属来说是一段令人焦虑不安的经历（Lam 等人，《国际护理研究》43:535-545, 2006）。然而，住院的经济负担是主要原因，还有许多其他因素也会显著导致这个问题，这些问题可以通过医生和其他医疗保健工作者的努力以及修改医院政策来解决（Bassett 等人，《医院医学杂志》15:652-658, 2020）。我们可以减少门诊就诊次数，并转为远程医疗来重新安排病例。可以在一次门诊就诊时完成麻醉前清除和所有相关检查，从而减少反复前往医院的需求。可以将医院的免费类别扩大到需要长期住院或需要多次住院接受化疗的实体瘤患者。与儿童福利非政府组织（NGO）合作也可以为患有复杂先天性畸形和实体瘤的患者的父母解决主要的经济问题。术前禁食期可以缩短至 2-4 小时，在清洁择期手术中完全避免或最小化使用抗生素，对于住在同一城市的儿童，如果需要在几天后（例如，尿道下裂，后矢状入路肛门直肠成形术）去除敷料/导尿管，可以在 5-7 天后出院，并在门诊就诊，前提是父母愿意在家照顾孩子。可以仅通过远程医疗就诊来随访接受小手术的患者。应将患有复杂先天性畸形的患者的父母转介给临床心理学家，并定期进行咨询。还应包括一名儿童心理学家来管理具有社会耻辱感的病例，例如膀胱外翻，肛门直肠畸形，需要终身随访以及肠灌洗或反复清洁间歇性导尿。必须在慢性患者的管理中纳入焦虑评估问卷，并确定高危父母（Tiedeman，《儿科护理杂志》12:110-119, 1997）。因此，我们提出在患者管理中采用以家庭为中心的方法，因为这可以最大限度地减少家庭住院的整体负担。
儿童住院会导致父母产生各种反应。因此，我们进行了一项基于医院的横断面研究，以确定住院儿童主要照顾者中焦虑和抑郁的患病率及其原因。
对一家三级护理医院儿科手术病房的 228 名儿童的家长进行访谈，使用 HADS-A 和汉密尔顿焦虑问卷评估住院期间的焦虑和抑郁患病率。他们还接受了一份包含 52 个问题的问卷，问题涵盖了 5 个部分：人口统计学细节、经济负担、对兄弟姐妹和其他家庭成员的影响、实际问题和手术相关问题。
30%的父母因孩子住院而出现严重焦虑，20%的父母出现抑郁。我们测试了这些抑郁和焦虑与本研究中的 56 个变量之间的关联。过度的贷款金额（r=0.449, r=0.557）、反复前往医院（r=0.274, r=0.231）、经济负担（r=0.193, r=0.186）、重复采样（r=0.248, r=0.203）、长时间缺勤（r=0.440, r=0.424）是导致这种焦虑和抑郁的主要原因。
儿科外科患者主要照顾者的焦虑和抑郁负担非常大。确定涉及因素至关重要。简单的改革，如减少门诊就诊次数、扩大免费类别、与非政府组织合作以及聘请临床心理学家，都可以显著改善患者及其父母的就医体验。（r 为抑郁的相关系数，r 为焦虑的相关系数）。
