Natoshia R Cunningham1,2, Erin Moorman3, Courtney M Brown2,4,5, Daniel Mallon2,6, Pavan K Chundi5, Constance A Mara3,2, Scott Pentiuk2,6, Anne M Lynch-Jordan3,2, Dana M H Dykes2,6, Julie Elfers6, Michael K Farrell2,6. 1. Divisions of Behavioral Medicine and Clinical Psychology, natoshia.cunningham@cchmc.org. 2. Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio. 3. Divisions of Behavioral Medicine and Clinical Psychology. 4. General and Community Pediatrics, and. 5. James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and. 6. Gastroenterology, Hepatology and Nutrition, and.
Abstract
BACKGROUND: Pediatric functional abdominal pain disorders are common, costly, and disabling. Clinical anxiety is highly prevalent and is associated with increased pain and functional disability. Thus, a psychological screening process is recommended but is infrequently used in current practice. METHODS: A screening process for patient-reported anxiety (Screen for Child Anxiety and Related Disorders), functional disability (Functional Disability Inventory), and pain levels was implemented in a large gastroenterology division within a major medical center. Quality improvement methods and traditional analytic approaches were used to test the feasibility and outcomes of routine screening in patients ages 8 to 18 with abdominal pain. RESULTS: Screening rates increased from <1% to >80%. A total of 1291 patients who reported having abdominal pain completed the screening during the first 6 months. Clinically significant anxiety (43.1%), at least moderate disability (45%), and elevated pain (61.5%) were common in children with abdominal pain. The presence of clinically significant anxiety corresponded with higher pain and pain-related disability. Twenty-one percent of youth had clinical elevations in all 3 areas. In such instances, medical providers received an automated prompt to tailor care, including to consider a psychological referral. After the project implementation, psychological referral rates increased from 8.3 per 1000 patients to 15.2 per 1000 patients. CONCLUSIONS: Systematic screening for anxiety, pain, and pain-related disability as a routine part of medical care can be reliably implemented with clinically meaningful results. Future directions include examining the role of anxiety over the long-term and reducing clinician burden.
BACKGROUND: Pediatric functional abdominal pain disorders are common, costly, and disabling. Clinical anxiety is highly prevalent and is associated with increased pain and functional disability. Thus, a psychological screening process is recommended but is infrequently used in current practice. METHODS: A screening process for patient-reported anxiety (Screen for ChildAnxiety and Related Disorders), functional disability (Functional Disability Inventory), and pain levels was implemented in a large gastroenterology division within a major medical center. Quality improvement methods and traditional analytic approaches were used to test the feasibility and outcomes of routine screening in patients ages 8 to 18 with abdominal pain. RESULTS: Screening rates increased from <1% to >80%. A total of 1291 patients who reported having abdominal pain completed the screening during the first 6 months. Clinically significant anxiety (43.1%), at least moderate disability (45%), and elevated pain (61.5%) were common in children with abdominal pain. The presence of clinically significant anxiety corresponded with higher pain and pain-related disability. Twenty-one percent of youth had clinical elevations in all 3 areas. In such instances, medical providers received an automated prompt to tailor care, including to consider a psychological referral. After the project implementation, psychological referral rates increased from 8.3 per 1000 patients to 15.2 per 1000 patients. CONCLUSIONS: Systematic screening for anxiety, pain, and pain-related disability as a routine part of medical care can be reliably implemented with clinically meaningful results. Future directions include examining the role of anxiety over the long-term and reducing clinician burden.
Authors: Kaitlyn L Gamwell; Constance A Mara; Kevin A Hommel; Susmita Kashikar-Zuck; Natoshia R Cunningham Journal: Clin J Pain Date: 2021-12-17 Impact factor: 3.442
Authors: Becky H Lois; Tamaki H Urban; Christina Wong; Erin Collins; Lara Brodzinsky; Mary Ann Harris; Hayley Adkisson; Monique Armstrong; Jeanmarie Pontieri; Diana Delgado; Jeremiah Levine; K Ron-Li Liaw Journal: Pediatr Qual Saf Date: 2020-06-08
Authors: Maria Luísa Cordeiro Santos; Ronaldo Teixeira da Silva Júnior; Breno Bittencourt de Brito; Filipe Antônio França da Silva; Hanna Santos Marques; Vinícius Lima de Souza Gonçalves; Talita Costa Dos Santos; Carolina Ladeia Cirne; Natália Oliveira E Silva; Márcio Vasconcelos Oliveira; Fabrício Freire de Melo Journal: World J Clin Pediatr Date: 2022-03-09