PCP-led action plan reduces pediatric GI referrals for constipation

WASHINGTON — Implementing a patient-specific action plan helped reduce unnecessary referrals to pediatric gastroenterologists among children with constipation, according to research presented at Digestive Disease Week.

Jennifer Webster, DO, of the Children’s Hospital of Philadelphia (CHOP), said pediatric constipation accounts for 5% of visits to general pediatricians and 25% of referrals to pediatric gastroenterologists. Children with constipation also account for an estimated $3.9 billion in excess spending compared with those without, she said.

“We decided to look for a root cause from the patient perspective as to why patients are using excess health care resources,” Webster said in her presentation.

Therefore, Webster and colleagues called patients who visited the emergency department for constipation to ascertain the root cause of poorly controlled constipation. They found a primary reason was that families were unaware how to handle an emergency, and they wanted to know what medication to use in that situation.

Using these data, Webster and colleagues developed a patient-specific constipation action plan within the electronic medical record to help personalize and standardize treatment for functional constipation.

The action plan included descriptions of different stages of constipation severity and guided parents in what to do within each “zone.” Webster and colleagues also included dosing logic in the action plan to help physicians choose the appropriate medications for their patients.

Prior to implementing the program in September 2017, the primary care sites within the CHOP network included in the study had a mean number of referrals to the pediatric GI of 8.25 per month for constipation (5.19% referral rate). That mean number has gone down to 6.33 per month (4.14% referral rate).

Webster said they expect the number of referrals to continue to go down as more patients and practitioners adhere to the action plan.

“Our next steps include development of a clinical pathway to help better aid practitioners in choosing the appropriate medications, as well as the appropriate patients to refer to the gastroenterology office,” she said. “We are also evaluating the cost to the health care system as we shift the care of these patients from sub-specialty care to primary care.” - by Alex Young

Reference:

Webster J, et al. Abstract 691. Presented at: Digestive Disease Week; June 2-5, 2018; Washington, D.C.

Disclosures: Webster reports no relevant financial disclosures. Please see the DDW faculty disclosure index for a list of all other authors’ relevant financial disclosures.