THE PEDIATRIC BOWEL MANAGEMENT CLINIC - INITIAL RESULTS OF A MULTIDISCIPLINARY APPROACH TO FUNCTIONAL CONSTIPATION IN CHILDREN

The multifactorial nature of functional constipation in children sugge sts that a multidisciplinary management approach may be effective, The authors tested this hypothesis in a newly created pediatric Bowel Man agement Clinic (BMC). Detailed data were collected prospectively on al l patients seen in the clinic over the first 16 months. Both quantitat ive and qualitative analyses were performed to describe the index popu lation and to demonstrate the impact of the intervention. Satisfaction with care in the clinic was measured using the Measure of Processes o f Care tool, then compared with a normative sample, One hundred fourte en patients, all previously treated unsuccessfully for constipation, w ere referred to a team comprised of a physician, nurse practitioner, n urse educator, dietitian, and psychosocial nurse specialist. The mean age was 5.4 years with equal gender distribution. Between the first an d last visits recorded, several variables including stool consistency and frequency, soiling frequency, abdominal pain, rectal pain, and rec tal bleeding all showed statistically significant (P <.05) improvement , Qualitative data analysis showed the significant psychosocial impact of constipation on patients and their families. In the Measures of Pr ocesses of Care questionnaire, scores for the BMC were higher than nor mal on all scales except in provision of information. A multidisciplin ary approach to functional constipation leads to both patient and pare nt satisfaction and significant shortterm improvement. Further studies will examine the longterm impact of the clinic. Copyright (C) 1997 by W.B. Saunders Company.