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Arizmendi BJ, Craven MR, Martinez-Camblor P, Tormey LK, Salwen-Deremer JK. Engagement in GI Behavioral Health Is Associated with Reduced Portal Messages, Phone Calls, and ED Visits. Dig Dis Sci 2024:10.1007/s10620-024-08428-3. [PMID: 38622464 DOI: 10.1007/s10620-024-08428-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/06/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND AND AIMS Chronic digestive disorders are associated with increased costs for healthcare systems and often require provision of both urgent care and non-face-to-face (non-F2F) care, such as responding to patient messages. Numerous benefits of integrated gastroenterology (GI) behavioral health have been identified; however, it is unclear if integrated care impacts healthcare utilization, including urgent care and non-F2F contact. We sought to investigate the association between patient engagement with GI behavioral health and healthcare utilization. METHODS We performed a retrospective chart review study of adult patients who were referred for and completed at least one behavioral health appointment between January 1, 2019 and December 21, 2021 in the Gastroenterology and Hepatology department of a large academic medical center. Data on electronic medical record (EMR) messages, phone calls, and Emergency Department utilization were collected 6 months before and 9 months after patient engagement with GI behavioral health. RESULTS 466 adult patients completed at least one behavioral health visit from 2019 to 2021. Overall, messages, phone calls, and ED visits all decreased significantly from the 6 months before behavioral health treatment to 6 months after (all P values < 0.001). CONCLUSION Engagement with integrated GI behavioral health is associated with reduced non-F2F care and emergency department utilization in patients with chronic digestive disorders. Increasing access to GI behavioral health may result in reduced provider workload and healthcare system costs.
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Affiliation(s)
- Brian J Arizmendi
- Department of Psychiatry and Psychology, Mayo Clinic Arizona, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA.
| | - Meredith R Craven
- Department of Gastroenterology and Hepatology, Stanford University, Palo Alto, CA, USA
| | - Pablo Martinez-Camblor
- Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Department of Biomedical Data Science, Geisel School of Medicine, Hanover, NH, USA
| | - Lauren K Tormey
- Department of Medicine, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Jessica K Salwen-Deremer
- Department of Medicine, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Axelsson E, Kern D, Hedman-Lagerlöf E, Lindfors P, Palmgren J, Hesser H, Andersson E, Johansson R, Olén O, Bonnert M, Lalouni M, Ljótsson B. Psychological treatments for irritable bowel syndrome: a comprehensive systematic review and meta-analysis. Cogn Behav Ther 2023; 52:565-584. [PMID: 37341454 DOI: 10.1080/16506073.2023.2225745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 06/05/2023] [Indexed: 06/22/2023]
Abstract
A wide range of psychological treatments have been found to reduce the symptoms of irritable bowel syndrome (IBS) but their relative effects are unclear. In this systematic review and meta-analysis, we determined the effects of psychological treatments for IBS, including subtypes of cognitive behavior therapy, versus attention controls. We searched 11 databases (March 2022) for studies of psychological treatments for IBS, reported in journal articles, books, dissertations, and conference abstracts. The resulting database comprised 9 outcome domains from 118 studies published in 1983-2022. Using data from 62 studies and 6496 participants, we estimated the effect of treatment type on improvement in composite IBS severity using random-effects meta-regression. In comparison with the attention controls, there was a significant added effect of exposure therapy (g = 0.52, 95% CI = 0.17-0.88) and hypnotherapy (g = 0.36, 95% CI = 0.06-0.67) when controlling for the pre- to post-assessment duration. When additional potential confounders were included, exposure therapy but not hypnotherapy retained a significant added effect. Effects were also larger with a longer duration, individual treatment, questionnaire (non-diary) outcomes, and recruitment outside of routine care. Heterogeneity was substantial. Tentatively, exposure therapy appears to be a particularly promising treatment for IBS. More direct comparisons in randomized controlled trials are needed. OSF.io identifier: 5yh9a.
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Affiliation(s)
- Erland Axelsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Liljeholmen Primary Health Care Center, Region Stockholm, Stockholm, Sweden
- Academic Primary Health Care Center, Region Stockholm, Stockholm, Sweden
| | - Dorian Kern
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Erik Hedman-Lagerlöf
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Perjohan Lindfors
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Josefin Palmgren
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Hugo Hesser
- Center for Health and Medical Psychology, School of Behavioural, Social and Legal Sciences, Örebro University, Örebro, Sweden
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Erik Andersson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Robert Johansson
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Ola Olén
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
- Department of Pediatric Gastroenterology and Nutrition, Sachs' Children's Hospital, Stockholm, Sweden
| | - Marianne Bonnert
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Maria Lalouni
- Division of Neuro, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Burton Murray H, Weeks I, Becker KR, Ljótsson B, Madva EN, Eddy KT, Staller K, Kuo B, Thomas JJ. Development of a brief cognitive-behavioral treatment for avoidant/restrictive food intake disorder in the context of disorders of gut-brain interaction: Initial feasibility, acceptability, and clinical outcomes. Int J Eat Disord 2023; 56:616-627. [PMID: 36550697 PMCID: PMC9992156 DOI: 10.1002/eat.23874] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/29/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Avoidant/restrictive food intake disorder (ARFID) symptoms are common (up to 40%) among adults with disorders of gut-brain interaction (DGBI), but treatments for this population (DGBI + ARFID) have yet to be evaluated. We aimed to identify initial feasibility, acceptability, and clinical effects of an exposure-based cognitive-behavioral treatment (CBT) for adults with DGBI + ARFID. METHODS Patients (N = 14) received CBT as part of routine care in an outpatient gastroenterology clinic. A two-part investigation of the CBT included a retrospective evaluation of patients who were offered a flexible (8-10) session length and an observational prospective study of patients who were offered eight sessions. Feasibility benchmarks were ≥75% completion of sessions, quantitative measures (for treatment completers), and qualitative interviews. Acceptability was assessed with a benchmark of ≥70% patients reporting a posttreatment satisfaction scores ≥3 on 1-4 scale and with posttreatment qualitative interviews. Mixed model analysis explored signals of improvement in clinical outcomes. RESULTS All feasibility and acceptability benchmarks were achieved (and qualitative feedback revealed high satisfaction with the treatment and outcomes). There were improvements in clinical outcomes across treatment (all p's < .0001) with large effects for ARFID fear (-52%; Hedge's g = 1.5; 95% CI = 0.6, 2.5) and gastrointestinal-specific anxiety (-42%; Hedge's g = 1.0; 95% CI = 0.5, 16). Among those who needed to gain weight (n = 10), 94%-103% of expected weight gain goals were achieved. DISCUSSION Initial development and testing of a brief 8-session CBT protocol for DGBI + ARFID showed high feasibility, acceptability, and promising clinical improvements. Findings will inform an NIH Stage 1B randomized control trial. PUBLIC SIGNIFICANCE While cognitive-behavioral treatments (CBTs) for ARFID have been created in outpatient feeding and eating disorder clinics, they have yet to be developed and refined for other clinic settings or populations. In line with the recommendations for behavioral treatment development, we conducted a two-part investigation of an exposure-based CBT for a patient population with high rates of ARFID-adults with disorders of gut-brain interaction (also known as functional gastrointestinal disorders). We found patients had high satisfaction with treatment and there were promising improvements for both gastrointestinal and ARFID outcomes. The refined treatment includes eight sessions delivered by a behavioral health care provider and the findings reported in this article will be studied next in an NIH Stage 1B randomized controlled trial.
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Affiliation(s)
- Helen Burton Murray
- Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215
- Center for Neurointestinal Health, Division of Gastroenterology, Massachusetts General Hospital, 55 Fruit Street, Wang 5, Boston, MA 02114
| | - Imani Weeks
- Center for Neurointestinal Health, Division of Gastroenterology, Massachusetts General Hospital, 55 Fruit Street, Wang 5, Boston, MA 02114
| | - Kendra R. Becker
- Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA 02114
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Elizabeth N Madva
- Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215
- Center for Neurointestinal Health, Division of Gastroenterology, Massachusetts General Hospital, 55 Fruit Street, Wang 5, Boston, MA 02114
| | - Kamryn T Eddy
- Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA 02114
| | - Kyle Staller
- Center for Neurointestinal Health, Division of Gastroenterology, Massachusetts General Hospital, 55 Fruit Street, Wang 5, Boston, MA 02114
- Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA 02115
| | - Braden Kuo
- Center for Neurointestinal Health, Division of Gastroenterology, Massachusetts General Hospital, 55 Fruit Street, Wang 5, Boston, MA 02114
- Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA 02115
| | - Jennifer J. Thomas
- Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA 02215
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, 2 Longfellow Place, Suite 200, Boston, MA 02114
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Atkins M, Burton Murray H, Staller K. Assessment and management of disorders of gut-brain interaction in patients with eating disorders. J Eat Disord 2023; 11:20. [PMID: 36782302 PMCID: PMC9926752 DOI: 10.1186/s40337-022-00731-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/28/2022] [Indexed: 02/15/2023] Open
Abstract
Disorders of gut-brain interaction (DBGI), also known as functional gastrointestinal disorders, are common in individuals with eating disorders, and may precede or perpetuate disordered eating. Understanding the pathophysiology of common gastrointestinal symptoms in DGBI can be important for the care of many patients with eating disorders. In this review, we summarize the literature to date on the complex relationship between DBGI and eating disorders and provide guidance on the assessment and management of the most common symptoms of DBGI by anatomic region: esophageal symptoms (globus and functional dysphagia), gastroduodenal symptoms (functional dyspepsia and nausea), and bowel symptoms (abdominal pain, bloating and constipation).
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Affiliation(s)
- Micaela Atkins
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA. .,Division of Gastroenterology, Center for Neurointestinal Health, Massachusetts General Hospital, 55 Fruit Street, Wang 5, Boston, MA, 02114, USA.
| | - Helen Burton Murray
- Division of Gastroenterology, Center for Neurointestinal Health, Massachusetts General Hospital, 55 Fruit Street, Wang 5, Boston, MA, 02114, USA.,Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA, 02215, USA
| | - Kyle Staller
- Division of Gastroenterology, Center for Neurointestinal Health, Massachusetts General Hospital, 55 Fruit Street, Wang 5, Boston, MA, 02114, USA.,Department of Medicine, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
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