Observational Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 14, 2015; 21(6): 1893-1899
Published online Feb 14, 2015. doi: 10.3748/wjg.v21.i6.1893
Snapshot of an integrated psychosocial gastroenterology service
Sarah W Kinsinger, Sarah Ballou, Laurie Keefer
Sarah W Kinsinger, Sarah Ballou, Laurie Keefer, Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
Author contributions: Kinsinger SW performed the majority of the study design and manuscript preparation (i.e., data collection, data entry, interpretation and writing); Ballou S contributed to data entry, analysis and interpretation of results; and Keefer L contributed to study design, interpretation of results and editing of final manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Sarah W Kinsinger, PhD, Assistant Professor of Medicine and Psychiatry, Division of Gastroenterology, Northwestern University, 676 N. St. Clair St., suite 1400, Chicago, IL 60611, United States. s-kinsinger@northwestern.edu
Telephone: +1-312-6959317 Fax: +1-312-6957095
Received: May 27, 2014
Peer-review started: May 28, 2014
First decision: June 18, 2014
Revised: July 11, 2014
Accepted: September 5, 2014
Article in press: September 5, 2014
Published online: February 14, 2015
Abstract

AIM: To characterize the patients utilizing a gastroenterology behavioral medicine service and examine the effect of treatment on health care utilization.

METHODS: Patients were referred by their gastroenterologists for psychological treatment during a 15 mo period. Patients seen for an intake with a psychologist completed the Brief Symptom Inventory (BSI) and a checklist of psychosocial concerns. A subset of patients with functional bowel disorders also completed a disease specific quality of life measure. Chart review was conducted to obtain information on type and frequency of sessions with the psychologist, the number of outpatient gastroenterology visits, and number of gastroenterology-related medical procedures during the 6 mo following psychological intake.

RESULTS: Of 259 patients referred for treatment, 118 (46%) completed an intake with a psychologist. Diagnoses included: irritable bowel syndrome (42%), functional dyspepsia (20%), inflammatory bowel diseases (20%), esophageal symptoms (10%), and “other” (8%). Demographic variables and disease type did not differentiate between those who did and did not schedule an intake. Mean t-scores for the BSI global score index and the depression, anxiety, and somatization subscales fell below the cutoff for clinical significance (t = 63). Treatments were predominantly gut-directed hypnosis (48%) and cognitive behavioral therapy (44%). Average length of treatment was 4 sessions. Among functional gastrointestinal (GI) patients, those patients who initiated treatment received significantly fewer GI-related medical procedures during the 6 mo following the referral than patients who did not schedule an intake [t (197) = 2.69, P < 0.01].

CONCLUSION: Patients are receptive to psychological interventions for GI conditions and there is preliminary evidence that treatment can decrease health-care utilization among patients with functional GI conditions.

Keywords: Psychological treatment, Irritable bowel syndrome, Functional gastrointestinal disorders, Hypnosis, Cognitive-behavioral therapy

Core tip: Psychological interventions are effective treatment options for many chronic gastrointestinal conditions, particularly functional bowel disorders. However, psychological care has not been well integrated into standard clinical practice for gastrointestinal disorders. The aim of the current study was to examine the feasibility and acceptability of offering psychological services to patients in an outpatient gastroenterology practice and the potential impact of treatment on health care utilization.