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Impact of Psychiatric Co-morbidity on Health Resource Utilization Associated With Management of Chronic Abdominal Pain

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Abraham, Neena MD, MSc (Epi), FACG; Chang, Yu-Hui H. PhD

American Journal of Gastroenterology: October 2017 - Volume 112 - Issue - p S239
Abstracts: ACCEPTED: FUNCTIONAL BOWEL DISEASE
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Mayo Clinic, Scottsdale, AZ

Introduction: Chronic abdominal pain (CAP) can be disabling for patients and incur major social and economic burden given the lack of effective therapies. The role of the central nervous system and the “brain-gut axis” is central to the impaired neural processing of visceral stimuli in patients with CAP. Underlying psychiatric conditions also contribute to stress and negative emotions which magnify frequency and severity of symptoms which may contribute to increased patient care encounters. In this study, we reviewed a 10-year history of outpatient experience with this population to better understand health resource utilization associated with the management of the functional GI disorder (FGID) population.

Methods: Administrative billing data from a large tertiary care medical center (1/1/07-12/31/16) was used to identify cases of functional GI disorders (FGID), including chronic abdominal pain (CAP) with and without underlying psychiatric co-morbidity. Descriptive analysis of demographic and clinical characteristics, and longitudinal practice trends were examined. Cases were propensity- matched in a 1:1 fashion to controls. Generalized estimating equations were created to predict health resource utilization of interest (endoscopy, radiology) and Poisson regression used to quantify GI return visits and Emergency Department (ED) visits. Psychiatric co-morbidity was treated as an effect modifier to better evaluate the impact of this underlying condition on health care utilization.

Results: We identified 31,324 patients with FGID (cases), of which CAP was the primary diagnosis in 13,271; cases were matched to 48,434 controls. The median age was 59 years (49-69), 55% were female, 93% white, 64.9% had commercial insurance and 37% had a Charlson-Deyo score ≥ 1. Psychiatric comorbidity was greater among cases vs. controls (11.7% vs. 8.0%; P<0.001). Overall healthcare utilization was higher in cases vs. controls with strongest association among those with psychiatric co-morbidity (Figure 1). CAP patients with underlying psychiatric co-morbidity were more likely to self-refer (20.9% vs. 10.8%; P<0.001), require endoscopy (75.7% vs. 69.6%; P<0.001), incur multiple GI follow-up (88.6% vs. 55.9%; P<0.001) and ED visits (49.2% vs. 41.3%; P<0.001).

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Conclusion: Underlying psychiatric co-morbidity is an important driver of health resource utilization among FGID patients. Patients who present with CAP and psychiatric disorders have the greatest health resource utilization when compared to controls. This study highlights the importance of the active participation of a mental health provider in the care of FGID patients. The potential role of psychological therapeutic approaches to address anticipatory negative emotions and painrelated expectations to decrease excessive health resource utilization is an area which merits further investigation.

© The American College of Gastroenterology 2017. All Rights Reserved.