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Bladder and Bowel Dysfunction Network: Improving the Management of Pediatric Bladder and Bowel Dysfunction
Martha Pokarowski1, Mandy Rickard1, Ronik Kanani2
1Division of Urology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
A new network of community pediatricians trained in bladder and bowel dysfunction (BBD) management offers shorter wait times for patients. This approach provides similar symptom improvement and high satisfaction compared to traditional hospital clinics.
Area of Science:
- Pediatric Urology
- Community Health
- Behavioral Pediatrics
Background:
- Bladder and bowel dysfunction (BBD) presents with lower urinary tract symptoms and constipation.
- High referral volumes to pediatric urology clinics lead to prolonged wait times.
- Initial BBD management involves behavioral strategies suitable for community pediatricians.
Purpose of the Study:
- To establish a Bladder and Bowel Dysfunction Network (BBDN) of community pediatricians.
- To assess the impact of the BBDN on patient care and wait times.
- To compare BBDN management with traditional hospital pediatric urology clinic care.
Main Methods:
- Pediatricians received training in BBD management through lectures and clinical shadowing.
- Patients referred to pediatric urology were triaged to the BBDN or remained in the hospital clinic.
- Dysfunctional voiding symptom score, Bristol stool chart, and satisfaction surveys were used for assessment.
Main Results:
- Community pediatricians primarily used PEG3350 and diet for BBD management, less often recommending bladder retraining.
- Both BBDN and hospital clinic groups showed similar improvements in dysfunctional voiding symptom scores.
- BBDN patients experienced significantly shorter wait times for follow-up appointments (56 days vs. 94.5 days).
Conclusions:
- Community pediatricians may benefit from enhanced knowledge of BBD management strategies.
- Implementing a BBDN is feasible and reduces wait times for pediatric BBD care.
- The BBDN model achieves comparable symptom improvement and patient satisfaction to hospital-based clinics.
Abstract:
Lower urinary tract symptoms with constipation characterize bladder and bowel dysfunction (BBD). Due to high referral volumes to hospital pediatric urology clinics and time-consuming appointments, wait times are prolonged. Initial management consists of behavioral modification strategies that could be accomplished by community pediatricians. We aimed to create a network of community pediatricians trained in BBD (BBDN) management and assess its impact on care.
Methods:
We distributed a survey to pediatricians, and those interested attended training consisting of lectures and clinical shadowing. Patients referred to a hospital pediatric urology clinic were triaged to the BBDN and completed the dysfunctional voiding symptom score and satisfaction surveys at baseline and follow-up. The Bristol stool chart was used to assess constipation. Results were compared between BBDN and hospital clinic patients.
Results:
Surveyed pediatricians (n = 100) most commonly managed BBD with PEG3350 and dietary changes and were less likely to recommend bladder retraining strategies. Baseline characteristics were similar in BBDN (n = 100) and hospital clinic patients (n = 23). Both groups had similar improvements in dysfunctional voiding symptom score from baseline to follow-up (10.1 ± 4.2 to 5.6 ± 3.3, P = 0.01, versus 10.1 ± 4.2 to 7.8 ± 4.5, P = 0.02). BBDN patients waited less time for their follow-up visit with 56 (28-70) days versus 94.5 (85-109) days for hospital clinic patients (P < 0.001). Both groups demonstrated high familial satisfaction.
Conclusions:
Community pediatricians may require more knowledge of management strategies for BBD. Our pilot study demonstrates that implementing a BBDN is feasible, results in shorter wait times, and similar improvement in symptoms and patient satisfaction than a hospital pediatric urology clinic.
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