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The Uniformed Services Constipation Action Plan: An Effective Tool for the Management of Children with Functional
Patrick T Reeves1, Benjamin O Jack2, Philip L Rogers3
1Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD; Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD; Department of Pediatrics, Brooke Army Medical Center, San Antonio, TX.
Insights
The Uniformed Services Constipation Action Plan (USCAP) improved clinical outcomes and quality of life for children with functional constipation. This simple plan is recommended for standard clinical practice.
Area of Science:
- Pediatric Gastroenterology
- Implementation Science
- Clinical Trial Design
Background:
- Functional constipation is a common pediatric condition impacting quality of life.
- Current management strategies require effective implementation tools.
- The Uniformed Services Constipation Action Plan (USCAP) was developed to address these needs.
Purpose of the Study:
- To implement and evaluate the effectiveness of the USCAP in a pediatric gastroenterology clinic.
- To assess the impact of USCAP on clinical, patient-related, and health confidence outcomes for children with functional constipation.
Main Methods:
- An implementation science study involving toilet-trained children aged 4+ meeting Rome IV criteria for functional constipation.
- Block randomization to either USCAP or a control group.
- Pharmacotherapy continuation for 4 months, with outcomes including constipation resolution, Pediatric Bristol Stool Form Scale (PBSFS) scores, health-related quality of life (HRQoL), and Health Confidence Score (HCS).
Main Results:
- 77% of the USCAP group achieved a PBSFS score of 3 or 4, compared to 59% in controls (P=.03).
- USCAP recipients showed greater adherence to pharmacotherapy (P<.001) and improved HRQoL scores (P=.04).
Conclusions:
- The USCAP is a simple, cost-effective tool for managing pediatric functional constipation.
- Implementation of USCAP demonstrated significant improvements in clinical and patient-reported outcomes.
- USCAP is recommended for integration into standard clinical practice for functional constipation in children.
Objective:
To implement and to evaluate the effectiveness of the Uniformed Services Constipation Action Plan (USCAP) in our gastroenterology clinic for children with functional constipation.
Study Design:
This implementation science study included toilet-trained subjects aged 4 years and older who met the Rome IV criteria for functional constipation. Children were block randomized to receive either the USCAP or control. All clinic functional constipation plans recommended subjects continue pharmacotherapy for 4 months. Endpoints measured were clinical outcomes (resolution of functional constipation and achievement of a Pediatric Bristol Stool Form Scale [PBSFS] score of 3 or 4), patient-related outcomes (health-related quality of life [HRQoL] total scale score), and health confidence outcomes (Health Confidence Score [HCS]).
Results:
Fifty-seven treatment group subjects (44%) received a USCAP (52% male; mean age, 10.9 [4.9] years) compared with 73 controls (56%; 48% male; mean age,10.9 [5.3] years). A PBSFS score of 3 or 4 was achieved by 77% of the treatment group compared with 59% of controls (P = .03). Subjects from the treatment group were more likely than the controls to endorse adherence to the 4-month course of pharmacotherapy (P < .001). Subjects who received a USCAP had greater improvements in HRQoL total scale score by the end of the project (P = .04).
Conclusions:
The USCAP is a simple, inexpensive tool that has the potential to improve global outcomes for functional constipation in children and should be recommended as standard clinical practice.
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