Educational needs in the diagnosis and management of pediatric functional constipation: a US survey of specialist and primary care clinicians.
OBJECTIVES
The goal of this study was to identify opportunities among gastroenterologists and gastroenterology nurse practitioners (NPs)/physician assistants (PAs) for continuing medical education (CME) related to functional constipation.


METHODS
An online, case-vignette survey was designed to identify and quantify practice patterns of pediatric gastroenterology clinicians. Case vignettes are a validated method for assessing clinician practice patterns. The survey consisted of three patient cases: a 3-year-old female with a 6-month history of constipation; a 6-year-old male with a 1-year history of constipation refractory to treatment and a sacral dimple with nearby tuft of hair; and a 16-year-old male with a 10-year history of constipation, and a sullen, depressed mood. Survey responses were compared to NASPGHAN guideline recommendations for diagnosis and management to identify areas where additional education may be beneficial.


RESULTS
Responses were collected from 197 gastroenterologists, 116 gastroenterology NPs/PAs, and 206 pediatrician/primary care clinicians. Several of the practice patterns observed suggest opportunities for future CME: low use of applicable Rome III diagnostic criteria; approximately 85% recommended testing beyond what is recommended for the 3-year-old patient; over 1/3 did not perform several recommended tests for the 6-year-old patient; and over 25% did not refer the 16-year-old patient for psychological evaluation. Further, there was little consensus in treatment approach among the three clinician groups. Primary care familiarity with NASPGHAN guidelines was low.


CONCLUSIONS
CME programs focusing on applying diagnostic criteria, matching diagnostic workup to patient presentation, treatment selection, and identifying patients who may benefit from psychological evaluation may fill knowledge and practice gaps of clinicians who manage pediatric patients with functional constipation.
['Barnes|Justin|J|', 'Coleman|Brandon|B|', 'Hwang|Sharon|S|', 'Stolic|Aleksandra|A|', 'Bousvaros|Athos|A|', 'Nurko|Samuel|S|', 'Salinas|Gregory D|GD|']
D003248:Constipation D004502:Education, Medical, Continuing D000072102:Gastroenterologists D005762:Gastroenterology D019983:Guideline Adherence D006801:Humans D020380:Needs Assessment D009722:Nurse Practitioners D000072143:Pediatricians D010823:Physician Assistants D058007:Physicians, Primary Care D017410:Practice Guidelines as Topic D010818:Practice Patterns, Physicians' D011795:Surveys and Questionnaires
Constipation survey gastroenterology continuing medical education Rome III clinical practice patterns