Chronic intestinal pseudo-obstruction and enteric dysmotility : aspects on patients' health-care use, coping capacity and quality of life

Sammanfattning: Aims of the thesis: To measure health care consumption before and after the introduction of a specialized day-care unit and to investigate if patients with chronic intestinal pseudo-obstruction (CIP) differ from those with enteric dysmotility (ED) regarding clinical features, self-reported functional status, health-related quality of life (HRQL), and sense of coherence (SOC). Methods: Retrospective analysis of medical records for 125 and 54 patients with CIP or ED (paper I-II). Prospective collection of data from 54 patients with CIP or ED using 4 self-reported questionnaires: Sense of Coherence (SOC) (paper IV), Sickness Impact Profile (SIP), Swedish Health-Related Quality of Life Questionnaire (SWED-QUAL), and Gastrointestinal Symptom Rating Scale (GSRS) (paper III-IV). Results: Survival among patients with CIP was significantly worse (p<0.05) and they more often (49%) needed parenteral nutrition than patients with ED (14%). Time in hospital care was reduced from 39.4 to 3.3 days per patient and year and costs from $32,698 during traditional health-care services to $9,681 after introducing the day-care unit (p<0.002). Patients with CIP reported significantly greater functional impairment in the aggregated physical dimension of SIP (p<0.01) and significantly poorer general health (p<0.01) compared to those with ED. We found no difference in SOC between patients with CIP and ED. Conclusions: CIP and ED differ with respect to severity of measurable physiological derangement, nutritional needs, long-term prognosis, functional status and general health perception. Individually tailored care at a specialized day-care unit leads to a substantially decreased need for hospital stays and lower costs.