Abstract: FR-PO419
Impact of Psychology Integration on Pre-ESKD Care of Children With Congenital Anomalies of the Kidney and Urinary Tract (CAKUT)
Session Information
- Pediatric Nephrology - I
November 04, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Pediatric Nephrology
- 1800 Pediatric Nephrology
Authors
- Dawson, Anne E., Department of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, Ohio, United States
- Wilson, Camille, Department of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, Ohio, United States
- Cass, Jennifer, Department of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, Ohio, United States
- Mcleod, Daryl J., Department of Pediatric Urology, Nationwide Children's Hospital, Columbus, Ohio, United States
- Becknell, Brian, Division of Pediatric Nephrology and Hypertension, Nationwide Children's Hospital, Columbus, Ohio, United States
Group or Team Name
- Kidney and Urinary Tract Center
Background
Children with congenital disorders of the kidney and urinary tract (CAKUT) require laboratory monitoring, invasive tests, surgical interventions, and multiple medications. These stressors are associated with anxiety, nonadherence and quality of life concerns. Moreover, CAKUT and associated kidney disease can impact neurodevelopmental outcomes. The role of psychology in caring for these children has been historically reserved for later stages of kidney disease. This study examines rates and outcomes of psychology referrals before and after integration of a psychology provider in the multidisciplinary urology/nephrology clinic, which follows children with all pre-ESKD stages of kidney disease with CAKUT.
Methods
A retrospective chart review identified psychology referrals placed from the Urology/Nephrology Clinic at Nationwide Children’s Hospital (pre- and post-psychology integration). Number of referrals placed, adherence to follow-up recommendations, common diagnoses and results of evaluations were recorded.
Results
From 2014-2018 (pre-integration), no patients were referred to pediatric psychology/neuropsychology (PPNP). In 2020, once psychology was integrated fully, referrals increased 10 fold, which was sustained in 2021 with 12% of patients referred and the majority successfully scheduling an appointment. Most common medical diagnoses of referred patients included prune belly syndrome, posterior urethral valves, and solitary kidney. PPNP evaluations identified low cognitive functioning, risk for attention disorders, and areas of specific learning deficits in the majority of patients and provided recommendations for intervention, including behavioral health supports and school accommodations.
Conclusion
Integration of psychology into a multidisciplinary urology/nephrology clinic allows for a holistic assessment of patient and family. Without psychology support, patients may go undiagnosed and/or miss the opportunity for early intervention. By intervening early, patients may benefit from interventions to promote disease self-management and engagement, ease learning burdens in school, address mental health concerns and enhance quality of life. Future studies are necessary to evaluate the potential impact of early psychology involvement on disease progression by enhancing patient compliance and adherence to interventions related to disease mitigation.