Jayachidambaram Ambalavanan, MBBS1, Nikitha Vobugari, MD1, Nadim G. Haddad, MD2, Sandeep Nadella, MBBS3; 1MedStar Washington Hospital Center, Washington, DC; 2MedStar Georgetown University Hospital, Potomac, MD; 3MedStar Georgetown University Hospital, Washington, DC
Introduction: Treatment of Chronic pancreatitis (CP) predominantly includes pain control, pancreatic enzyme supplementation and smoking/alcohol cessation. Opiates are recommended only when other therapeutic treatment options have been exhausted as per latest ACG guidelines. Strong recommendation has been advocated for smoking and alcohol cessation to prevent progression and readmission rates of CP. There is limited data to prove that tertiary care centers (with access to a gastroenterologist) are managed effectively when compared to non-tertiary care hospitals. To better understand the gaps in treatment practices of this chronic, often disabling illness, we performed a retrospective analysis of 215 patients with CP treated at 9 hospitals of MedStar Health. Methods: Using ICD 10 codes, we retrieved charts of patients presenting to acute care sites- Tertiary care Hospitals (TH) and Non-tertiary care Hospital (NTH) within the MedStar Health system between March 2015 - June 2019. These included emergency room visits and inpatient admissions. The following 3 variables pertaining to the treatment of CP were manually extracted: 1. Differences in narcotics/pancreatic exocrine replacement therapy (PERT) 2. Differences in smoking/alcohol cessation counselling 3. Differences in follow up with a gastroenterologist. Statistical analysis was performed using Chi- Square from Microsoft Excel. Results: 215 encounters were eligible for retrospective chart review.56% of CP patients were put on narcotics for pain relief. The chances of being prescribed a narcotic was more in the NTH setting (55% vs. 45%). 8% of TH patients received PERT. 80% of these had documented pancreatic insufficiency (fecal elastase/ stool fat). In contrast, 10% of NTH patients received PERT, among which 10% had documented pancreatic insufficiency. Both hospitals performed well in discussing alcohol cessation( >75% of patients) but only >50% patients received smoking cessation instructions. 60% of TH patients were referred and followed by a gastroenterologist in contrast to 41.5% in NTH setting (P=0.15). Discussion: Treatment guidelines were more likely to be followed in TH given direct access to specialists. PERT was part of the treatment plan in TH only after documenting exocrine insufficiency. There was no significant difference in smoking and alcohol counselling cessation practices between the two settings. Patients were most likely to have an outpatient follow-up with gastroenterologist after a TH visit.
Retrospective Study Characteristics
Tables (PERT,Treatment Modalities,Specialist follow up Comparison)
Tables (Smoking and Alcohol Cessation Counselling Comparison)
Disclosures: Jayachidambaram Ambalavanan indicated no relevant financial relationships. Nikitha Vobugari indicated no relevant financial relationships. Nadim Haddad indicated no relevant financial relationships. Sandeep Nadella indicated no relevant financial relationships.