Jakob Saidman, MD1, Zachary Jurkowski, MD1, Adam C. Ehrlich, MD, MPH2; 1Temple University, Philadelphia, PA; 2Lewis Katz School of Medicine at Temple University, Philadelphia, PA
Introduction: Constipation is the one of the most common reasons for obtaining gastroenterology consultation. Use of opioid medications is a frequent contributor to constipation, and the opioid epidemic has increased awareness about this public health concern. Many states have mandated centralized monitoring of opioid prescriptions to limit abuse. The aim of this study was to determine how physician knowledge of opioid use affects care of patients with constipation. Methods: Adult patients who presented to our outpatient GI clinic with a diagnosis of constipation from 2016-2019 were identified. Diagnosis of constipation was defined by ICD-10 codes listed in Table 1. Those with active malignancy were excluded. Opioid use was defined as any opioid prescription within 3 months prior to the first clinic visit as listed in our state’s prescription drug monitoring program (PDMP). Data extracted from the chart included demographics and medication details. Physician knowledge of opioid use was determined if opioid use was mentioned in the progress note, if PDMP was checked during visit, if PDMP audit trail was used or if an opioid was on the active medication list. Data was analyzed using SPSS v25. Results: A total of 233 patients met inclusion criteria. Demographic information is reported in Table 2. Of all the patients presenting for an initial visit for constipation, 55% were on opioids 3 months before their first appointment. When examining progress notes compared to the “gold standard” PDMP, GI physicians were unaware of the opioid use in 70% of these patients. Patients taking opioids known to the provider were more likely to be prescribed constipation medication on initial consult compared to unknown opioids though this was not significant (53% vs 46%, p=0.40). Basic demographic factors were not significant predictors of whether a patient was on opioids in the preceding 3 months. 71 patients underwent lower endoscopy between 1st and 2nd visit. Opioid use was associated with a lower chance of having a procedure with a trend towards significance (OR=0.597, p=0.07). Discussion: At our safety-net hospital, in an area plagued by opioid abuse, a significant number of patients were taking opioids. Furthermore, GI providers were unaware of this use in the majority of cases though this did not seem to affect prescribing patterns. Provider education is needed to increase the accuracy of the EMR, and further studies are needed to identify the effect of the opioid crisis on GI patients.
Table 1: ICD-10 Codes and Descriptions
Table 2: Demographics of Patients Presenting with Constipation (n=233)
Disclosures: Jakob Saidman indicated no relevant financial relationships. Zachary Jurkowski indicated no relevant financial relationships. Adam Ehrlich indicated no relevant financial relationships.