Lenox Hill Hospital, Northwell Health New York, NY, United States
Sohil Khurana, DO1, Megan C. Buckley, DO2, Richa Bhardwaj, MD1, Angelica Nocerino, MD1, Anand Kumar, MD1, Elena Ivanina, DO1 1Lenox Hill Hospital, Northwell Health, New York, NY; 2Northwell Health, Lenox Hill Hospital, New York, NY
Introduction: Chronic Constipation (CC) is a commonly encountered disorder in clinical practice. Subtypes of CC include normal colonic transit constipation, slow transit constipation, and dyssynergic defecation (DD). Evaluation requires comprehensive history, focused rectal exam, and evaluation for metabolic and structural causes. An overlooked cause of CC is DD, which is an acquired behavioral problem due to the inability to coordinate the abdominal and pelvic floor muscles to evacuate stools. This project's goal was to assess the approach of our primary care physicians (PCPs), regarding diagnosis and management of CC, assess for potential knowledge gaps,and to implement targeted interventions to improve patient care.
Methods: We created an electronic questionnaire survey and emailed it to outpatient PCPs at a single academic institution. The survey tool consisted of questions pertaining to the diagnostic criteria of CC and DD, and whether the evaluation for alarm symptoms and performance of a rectal exam were routinely performed by PCPs. The survey also assessed whether PCPs referred to gastroenterologist (GI) for anorectal manometry (ARM) testing in patients with suspected DD. Participation was voluntary and anonymous.
Results: A total of 53 PCPs completed the survey questionnaire. Only 30% of PCPs defined CC correctly, and 41.5% routinely assessed for symptoms related to pelvic floor dysfunction. Only 17% of PCPs performed a rectal exam on these patients. 79% of responders were not familiar with DD and 76% never referred a patient for ARM. Only 9.4% responders felt the need to refer CC patients routinely to GI. Despite this 86.5% PCPs felt comfortable in managing patients with CC. Approximately 87% responders reported recommending lifestyle modifications and 13% recommended OTC laxatives as the initial approach for management of CC. A graph of the survey results is provided (Figure 1).
Discussion: Our study highlights a significant knowledge gap that exists among the PCPs regarding the appropriate diagnosis and management of CC. Most PCPs were unfamiliar with DD and the work-up required. Through this quality improvement initiative, we hope to fill this knowledge gap, and in turn facilitate accurate assessment and treatment of DD. We provided PCPs with educational pamphlets on CC and DD. A brief online teaching session will be held to clarify any specific questions. Three months after these interventions, will will send a post-intervention survey to assess changes in knowledge and clinical practice.
Figure: Figure 1: Results from the PCPs completed survey questionnaire. Only 17% of PCPs performed a rectal exam on these patients. 83% of providers screen for alarm features. 79% of responders were not familiar with DD and 76% never referred a patient for ARM. Only 41.5% of providers routinely assessed for symptoms related to pelvic floor dysfunction. Only 9.4% responders felt the need to refer CC patients routinely to a gastroenterologist. Despite this 86.5% PCPs felt comfortable in managing patients with CC.
Disclosures:
Sohil Khurana indicated no relevant financial relationships.
Megan Buckley indicated no relevant financial relationships.
Richa Bhardwaj indicated no relevant financial relationships.
Angelica Nocerino indicated no relevant financial relationships.
Anand Kumar indicated no relevant financial relationships.
Elena Ivanina indicated no relevant financial relationships.
Sohil Khurana, DO1, Megan C. Buckley, DO2, Richa Bhardwaj, MD1, Angelica Nocerino, MD1, Anand Kumar, MD1, Elena Ivanina, DO1. P2213 - Chronic Constipation Evaluation: A Survey Based Study Targeting Primary Care Physicians, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
