Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milano, Italy ; 'Clinica del Lavoro Luigi Devoto', Fondazione IRCCS 'Ca' Granda - Ospedale Maggiore Policlinico, Milano, Italy.
Gastroenterology Unit, Fondazione IRCCS 'Ca' Granda - Ospedale Maggiore Policlinico', Milano, Italy.
United European Gastroenterol J. 2014 Apr;2(2):138-47. doi: 10.1177/2050640614528175.
We sought to evaluate the association between constipation severity, productivity losses and healthcare utilization in a national sample of Italian patients with chronic non-organic constipation (CC).
We enrolled 878 outpatients with CC. Clinical and demographic data were collected by physicians during clinical examinations. Patients completed a self-administered questionnaire (Patient Assessment of Constipation-Symptoms, PAC-SYM; Work Productivity and Activity Impairment; healthcare utilization, and Symptoms Checklist 90 Revised - Somatization Scale, SCL-90 R).
Mean PAC-SYM score was 1.62 ± 0.69. Mean weekly sick time due to constipation was 2.7 ± 8.6 h and productivity losses due to presenteeism was 19.7% ± 22.3%. Adjusted productivity losses in patients with severe CC (PAC-SYM score 2.3-4.0) compared to patients with mild symptoms (PAC-SYM score 0.0-1.0) was Italian Purchase Power Parity US$ 6160. Constipation severity (PAC-SYM quintiles) was associated with higher healthcare utilization (RRPAC-SYM 4/01.84; p-value for linear trend <0.01). After adjustment for somatization scores, the association of constipation severity with productivity losses and healthcare utilization rates was attenuated yet statistically significant.
We observed a graded increase in productivity losses and healthcare utilization with increasing constipation severity. Further studies should evaluate whether significant savings might be achieved with regimens aimed at reducing the constipation severity.
我们旨在评估意大利慢性非器质性便秘（CC）患者中便秘严重程度、生产力损失和医疗保健利用之间的关系。
我们招募了 878 名慢性非器质性便秘门诊患者。临床医生在临床检查期间收集了临床和人口统计学数据。患者填写了一份自我管理问卷（便秘症状患者评估问卷，PAC-SYM；工作生产力和活动障碍；医疗保健利用，以及症状检查表 90 修订版-躯体化量表，SCL-90R）。
PAC-SYM 平均得分为 1.62±0.69。每周因便秘而请病假的平均时间为 2.7±8.6 小时，因旷工导致的生产力损失为 19.7%±22.3%。与轻度症状（PAC-SYM 评分 0.0-1.0）患者相比，严重便秘（PAC-SYM 评分 2.3-4.0）患者的调整后生产力损失为意大利实际购买力平价 6160 美元。便秘严重程度（PAC-SYM 五分位数）与更高的医疗保健利用率（RRPAC-SYM 4/01.84；p 值<0.01）相关。在调整躯体化评分后，便秘严重程度与生产力损失和医疗保健利用率之间的相关性虽然减弱但仍具有统计学意义。
我们观察到随着便秘严重程度的增加，生产力损失和医疗保健利用率呈递增趋势。进一步的研究应该评估旨在降低便秘严重程度的治疗方案是否可以显著节省成本。
