College of Nursing, Wayne State University, Detroit, Michigan, USA.
Linguistic Insights & Analytics, Verilogue, Horsham, Pennsylvania, USA.
Pain Med. 2019 May 1;20(5):889-896. doi: 10.1093/pm/pny151.
This analysis of patient-health care provider discussions of opioid-induced constipation (OIC) evaluated the dynamics of interactions, identified communication gaps, and assessed the functional burden of opioid-induced constipation on patients' lives.
Retrospective analysis of a Health Insurance Portability and Accountability Act-compliant database of >120,000 patient-provider conversations.
Outpatient offices in the United States.
Conversations between providers and patients prescribed opioids that occurred in the United States (January 2014-May 2016) and included a discussion of opioid-induced constipation were identified. Demographics and prespecified opioid-induced constipation conversation characteristics were evaluated for these conversations.
This analysis included 216 patient-provider discussions. Most patients (76.4% [165/216]) were ≥50 years old. Most conversations were with pain management specialists (39.8% [86/216]) or primary care physicians (36.6% [79/216]). Overall, 64.4% (139/216) of patients reported experiencing symptoms of constipation. Health care providers indicated that symptoms of constipation could be caused by opioid use for 75.5% (105/139) of patients with constipation. In most cases (82.4% [178/216]), providers did not probe about specific constipation symptoms. Few patients (11.5% [16/139]) with OIC discussed the burden of OIC with their providers; burdens reported by patients with OIC included emergency room visits and reduced food or fluid intake. No specific action was recommended for 33.8% (47/139) of patients with constipation.
In this analysis, when opioid-induced constipation was discussed, health care providers did not inquire about specific symptoms for most patients, opioids were not cited as a cause of constipation in approximately one-quarter of patients with opioid-induced constipation, and no clear treatment plan or guidance was recommended for one-third of patients. Results of this analysis suggest that more education may be needed to improve patient-provider communication about opioid-induced constipation.
本分析评估了患者-医疗保健提供者关于阿片类药物诱导性便秘（OIC）讨论的动态，发现了沟通差距，并评估了 OIC 对患者生活的功能性负担。
对超过 120,000 例患者-提供者对话的符合《健康保险流通与责任法案》（HIPAA）的数据库进行回顾性分析。
美国的门诊办公室。
确定在美国发生的（2014 年 1 月至 2016 年 5 月）且包含 OIC 讨论的阿片类药物处方患者-提供者对话。对这些对话的人口统计学特征和预设的 OIC 对话特征进行了评估。
本分析包括 216 例患者-提供者讨论。大多数患者（76.4%[165/216]）年龄≥50 岁。大多数对话是与疼痛管理专家（39.8%[86/216]）或初级保健医生（36.6%[79/216]）进行的。总体而言，64.4%（139/216）的患者报告有便秘症状。医疗保健提供者表示，75.5%（105/139）有便秘症状的患者的便秘可能是由阿片类药物使用引起的。在大多数情况下（82.4%[178/216]），提供者没有探查特定的便秘症状。只有少数（11.5%[16/139]）OIC 患者与提供者讨论了 OIC 的负担；OIC 患者报告的负担包括急诊就诊和减少食物或液体摄入。对于 33.8%（47/139）有便秘的患者，没有推荐具体的治疗措施。
在本分析中，当讨论 OIC 时，对于大多数患者，医疗保健提供者没有询问具体症状，大约四分之一有 OIC 的患者没有将阿片类药物列为便秘的原因，对于三分之一的患者没有推荐明确的治疗计划或指导。本分析结果表明，可能需要更多的教育来改善患者-提供者关于 OIC 的沟通。
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