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. 2015 Nov;21(11):1077-87.
doi: 10.18553/jmcp.2015.21.11.1077.

Prescribing Patterns for Outpatient Treatment of Constipation, Irritable Bowel Syndrome-Related Constipation, and Opioid-Induced Constipation: A Retrospective Cross-Sectional Study

Katy E Trinkley  1 , Bruce E Sill, Kyle Porter, Milap C Nahata
Affiliations

Prescribing Patterns for Outpatient Treatment of Constipation, Irritable Bowel Syndrome-Related Constipation, and Opioid-Induced Constipation: A Retrospective Cross-Sectional Study

Katy E Trinkley et al. J Manag Care Spec Pharm. 2015 Nov.

Abstract

Background: Despite national recommendations for treatment of constipation, prescribing patterns for treatment are inconsistent, and health care utilization has increased.

Objective: To identify patterns in pharmacologic and nonpharmacologic treatment of constipation and associations between treatment and other variables across age groups.

Methods: This was a retrospective cross-sectional study that used the National Ambulatory Medical Care Survey (NAMCS) to compare prescribing from 2000 to 2004 and from 2005 to 2009. Treatment patterns for constipation, irritable bowel syndrome-related constipation (IBS-C), and opioid-induced constipation were considered.

Results: From 2000 to 2009, there were 89.6 million office visits related to constipation: 63.4 million for constipation alone, 28.2 million for IBS-C alone, and 3.7 million for opioid-induced constipation. For constipation, there was an overall decrease in the prescription of combination therapy (17% vs. 11%, P less than 0.05); an increase in the prescription of medication monotherapy (21% vs. 29%, P less than 0.05); decreases in the use of lubricants (9% vs. 2%, P less than 0.05) and saline (7% vs. 1%, P less than 0.001) among patients aged less than 18 years; a decrease in combination therapy (31% vs. 17%, P less than 0.05); and age group differences in the prescription of specific medications. For IBS-C and opioid-induced constipation, there were no changes in major treatment category or specific medication. Age, gender, race, ethnicity, payer source, physician specialty, and region were all found to be associated with treatment choice.

Conclusions: Health care utilization for constipation increased, and prescribing patterns shifted significantly from 2000 to 2009 for constipation and IBS-C. Patterns in treatment were significantly influenced by many factors, including age, gender, and race. Changes in treatment categories over time included a decrease in combination therapy for patients aged less than 18 years and an increase in medication monotherapy for all ages, which are in contrast to national recommendations.

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Conflict of interest statement

This study was funded by Takeda Pharmaceuticals International. At the time this study was conducted, Sill was employed by Takeda Pharmaceuticals and assisted significantly with the study and writing of the manuscript; however, the study was done independently of financial support to avoid financial bias of the data. The authors have no other commercial or financial conflicts of interest to disclose.

Study concept and design were contributed by Nahata and Sill, with assistance from Trinkley. Porter took the lead in data collection, along with Trinkley, with data interpretation performed by Trinkley, Porter, and Nahata, with assistance from Sill. The manuscript was primarily written by Trinkley and Nahata, with assistance from Sill and Porter, and revised primarily by Trinkley, along with Nahata and assisted by Sill and Porter.

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