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Observational Study
. 2022 Dec 5;23(1):312.
doi: 10.1186/s12875-022-01911-8.

Adherence to coprescribing of laxatives with opioids and associated characteristics in general practices in the Netherlands

Karin Hek #  1 , Fouzia Lghoul-Oulad Saïd #  2   3   4 , Joke C Korevaar  5 , Linda E Flinterman  5 , Liset van Dijk  5   6 , Patricia M L A van den Bemt  3
Affiliations
Observational Study

Adherence to coprescribing of laxatives with opioids and associated characteristics in general practices in the Netherlands

Karin Hek et al. BMC Prim Care. .

Abstract

Background: Guidelines recommend to prescribe a laxative with an opioid to prevent constipation. We aimed to determine the adherence by general practitioners (GPs) to this recommendation and to explore which GP- and patient related factors were associated with it from the perspective of the GP. METHODS: We conducted an observational study using GPs' prescription data from the Nivel Primary Care Database combined with a questionnaire asking for reasons of non-adherence. The proportion of first opioid prescriptions prescribed together with a laxative was determined as primary outcome. Possible explanatory factors such as the quality of registration, the level of collaboration with the pharmacy, familiarity with the recommendation and use of a clinical decision support system were explored, as were the self-reported reasons for non-adherence (classified as either GP-related or patient-related). We assessed the association of factors with the primary outcome using univariable multilevel logistic regression analysis.

Results: The recommendation was measured in 195 general practices. The median proportion of first opioid prescriptions prescribed together with a laxative in these practices was 54% (practice range 18-88%). None of the determinants was consistently associated with the primary outcome. GPs from 211 practices filled out the questionnaire and the most frequently mentioned reason not to prescribe a laxative was that the patient has laxatives in stock, followed by that the patient doesn't want a laxative; both were patient-related factors.

Conclusion: There was room for improvement in following the guideline on laxative prescribing in opioid use. A main reason seemed to be that the patient refuses a laxative. Improvement measures should therefore focus on communication between GPs and patients on the relevance of co-using a laxative with opioids. Future studies need to establish the effect of such improvement measures, and determine whether reasons for non-adherence to the guideline changed over time.

Keywords: Adverse drug event; Analgesics; Guideline adherence; Laxatives; Opioids; Primary care.

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Conflict of interest statement

Karin Hek: None. Fouzia Lghoul—Oulad Saïd: None. Joke Korevaar: None. Linda Flinterman: None. Liset van Dijk: Has received funding for a project not related to this study from AbbVie, Pfizer and TEVA. Patricia van den Bemt: None.

Figures

Fig.1
Fig.1
Percentage of patients with a first opioid prescription and a laxative coprescribed by practice; Horizontal line = median of all practices
See this image and copyright information in PMC

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    Vanhommerig JW, Verheij RA, Hek K, Ramerman L, Hooiveld M, Veldhuijzen NJ, Veldkamp R, van Dronkelaar C, Stelma FF, Knottnerus BJ, Meijer WM, Hasselaar J, Overbeek LI. Vanhommerig JW, et al. Int J Epidemiol. 2025 Feb 16;54(2):dyaf017. doi: 10.1093/ije/dyaf017. Int J Epidemiol. 2025. PMID: 40083190 Free PMC article. No abstract available.

References

    1. Chou R, Fanciullo GJ, Fine PG, et al. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain. 2009;10(2):113–130. doi: 10.1016/j.jpain.2008.10.008. - DOI - PMC - PubMed
    1. Noori A, Sadeghirad B, Wang L, et al. Comparative benefits and harms of individual opioids for chronic non-cancer pain: a systematic review and network meta-analysis of randomised trials. Br J Anaesth. 2022;S0007–0912(22):00288–294. - PubMed
    1. Nadeau SE, Lawhern RA. Management of chronic non-cancer pain: a framework. Pain Manag. 2022;12(6):751–777. doi: 10.2217/pmt-2022-0017. - DOI - PubMed
    1. Dzierżanowski T, Mercadante S. Constipation in Cancer Patients - an Update of Clinical Evidence. Curr Treat Options Oncol. 2022;23(7):936–950. doi: 10.1007/s11864-022-00976-y. - DOI - PubMed
    1. Farmer AD, Drewes AM, Chiarioni G, et al. Pathophysiology and management of opioid-induced constipation: European expert consensus statement. United European Gastroenterol J. 2019;7(1):7–20. doi: 10.1177/2050640618818305. - DOI - PMC - PubMed

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