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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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