The Burden and Treatment of Chronic Constipation Among US Nursing Home Residents.

Autor:	Zhang T; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA., Zullo AR; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA; Department of Pharmacy, Lifespan-Rhode Island Hospital, Providence, RI, USA., James HO; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA., Lee Y; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA., Taylor DCA; Ironwood Pharmaceuticals, Boston, MA, USA., Daiello LA; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA. Electronic address: lori_daiello@brown.edu.
Jazyk:	angličtina
Zdroj:	Journal of the American Medical Directors Association [J Am Med Dir Assoc] 2023 Aug; Vol. 24 (8), pp. 1247-1252.e5. Date of Electronic Publication: 2023 Jun 09.
DOI:	10.1016/j.jamda.2023.05.006
Abstrakt:	Objective: To evaluate the burden of chronic constipation (CC) and the use of drugs to treat constipation (DTC) in 2 complementary data sources. Design: Retrospective cohort study. Setting and Participants: US nursing home residents aged ≥65 years with CC. Methods: We conducted 2 retrospective cohort studies in parallel using (1) 2016 electronic health record (EHR) data from 126 nursing homes and (2) 2014-2016 Medicare claims, each linked with the Minimum Data Set (MDS). CC was defined as (1) the MDS constipation indicator and/or (2) chronic DTC use. We described the prevalence and incidence rate of CC and the use of DTC. Results: In the EHR cohort, we identified 25,739 residents (71.8%) with CC during 2016. Among residents with prevalent CC, 37% received a DTC, with an average duration of use of 19 days per resident-month during follow-up. The most frequently prescribed DTC classes included osmotic (22.6%), stimulant (20.9%), and emollient (17.9%) laxatives. In the Medicare cohort, a total of 245,578 residents (37.5%) had CC. Among residents with prevalent CC, 59% received a DTC and slightly more than half (55%) were prescribed an osmotic laxative. Duration of use was shorter (10 days per resident-month) in the Medicare (vs EHR) cohort. Conclusions and Implications: The burden of CC is high among nursing home residents. The differences in the estimates between the EHR and Medicare data confirm the importance of using secondary data sources that include over-the-counter drugs and other treatments unobservable in Medicare Part D claims to assess the burden of CC and DTC use in this population. (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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