Perceived Barriers to Treatment in Persons Treated for Functional Gastrointestinal Disease with Constipation
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ORIGINAL ARTICLE
Perceived Barriers to Treatment in Persons Treated for Functional Gastrointestinal Disease with Constipation Klaus Bielefeldt1 Received: 17 April 2020 / Accepted: 6 August 2020 © This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2020
Abstract Introduction Despite expanding treatment options, patients with functional gastrointestinal disorders (FGID) frequently express concerns about problems with access to care. We hypothesized that health insurance coverage contributes to the perceived problems with care delivery. Methods Using the Medical Expenditure Panel Survey, we examined a cohort of participants defined by the diagnosis code for FGID plus the recorded prescription for laxative therapy. Demographic data, healthcare utilization and cost, insurance coverage, comorbid conditions, and information about provider characteristics were extracted for the years 2005–2015. Age- and sex-matched controls were identified for each year included. Barriers to care were based on responses to questions about inability to receive timely care or medication. Logistic regression was used to identify independent predictors of perceived barriers. Results The cohort was female predominant (67.8%; mean age: 58.8 ± 0.33 years) with 15.4% reporting problems with access to care. Limited insurance coverage was most commonly cited by respondents. Consistent with this result, uninsured persons were significantly more likely to report barriers to care, while the type of insurance for those covered did not independently predict access problems. In addition, comorbidity burden and provider-specific factors, such as available contact options or insufficient explanations, correlated with perceived barriers to care delivery. Conclusion While the study design cannot establish causal links, persons with FGID commonly report access problems, which correlate with lack of health insurance and comorbidities. Providers can influence this perception by offering more flexible office hours and incorporating patient expectations related to treatment explanations and shared decision-making. Keywords Comorbidity · Access to care · Cost of care · Satisfaction · Irritable bowel syndrome
Introduction Constipation is a common problem, affecting about 14% of the general population [1]. It causes a significant direct and indirect burden due its effects on quality of life, related healthcare cost, and absenteeism with negative impact on productivity [2–6]. Several new drugs have been introduced, offering more treatment options for patients. However, Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10620-020-06544-4) contains supplementary material, which is available to authorized users. * Klaus Bielefeldt [email protected] 1
George E. Wahlen VA Medical Center, 500 Foothill Dr., Salt Lake City, UT 84103, USA
these medications often come with higher prices, are only available by prescription, and may not be included in
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