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United European Gastroenterol J. 2014 Apr;2(2):138-47. doi: 10.1177/2050640614528175.

Constipation severity is associated with productivity losses and healthcare utilization in patients with chronic constipation.

Author information

1
Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milano, Italy ; 'Clinica del Lavoro Luigi Devoto', Fondazione IRCCS 'Ca' Granda - Ospedale Maggiore Policlinico, Milano, Italy.
2
Gastroenterology Unit, Fondazione IRCCS 'Ca' Granda - Ospedale Maggiore Policlinico', Milano, Italy.
3
Dipartimento di Medicina Interna e Specialità Mediche, Gastroenterologia A, Università Sapienza, Roma, Italy.
4
Dipartimento di Medicina Clinica, Università Alma Mater Studiorum, Bologna, Italy.
5
Gastroenterology and Hepatology Section, Department of Clinical and Experimental Medicine, University of Perugia School of Medicine, Perugia, Italy.
6
Unità Operativa di Gastroenterologia Universitaria, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.
7
DoxaPharma, Milan, Italy.
8
Department of Clinical and Experimental Medicine, Federico II University Hospital School of Medicine, Naples, Italy.
9
D.E.T.O. Sezione Chirurgia generale e trapianto di fegato – Policlinico Consorzile, Bari, Italy
10
IRCCS Ospedale Casa Sollievo della Sofferenza San Giovanni Rotondo, Foggia, Italy
11
Gastroenterologia - AOUC Careggi, Firenze, Italy
12
Gastroenterology Unit, Fondazione IRCCS “Ca’ Granda – Ospedale Maggiore Policlinico”, Milano, Italy
13
Clinica di Gastroenterologie ed epatologia Ospedale S. Maria della Misericordia, Perugia, Italy
14
S.O.C. Gastroenterologia - Ospedale Cardinal Massaia, Asti, Italia
15
U.O. Riabilitazione Gastroenterologia Montecatone Rehabilitation Institute, Bologna, Italy
16
U.O. Gastroenterologia Universitaria AOUP, Pisa, Italy
17
Gastroenterologia Clinica - Ospedali Riuniti, Ancona, Italy
18
U.O. Gastroeneterologia Policlinico G.B. Rossi, Viterbo, Italy
19
U.O. Gastroenterologia A.O. Bufalini, Forlì, Italy
20
Ambulatorio fisiopatologia digestiva AOU Paolo Giaccone, Palermo, Italy
21
S.O.C. Gastroenterologia Centro di riferimento oncologico Aviano, Pordenone, Italy
22
Gastroenterologia ed endoscopia digestive, Policlinico Universitario Campus Biomedico, Roma, Italy
23
Unità operativa di gastroenterologia P.O. "A. Maresca" ASL Napoli 3 Sud, Napoli, Italy
24
Cogliandro, Rosanna, MD Dipartimento di Medicina clinica Policlinico S. Orsola Malpighi, Bologna, Italy
25
U.O. Gastroenterologia A.O. Bufalini, Forli-Cesena, Italy
26
Ospedale Civile Sanremo Gastroenterologia Sanremo, Imperia, Italy
27
Dipartimento di Medicina Interna e Specialità Mediche, Gastroenterologia A - Università Sapienza, Roma – Italy
28
U.O. Gastroenterologia Ospedale Universitario San Raffaele, Milano, Italy
29
U.B. Gastroenterologia ed endoscopia digestiva Ospedale Beuregard, Aosta, Italy
30
Department of Clinical & Experimental Medicine, Federico II University Hospital School of Medicine, Napoli - Italy
31
U.O. di Gastroenterologia - Az. Ospedaliera Universitaria "Maggiore Della Carità”, Novara, Italy
32
S.C. Gastroenterologia Ospedale Regionale Ca' Foncello, Treviso, Italy
33
Clinica Medica 1 - Università di Pavia Fondazione IRCCS - Policlinico S. Matteo, Pavia, Italy
34
Dipartimento di Medicina Interna - Policlinico G. Martino, Messina, Italy
35
UOC Gastroenterologia AO Università di Padova, Padova, Italy
36
U.O. di Gastroenterologia, Epatologia ed Endoscopia Digestiva – Ospedale Guglielmo da Saliceto, Piacenza, Italy
37
S.O.C. Gastroenterologia - Ospedale Cardinal Massaia, Asti, Italy
38
UO Gastroenterologia - Ospedale di Fermo, Fermo, Italy
39
U.O. di fisiopatologia digestiva Università degli studi "Magna Graecia", Cosenza, Italy
40
U.O.C. Gastroenterologia ARNAS Garibaldi Nesima, Catania, Italy
41
1. Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milano, Italy 2. “Clinica del Lavoro Luigi Devoto”, Fondazione IRCCS “Ca’ Granda – Ospedale Maggiore Policlinico, Milano, Italy 3. Center for Outcomes Research, Department of Health Management and Policy, Saint Louis University, Saint Louis, MO, USA
42
Gastroenterologia ed endoscopia digestiva – Pio Albergo Trivulzio, Milano, Italy
43
U.O. Gastroenterologia ed endoscopia digestiva – A.O. Bolognini, Bergamo, Italy
44
U.O. Gastroenterologia A.O. Bufalini, Forlì-Cesena, Italy
45
U.O.C. Geriatria AZ. ULSS 16 OSP. S. Antonio, Padova, Italy
46
U.O. Medicina Interna - Clinica Medica "A. Murri” Università di Bari, Bari, Italy
47
Gastroenterologia AZ. Ospedaliera S. Maria Degli Angeli, Pordenone, Italy
48
U.O. Clinica Gastroenterologia con Endoscopia A.O. Universitaria San Martino, Genova, Italy
49
Dipartimento di Medicina Clinica, Università Alma Mater Studiorum, Bologna, Italy
50
UOC/UOSD Gastroenterologia ed endoscopia digestiva - AO S. Giovanni Addolorata, Roma, Italy
51
S.C. Gastroenterologia - A.O. G Brotzu, Cagliari, Italy
52
ASL 1 Imperiese – S.S. Cure domiciliari Imperia e S.C. Gastroenterologia, Imperia, Italy

Abstract

OBJECTIVE:

We sought to evaluate the association between constipation severity, productivity losses and healthcare utilization in a national sample of Italian patients with chronic non-organic constipation (CC).

METHODS:

We enrolled 878 outpatients with CC. Clinical and demographic data were collected by physicians during clinical examinations. Patients completed a self-administered questionnaire (Patient Assessment of Constipation-Symptoms, PAC-SYM; Work Productivity and Activity Impairment; healthcare utilization, and Symptoms Checklist 90 Revised - Somatization Scale, SCL-90 R).

RESULTS:

Mean PAC-SYM score was 1.62 ± 0.69. Mean weekly sick time due to constipation was 2.7 ± 8.6 h and productivity losses due to presenteeism was 19.7% ± 22.3%. Adjusted productivity losses in patients with severe CC (PAC-SYM score 2.3-4.0) compared to patients with mild symptoms (PAC-SYM score 0.0-1.0) was Italian Purchase Power Parity US$ 6160. Constipation severity (PAC-SYM quintiles) was associated with higher healthcare utilization (RRPAC-SYM 4/01.84; p-value for linear trend <0.01). After adjustment for somatization scores, the association of constipation severity with productivity losses and healthcare utilization rates was attenuated yet statistically significant.

CONCLUSIONS:

We observed a graded increase in productivity losses and healthcare utilization with increasing constipation severity. Further studies should evaluate whether significant savings might be achieved with regimens aimed at reducing the constipation severity.

KEYWORDS:

Chronic constipation; cost-of-illness study; direct cost; functional constipation; healthcare utilization; indirect cost; irritable bowel syndrome; productivity loss

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