Despite patients' widespread acknowledgment of their recurring or chronic constipation, their knowledge of prescription and therapy options are low, according to a new report by Phreesia.
The “Patients in focus: Constipation treatment and perceptions” report surveyed more than 6,700 patients, 41% of whom said they live with constipation for at least 12 months. In addition, almost half of those surveyed admitted to experiencing constipation for more than five years.
And although 90% of patients said they understood that over-the-counter constipation drugs are not meant for long-term use, 50% still continued to take these OTC medications for more than a year.
So where is the disconnect between what patients know about constipation and why they are not getting advice and prescription solutions from doctors? While 41% of patients had spoken to physicians about their condition at some point, this discussion was held in fewer than one out of four appointments on average.
And the Phreesia analysis notes that this one-time, patient-doctor conversation is not enough. Patients reported not having enough time (34%) during an appointment, being happy with their current treatment (31%) and/or lacking awareness that constipation could be discussed with their provider (29%) as reasons for not having talking more with their physicians.
The Phreesia research team was not surprised to find that patients rely on OTC medications. However, Joyce Wang, associate director of research, noted in an interview that she was not expecting that nine out of 10 people are actually aware that long-term use of OTC constipation meds can be dangerous and use them nonetheless.
One problem is that patients are not adequately managing their symptoms, Wang said. “They are trying on their own home remedies, lifestyle changes and OTC meds. They are not using the healthcare system.”
She also acknowledges that there is a stigma around this subject matter—31% of patients have never discussed their constipation symptoms with a physician. Therefore, this report’s data call into question the quality of these patient-physician conversations.
Another critical factor is whether patients are following up with their doctor about how well their treatment is working. If patients are still experiencing symptoms, it shows that they are are not educated enough, Wang noted. But if patients do not know what to monitor for or what the effectiveness of the treatment should be, they will not know what to say to the doctor during a potential follow-up visit. In addition, Wang said, if patients feel they can control it, they wouldn't even be proactive in setting up follow-up appointments.
Wang sees the pharmaceutical companies as having an integral role in promoting these patient-physician conversations. Drug companies can help facilitate discussions by better educating patients about treatment options, how one prescription drug varies from another, etc.
Another responsibility is for drug companies to start discussing the serious risks behind long-term, untreated constipation. According to the survey, almost two-thirds of patients do not understand the risks associated with constipation.
In addition, pharmaceutical companies need to work on brand awareness within the educational conversations to promote product awareness.
As many as 68% of patients are using home remedies and OTC medications for constipation therapies. In contrast, more than half (54%) could not recall a single prescription brand in the category, according to the survey.
Of the recognized brands, AbbVie and Ironwood’s Linzess were familiar to 24% of respondents, and 2% to 6% knew about Mallinckrodt’s Amitiza, Abbott’s Duphalac, Braintree Laboratories’ GoLYTELY, Salix Pharmaceuticals’ Trulance or RedHill Biopharma’s Movantik.
Plus, adherence to these prescriptions is low. Of the 41% of patients who have taken Linzess at some point, only 22% were still taking it. These numbers indicate that for some reason, patients were not satisfied or could not stick with the prescription. Still, pharmaceutical marketers have a big opening: 70% of patients are willing to try another prescription brand.