- Email: [email protected]
Sa1086 Dose Escalation of Vedolizumab From Every 8 Weeks to Every 4 or 6 Weeks Enables Patients With Inflammatory Bowel Disease to Recapture Response
AGA Abstracts
Results: Sixty patients completed My Gi Health prior to their GI visit, leading to 60 physician and patient RFCs. The RFC pairs were in complete agreement in 15% of cases. The Table shows the concordance between the physician and patient RFCs for each individual issue. The highest agreement was seen for abnormal imaging evaluation, abdominal pain, dysphagia, and anemia evaluation. There was agreement less than 33% of the time for the remaining individual RFCs. There was no difference in the total number of issues mentioned in the RFCs generated by physicians vs. patients (mean 1.85 vs. 1.55; p=.06). The RFCs from both physicians and patients were fully addressed during the GI clinic visit in the majority of cases, and no difference was seen between groups (physician RFC 88.3% vs. patient RFC 80.0%; p=.21). Conclusion: There is very poor agreement between referring providers' reason for GI referral and patients' understanding of why they were visiting the GI clinic. Future research examining the etiology behind this discordance and its impact on patient satisfaction and resource utilization are warranted. Table. Concordance between physician- and patient-documented reason for consult
Sa1085 Telephone vs. Clinic Follow-Up in the Management of Patients With Inflammatory Bowel Disease: A Nurse Practitioner Led Study Usha Chauhan, David Armstrong, Yasamin Farbod, Smita L. Halder, Sharon Kaasalainen, John.K. Marshall, María Inés Pinto Sanchez, Jelena Popov, Frances Tse, Paul Moayyedi Background: Management of Inflammatory Bowel Disease (IBD) requires frequent contact with health care providers, but clinic visits impose an economic burden and can cause psychosocial distress. This study examines the effectiveness of telephone contact versus a clinic appointment among patients followed for IBD. Methods: This is mixed method study design. Consecutive IBD patients were randomly assigned to either clinic follow-up visit (CFV) by an IBD nurse practitioner or telephone follow-up visit (TFV) with an IBD nurse practitioner 3 months after their current appointment. Standardized questionnaires, including demographics, IBD phenotype, disease activity, medication, quality of life, resource utilization, anxiety and depression were completed at baseline and six months visits using an online survey. Patient satisfaction and preference were evaluated in focus group sessions. Results: Sixty patients were recruited from the outpatient clinic at McMaster Medical Center. There were no differences in the basic demographic between both groups (table). The average parking and travel costs for patients randomized to CFV were CAN $25.83, and their average loss of income was CAN $17.00. The median duration of health care contact was longer in the CFV group (52 minutes (IQR 38-81) vs. 17 minutes (IQR 15.0-21.2); p=<0.01), with wait time was longer in CFV (median 31.6 minutes (IQR 8-56) vs 0 minutes p<0.01). Rates of interim health care contact did not differ between the two arms. No significant change in health-related quality of life (Short Inflammatory Bowel Disease Questionnaire) or satisfaction (Patient Satisfaction Questionnaire) from baseline to 6-month follow-up was observed. There was also no significant change in C-reactive protein (CRP), Harvey-Bradshaw Index (Crohn's disease) or Partial Mayo Score (ulcerative colitis). At 6 months subjects in the TFV arm had lower median total HADS score (8 vs. 12, p=0.045) and lower median HADS depression score (p=0.046). A common theme mentioned by TFV subjects in focus groups was their satisfaction with time and money saved via telephone communication. Depending on their circumstances, the patients preferred telephone visits when in remission and clinic visits during relapse of their disease. Conclusion: Our feasibility study has shown that telephone visit is cost saving and preferred by patients with IBD. This mode of follow-up care was also associated with better anxiety and depression scores. Further research is needed to explore how TFV can best be integrated in patient management algorithms. This study was supported by Hamilton Health Sciences Clinical Health Professional Investigator Grant Demographic information
Sa1084 Replacing the Guaiac Fecal Occult Blood Test With the Fecal Immunochemical Test Results in Higher Colorectal Cancer Screening Completion in a Large Healthcare Setting in the United States Ali Akram, Derek Juang, Samir Gupta Background: The most commonly used non-invasive test for colorectal cancer (CRC) screening is the guaiac fecal occult blood test (gFOBT). The gFOBT requires 3 stool samples, dietary restrictions, and is often a challenge to complete. A newer test, the fecal immunochemical test (FIT), requires only 1 sample, is more sensitive for CRC and colorectal polyps, does not require dietary restriction, and is associated fewer false positives. However, FIT is more expensive, and has not yet replaced the gFOBT in all clinical settings. Experience with usual care replacement of gFOBT with FIT in routine clinical practice has not been reported. Our aim was to take advantage of a natural experiment, in which the VA San Diego Healthcare System replaced the gFOBT with FIT for CRC screening to determine whether the change was associated with 1) higher rates of screening completion (compliance), and 2) differences in rates of positive tests. Methods: We included Veterans at average risk for CRC age 5075, who were offered either a gFOBT (Beckman Coulter Hemoccult) or FIT (Polymedco OC Auto 80,100 ng hemoglobin/dL buffer cutoff) as part of routine primary care during the time period 3/2014-1/2015. The VA San Diego health system transitioned from offering gFOBT to FIT for screening on 7/2014. Local electronic health records were queried to identify Veterans who had gFOBT or FIT ordered for outpatient CRC screening, extract test dates and results, and demographic characteristics. For comparing gFOBT vs. FIT, primary outcomes were 1) proportion completing screening among veterans with ordered tests, and 2) proportion with positive tests. Results: 8,368 Veterans with gFOBT (n=3273) or FIT (n=5095) orders were identified during the study period. There were no clinically significant differences in demographic characteristics by test type ordered (Table). Test completion rates were superior for FIT (2995/5095, 58%) vs. gFOBT (1186/3273, 36%, p=<0.001). Among veterans with tests completed, FIT positivity rates was 8% (253/2995) vs. 5% (65/ 1186) for gFOBT (p=0.001). Conclusion: In usual practice, replacing gFOBT with FIT for CRC screening nearly doubles screening completion, but also results in higher rates of patients with positive tests requiring colonoscopy follow up. Widespread implementation of FIT over gFOBT should be strongly considered by all health systems. Demographic Characteristics of Veterans with Tests Ordered
Sa1086 Dose Escalation of Vedolizumab From Every 8 Weeks to Every 4 or 6 Weeks Enables Patients With Inflammatory Bowel Disease to Recapture Response Antonio H. Mendoza Ladd, Frank I. Scott, Rory Grace, Hillary Bownik, Gary R. Lichtenstein Introduction Vedolizumab (VDZ) dose escalation has demonstrated efficacy in recapturing response in patients with Crohn's disease (CD) and ulcerative colitis (UC) in a single study when escalating dose from 300 mg iv every 8 weeks to every 4 week (Sands BE, et al Am. J. Gastroenterol 2014; poster 1618). Information about the efficacy of dose escalation of VDZ outside the setting of clinical trials is lacking. In this study we analyzed the effect of dose escalation of VDZ from 300 mg every 8 weeks to VDZ 300 mg every 4 or every 6 weeks to recapture RES in patients with IBD in a large university referral practice. Methods A retrospective analysis of all medical records of adult patients (> 18 years of age) with IBD who initially achieved response to a maintenance dose of VDZ at 300 mg every 8 weeks from 06/2014 - 08/2015 was performed. Patients who lost response to VDZ 300 mg every 8 weeks and were started on a higher maintenance dose (VDZ 300 mg every 4 or 6 weeks) were identified. Information collected included age, gender, ethnicity, diagnosis, concurrent immunomodulators (IM) and/or steroids (CS), VDZ interval therapy (4 or 6 weeks), adverse events (AE) and total duration of VDZ therapy. Recapture of response was determined by expert review of the medical record and clinician's progress notes. Results 172 pts initiated VDZ; 108 completed 3 dose-induction (criteria for inclusion). Mean F/U from VDZ initiation was 23 wks (range: 6- 66 wks). Mean pt age was 45 yrs. A total of 42/83=50.6% pts with CD and 15/23=65% UC responded (mean HBI & SCCAI scores at weeks 0 and 14 were
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AGA Abstracts
10 & 7 and 6 & 4 respectively) when given VDZ 300 mg every 8 weeks. Of the 42 patients with CD and 15 with UC who responded to VDZ every 8 weeks, 16 with CD and 3 with UC were considered to have lost RES later on their course by their treating physicians. These patients were then started on a higher dose of VDZ (300 mg every 4 weeks [n=10] or 300 mg every 6 weeks [n=9]-Table 1. After dose escalation, all the patients receiving VDZ every 4 and 6 weeks had recaptured response by the end date of the study. Only 1 AE was seen which occurred in one patient in the Q4 weeks subgroup (pruritus). Conclusion In patients who lost RES to VDZ every 300 mg iv every 8 weeks at a large referral center, increased dosing frequency of VDZ 300 mg to every 6 or 4 weeks helped to recapture with apparent no significant increased risk for AE. Patient characteristics
NPI, claims data) as well as individual reporting by physicians using the network. Gastroenterology fellowship data was also gathered using NRMP and AMA FREIDA for all training programs in the US. Data was plotted and compared to the available NCI maps for colorectal cancer incidence, prevalence and mortality. Results A total of 12,994 gastroenterologists were identified across the US. They tend to be more concentrated in the Northeast and Midwest continental US. On a more granular level, a similar trend around large metropolitan areas was also noticed.(Fig 1) When this map was compared to colon cancer distribution, significant discrepancies with physician availability were noted, especially with regards to Southern Midwest region that exhibits the highest mortality rates from colon cancer. Data collected for gastroenterology fellowship spots (n=462) throughout the United States indicated a distribution pattern similar to that of practicing gastroenterologists(Fig 2). The use of this novel approach to mapping the physician workforce in gastroenterology provides near real-time data regarding geographical spread. Our results highlight the lack of significant growth in the total number of practicing gastroenterologists in areas of need. The discrepancies between the lack of gastroenterologists and the high mortality rates of colon cancer in certain geographic areas underscore the need for targeted interventions to balance the workforce. One possible approach could include increasing fellowship spots in ‘GI deserts' as previous studies have shown a trend for physicians to practice in areas where they trained. Summary The use of social network 'big data' to generate real time mapping of the gastroenterology workforce is novel. The availability of such granular data will help future policy making in the fight against colon cancer.
Sa1087 Evaluation of Accuracy and Consistency Between Symptom Checkers for Diagnosis and Triage of Gastrointestinal Symptoms Andrew C. Berry, Bruce B. Berry, Rahman Nakshabendi, Ozdemir Kanar, Travis Myers, Brooks D. Cash
Fig 1. Geographical distribution of Gastroenterologists in USA
Introduction: As patients are now more health conscious and apt to using multimedia, it is increasingly common for patients to utilize symptom checker websites to determine a differential diagnosis and triage level based on simply patient symptoms. As these symptom checkers may replace more traditional office telephone call lines, the US Congress is considering regulating apps that "provide a list of possible medical conditions and advice on when to consult a health care professional." Thus, we aim to determine the accuracy and reliability of the symptom checkers as a whole in regards to gastrointestinal symptoms, but also the degree of agreement/consistency between individual symptom checkers. Methods: 22 Gastrointestinal societal evidence-based diagnosis were categorized into: (7) Emergent (requiring emergent care); (9) Non-Emergent (where non emergent care was reasonable); (6) Self-Care (where a medical visit is unnecessary and self-care is sufficient). The top 5 clinical symptoms by occurrence as listed on UpToDate were entered for each diagnosis into 20 unique online symptom checkers: (9) with both diagnosis and triage, (8) diagnosis only, (3) triage only; yielding a total of (17) with diagnosis and (12) with triage capabilities. Results: Of all diagnosis vignettes, 227/374 (60.6%) were listed at all, 85/374 (22.3%) listed top 1, 145/374 (38.8%) listed top 3, and 203/374 (54.3%) listed top 10. There was no statistical difference with diagnosis broken down by type: emergent, non-emergent, or self-care; in regards to either listed top 1 (p=0.58), listed top 3 (p=0.41), or listed top 10 (p=0.41). Overall, 173/264 (65.5%) of triage scenarios were correct, with strong statistical difference between emergent (68/84: 81%), non-emergent (81/108: 75%), and self care vignettes (24/72: 33%) (p=9.4 x 10-11), with stratification of emergent diagnosis being the most accurately triaged. When comparing symptom checkers, the return of an accurate diagnosis listed in general (p= 9.83 X 10-13), listed 1st (p= 0.0097), or listed in the top 10 (p= 1.95 x 10-6) was not independent of the symptom checker used. Therefore, whether or not you get an accurate diagnosis is dependent on the symptom checker used. The likelihood of an accurate triage response is also not independent of the symptom checker used (p=0.0004). Therefore, some symptom checkers provide more accurate triage information than others. Conclusions: Though symptom checkers provide a means for patients to conveniently investigate a potential diagnosis, some symptom checkers clearly provide more accurate diagnosis than others. In addition, the type of potential diagnosis, be it emergent, non-emergent, or self-care, does not affect the accuracy for symptom checker diagnosis. However, symptom checkers providing triage advice tend to be accurate, especially with symptoms compatible of emergent triage advice.
Fig 2. Geographical distribution of Gastroenterology fellowship spots in USA
Sa1089 US Primary Care Providers Use of Over-the-Counter Medications for Gastroesophageal Reflux Disease and Chronic Constipation Samuel W. Chey, Stacy B. Menees, Sameer D. Saini, Arlene Weissman, Linda J. Harris, William D. Chey Background/Aims: Primary care providers (PCPs) treat the vast majority of gastroesophageal reflux (GERD) and chronic constipation (CC) patients but little is known about how they view and utilize products for their treatment. As cost and coverage of prescription medications for these conditions force patients to over-the-counter (OTC) treatments, it is important to evaluate how PCPs perceive and utilize store-brand (StoreB) and brand name (Branded) OTC products for GERD and CC. Methods: A 33-question survey was electronically sent to 622 eligible PCPs from the IM Insider Research panel, a representative panel of 1,286 American College of Physician members. The survey asked respondents about their usage of StoreB and Branded OTCs for GERD and CC and their opinions about the quality, efficacy, safety, and price of these medications. Chi-square and students t-tests were utilized for bivariate analysis. Results: A geographically representative group of 337 PCPs (54% response rate) completed the survey. The majority of respondents were men (58%) and white (63%) with a mean age of 45.6(± 12.9) years. 43% worked in private practice, 12% for the government, and 9% in an academic setting. 47% had practiced for 20+ years. For average GERD patients, 64% of PCPs utilized OTC medications while 36% utilized prescription drugs for first line treatment. While 79% of PCPs believed that StoreB PPIs had equal clinical effectiveness to Branded PPIs, 18% felt that the StoreB were less effective than Branded PPIs. 86% of PCPs believed that StoreB OTCs were less expensive than Branded products though PCPs tended to underestimate the potential cost savings. Only 25% regularly advised GERD patients to purchase StoreB PPIs, and more than a third never made this recommendation (Table 1). For average CC patients, over 98% of PCPs utilized OTC fiber-supplements, osmotic laxatives, stool softeners, or stimulant laxatives as a first line treatment, and 88% of PCPs continued to recommend OTC as second line treatment (Table 2). Branded products were rarely recommended by PCPs. 98% of PCPs believed that CC StoreB products had equal bioequivalence to Branded products. Additionally, 83% of PCPs believed that StoreB products were less expensive than Branded products. Despite this, only 25% of PCPs reported they had at least some discussion of StoreB products with their CC patients. Conclusions: For PCPs, OTC drugs are the cornerstone of treating GERD & CC patients. Though the
Sa1088 Novel Use of Social Network Data to Map the Geographical Distribution of the Gastroenterology Workforce in the United States Hafiz Muhamamd Sharjeel Arshad, Joumana Chaiban, Krishna Patel, Armand Krikorian Purpose Prevalence and mortality data published by the National Cancer Institute (NCI) indicate higher colon cancer incidence and mortality rates in the Midwest and Southern United States. While this discrepancy is multifactorial, it highlights the need for access to the appropriate number of qualified gastroenterologists in these areas to ensure proper screening and management. Little has been done in past 20 years to map the gastroenterology workforce in the USA, with the last attempt made by Meyer et al. in 1996. We propose to use social network data to assist in planning targeted interventions to meet population health care needs at a local level. Methods De-identified data about the number of board-certified gastroenterologists by zip code was obtained from the Doximity physician database. This database is refreshed monthly and contains up-to-date data from a variety of sources (AMA,
AGA Abstracts
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Results: Sixty patients completed My Gi Health prior to their GI visit, leading to 60 physician and patient RFCs. The RFC pairs were in complete agreement in 15% of cases. The Table shows the concordance between the physician and patient RFCs for each individual issue. The highest agreement was seen for abnormal imaging evaluation, abdominal pain, dysphagia, and anemia evaluation. There was agreement less than 33% of the time for the remaining individual RFCs. There was no difference in the total number of issues mentioned in the RFCs generated by physicians vs. patients (mean 1.85 vs. 1.55; p=.06). The RFCs from both physicians and patients were fully addressed during the GI clinic visit in the majority of cases, and no difference was seen between groups (physician RFC 88.3% vs. patient RFC 80.0%; p=.21). Conclusion: There is very poor agreement between referring providers' reason for GI referral and patients' understanding of why they were visiting the GI clinic. Future research examining the etiology behind this discordance and its impact on patient satisfaction and resource utilization are warranted. Table. Concordance between physician- and patient-documented reason for consult
Sa1085 Telephone vs. Clinic Follow-Up in the Management of Patients With Inflammatory Bowel Disease: A Nurse Practitioner Led Study Usha Chauhan, David Armstrong, Yasamin Farbod, Smita L. Halder, Sharon Kaasalainen, John.K. Marshall, María Inés Pinto Sanchez, Jelena Popov, Frances Tse, Paul Moayyedi Background: Management of Inflammatory Bowel Disease (IBD) requires frequent contact with health care providers, but clinic visits impose an economic burden and can cause psychosocial distress. This study examines the effectiveness of telephone contact versus a clinic appointment among patients followed for IBD. Methods: This is mixed method study design. Consecutive IBD patients were randomly assigned to either clinic follow-up visit (CFV) by an IBD nurse practitioner or telephone follow-up visit (TFV) with an IBD nurse practitioner 3 months after their current appointment. Standardized questionnaires, including demographics, IBD phenotype, disease activity, medication, quality of life, resource utilization, anxiety and depression were completed at baseline and six months visits using an online survey. Patient satisfaction and preference were evaluated in focus group sessions. Results: Sixty patients were recruited from the outpatient clinic at McMaster Medical Center. There were no differences in the basic demographic between both groups (table). The average parking and travel costs for patients randomized to CFV were CAN $25.83, and their average loss of income was CAN $17.00. The median duration of health care contact was longer in the CFV group (52 minutes (IQR 38-81) vs. 17 minutes (IQR 15.0-21.2); p=<0.01), with wait time was longer in CFV (median 31.6 minutes (IQR 8-56) vs 0 minutes p<0.01). Rates of interim health care contact did not differ between the two arms. No significant change in health-related quality of life (Short Inflammatory Bowel Disease Questionnaire) or satisfaction (Patient Satisfaction Questionnaire) from baseline to 6-month follow-up was observed. There was also no significant change in C-reactive protein (CRP), Harvey-Bradshaw Index (Crohn's disease) or Partial Mayo Score (ulcerative colitis). At 6 months subjects in the TFV arm had lower median total HADS score (8 vs. 12, p=0.045) and lower median HADS depression score (p=0.046). A common theme mentioned by TFV subjects in focus groups was their satisfaction with time and money saved via telephone communication. Depending on their circumstances, the patients preferred telephone visits when in remission and clinic visits during relapse of their disease. Conclusion: Our feasibility study has shown that telephone visit is cost saving and preferred by patients with IBD. This mode of follow-up care was also associated with better anxiety and depression scores. Further research is needed to explore how TFV can best be integrated in patient management algorithms. This study was supported by Hamilton Health Sciences Clinical Health Professional Investigator Grant Demographic information
Sa1084 Replacing the Guaiac Fecal Occult Blood Test With the Fecal Immunochemical Test Results in Higher Colorectal Cancer Screening Completion in a Large Healthcare Setting in the United States Ali Akram, Derek Juang, Samir Gupta Background: The most commonly used non-invasive test for colorectal cancer (CRC) screening is the guaiac fecal occult blood test (gFOBT). The gFOBT requires 3 stool samples, dietary restrictions, and is often a challenge to complete. A newer test, the fecal immunochemical test (FIT), requires only 1 sample, is more sensitive for CRC and colorectal polyps, does not require dietary restriction, and is associated fewer false positives. However, FIT is more expensive, and has not yet replaced the gFOBT in all clinical settings. Experience with usual care replacement of gFOBT with FIT in routine clinical practice has not been reported. Our aim was to take advantage of a natural experiment, in which the VA San Diego Healthcare System replaced the gFOBT with FIT for CRC screening to determine whether the change was associated with 1) higher rates of screening completion (compliance), and 2) differences in rates of positive tests. Methods: We included Veterans at average risk for CRC age 5075, who were offered either a gFOBT (Beckman Coulter Hemoccult) or FIT (Polymedco OC Auto 80,100 ng hemoglobin/dL buffer cutoff) as part of routine primary care during the time period 3/2014-1/2015. The VA San Diego health system transitioned from offering gFOBT to FIT for screening on 7/2014. Local electronic health records were queried to identify Veterans who had gFOBT or FIT ordered for outpatient CRC screening, extract test dates and results, and demographic characteristics. For comparing gFOBT vs. FIT, primary outcomes were 1) proportion completing screening among veterans with ordered tests, and 2) proportion with positive tests. Results: 8,368 Veterans with gFOBT (n=3273) or FIT (n=5095) orders were identified during the study period. There were no clinically significant differences in demographic characteristics by test type ordered (Table). Test completion rates were superior for FIT (2995/5095, 58%) vs. gFOBT (1186/3273, 36%, p=<0.001). Among veterans with tests completed, FIT positivity rates was 8% (253/2995) vs. 5% (65/ 1186) for gFOBT (p=0.001). Conclusion: In usual practice, replacing gFOBT with FIT for CRC screening nearly doubles screening completion, but also results in higher rates of patients with positive tests requiring colonoscopy follow up. Widespread implementation of FIT over gFOBT should be strongly considered by all health systems. Demographic Characteristics of Veterans with Tests Ordered
Sa1086 Dose Escalation of Vedolizumab From Every 8 Weeks to Every 4 or 6 Weeks Enables Patients With Inflammatory Bowel Disease to Recapture Response Antonio H. Mendoza Ladd, Frank I. Scott, Rory Grace, Hillary Bownik, Gary R. Lichtenstein Introduction Vedolizumab (VDZ) dose escalation has demonstrated efficacy in recapturing response in patients with Crohn's disease (CD) and ulcerative colitis (UC) in a single study when escalating dose from 300 mg iv every 8 weeks to every 4 week (Sands BE, et al Am. J. Gastroenterol 2014; poster 1618). Information about the efficacy of dose escalation of VDZ outside the setting of clinical trials is lacking. In this study we analyzed the effect of dose escalation of VDZ from 300 mg every 8 weeks to VDZ 300 mg every 4 or every 6 weeks to recapture RES in patients with IBD in a large university referral practice. Methods A retrospective analysis of all medical records of adult patients (> 18 years of age) with IBD who initially achieved response to a maintenance dose of VDZ at 300 mg every 8 weeks from 06/2014 - 08/2015 was performed. Patients who lost response to VDZ 300 mg every 8 weeks and were started on a higher maintenance dose (VDZ 300 mg every 4 or 6 weeks) were identified. Information collected included age, gender, ethnicity, diagnosis, concurrent immunomodulators (IM) and/or steroids (CS), VDZ interval therapy (4 or 6 weeks), adverse events (AE) and total duration of VDZ therapy. Recapture of response was determined by expert review of the medical record and clinician's progress notes. Results 172 pts initiated VDZ; 108 completed 3 dose-induction (criteria for inclusion). Mean F/U from VDZ initiation was 23 wks (range: 6- 66 wks). Mean pt age was 45 yrs. A total of 42/83=50.6% pts with CD and 15/23=65% UC responded (mean HBI & SCCAI scores at weeks 0 and 14 were
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10 & 7 and 6 & 4 respectively) when given VDZ 300 mg every 8 weeks. Of the 42 patients with CD and 15 with UC who responded to VDZ every 8 weeks, 16 with CD and 3 with UC were considered to have lost RES later on their course by their treating physicians. These patients were then started on a higher dose of VDZ (300 mg every 4 weeks [n=10] or 300 mg every 6 weeks [n=9]-Table 1. After dose escalation, all the patients receiving VDZ every 4 and 6 weeks had recaptured response by the end date of the study. Only 1 AE was seen which occurred in one patient in the Q4 weeks subgroup (pruritus). Conclusion In patients who lost RES to VDZ every 300 mg iv every 8 weeks at a large referral center, increased dosing frequency of VDZ 300 mg to every 6 or 4 weeks helped to recapture with apparent no significant increased risk for AE. Patient characteristics
NPI, claims data) as well as individual reporting by physicians using the network. Gastroenterology fellowship data was also gathered using NRMP and AMA FREIDA for all training programs in the US. Data was plotted and compared to the available NCI maps for colorectal cancer incidence, prevalence and mortality. Results A total of 12,994 gastroenterologists were identified across the US. They tend to be more concentrated in the Northeast and Midwest continental US. On a more granular level, a similar trend around large metropolitan areas was also noticed.(Fig 1) When this map was compared to colon cancer distribution, significant discrepancies with physician availability were noted, especially with regards to Southern Midwest region that exhibits the highest mortality rates from colon cancer. Data collected for gastroenterology fellowship spots (n=462) throughout the United States indicated a distribution pattern similar to that of practicing gastroenterologists(Fig 2). The use of this novel approach to mapping the physician workforce in gastroenterology provides near real-time data regarding geographical spread. Our results highlight the lack of significant growth in the total number of practicing gastroenterologists in areas of need. The discrepancies between the lack of gastroenterologists and the high mortality rates of colon cancer in certain geographic areas underscore the need for targeted interventions to balance the workforce. One possible approach could include increasing fellowship spots in ‘GI deserts' as previous studies have shown a trend for physicians to practice in areas where they trained. Summary The use of social network 'big data' to generate real time mapping of the gastroenterology workforce is novel. The availability of such granular data will help future policy making in the fight against colon cancer.
Sa1087 Evaluation of Accuracy and Consistency Between Symptom Checkers for Diagnosis and Triage of Gastrointestinal Symptoms Andrew C. Berry, Bruce B. Berry, Rahman Nakshabendi, Ozdemir Kanar, Travis Myers, Brooks D. Cash
Fig 1. Geographical distribution of Gastroenterologists in USA
Introduction: As patients are now more health conscious and apt to using multimedia, it is increasingly common for patients to utilize symptom checker websites to determine a differential diagnosis and triage level based on simply patient symptoms. As these symptom checkers may replace more traditional office telephone call lines, the US Congress is considering regulating apps that "provide a list of possible medical conditions and advice on when to consult a health care professional." Thus, we aim to determine the accuracy and reliability of the symptom checkers as a whole in regards to gastrointestinal symptoms, but also the degree of agreement/consistency between individual symptom checkers. Methods: 22 Gastrointestinal societal evidence-based diagnosis were categorized into: (7) Emergent (requiring emergent care); (9) Non-Emergent (where non emergent care was reasonable); (6) Self-Care (where a medical visit is unnecessary and self-care is sufficient). The top 5 clinical symptoms by occurrence as listed on UpToDate were entered for each diagnosis into 20 unique online symptom checkers: (9) with both diagnosis and triage, (8) diagnosis only, (3) triage only; yielding a total of (17) with diagnosis and (12) with triage capabilities. Results: Of all diagnosis vignettes, 227/374 (60.6%) were listed at all, 85/374 (22.3%) listed top 1, 145/374 (38.8%) listed top 3, and 203/374 (54.3%) listed top 10. There was no statistical difference with diagnosis broken down by type: emergent, non-emergent, or self-care; in regards to either listed top 1 (p=0.58), listed top 3 (p=0.41), or listed top 10 (p=0.41). Overall, 173/264 (65.5%) of triage scenarios were correct, with strong statistical difference between emergent (68/84: 81%), non-emergent (81/108: 75%), and self care vignettes (24/72: 33%) (p=9.4 x 10-11), with stratification of emergent diagnosis being the most accurately triaged. When comparing symptom checkers, the return of an accurate diagnosis listed in general (p= 9.83 X 10-13), listed 1st (p= 0.0097), or listed in the top 10 (p= 1.95 x 10-6) was not independent of the symptom checker used. Therefore, whether or not you get an accurate diagnosis is dependent on the symptom checker used. The likelihood of an accurate triage response is also not independent of the symptom checker used (p=0.0004). Therefore, some symptom checkers provide more accurate triage information than others. Conclusions: Though symptom checkers provide a means for patients to conveniently investigate a potential diagnosis, some symptom checkers clearly provide more accurate diagnosis than others. In addition, the type of potential diagnosis, be it emergent, non-emergent, or self-care, does not affect the accuracy for symptom checker diagnosis. However, symptom checkers providing triage advice tend to be accurate, especially with symptoms compatible of emergent triage advice.
Fig 2. Geographical distribution of Gastroenterology fellowship spots in USA
Sa1089 US Primary Care Providers Use of Over-the-Counter Medications for Gastroesophageal Reflux Disease and Chronic Constipation Samuel W. Chey, Stacy B. Menees, Sameer D. Saini, Arlene Weissman, Linda J. Harris, William D. Chey Background/Aims: Primary care providers (PCPs) treat the vast majority of gastroesophageal reflux (GERD) and chronic constipation (CC) patients but little is known about how they view and utilize products for their treatment. As cost and coverage of prescription medications for these conditions force patients to over-the-counter (OTC) treatments, it is important to evaluate how PCPs perceive and utilize store-brand (StoreB) and brand name (Branded) OTC products for GERD and CC. Methods: A 33-question survey was electronically sent to 622 eligible PCPs from the IM Insider Research panel, a representative panel of 1,286 American College of Physician members. The survey asked respondents about their usage of StoreB and Branded OTCs for GERD and CC and their opinions about the quality, efficacy, safety, and price of these medications. Chi-square and students t-tests were utilized for bivariate analysis. Results: A geographically representative group of 337 PCPs (54% response rate) completed the survey. The majority of respondents were men (58%) and white (63%) with a mean age of 45.6(± 12.9) years. 43% worked in private practice, 12% for the government, and 9% in an academic setting. 47% had practiced for 20+ years. For average GERD patients, 64% of PCPs utilized OTC medications while 36% utilized prescription drugs for first line treatment. While 79% of PCPs believed that StoreB PPIs had equal clinical effectiveness to Branded PPIs, 18% felt that the StoreB were less effective than Branded PPIs. 86% of PCPs believed that StoreB OTCs were less expensive than Branded products though PCPs tended to underestimate the potential cost savings. Only 25% regularly advised GERD patients to purchase StoreB PPIs, and more than a third never made this recommendation (Table 1). For average CC patients, over 98% of PCPs utilized OTC fiber-supplements, osmotic laxatives, stool softeners, or stimulant laxatives as a first line treatment, and 88% of PCPs continued to recommend OTC as second line treatment (Table 2). Branded products were rarely recommended by PCPs. 98% of PCPs believed that CC StoreB products had equal bioequivalence to Branded products. Additionally, 83% of PCPs believed that StoreB products were less expensive than Branded products. Despite this, only 25% of PCPs reported they had at least some discussion of StoreB products with their CC patients. Conclusions: For PCPs, OTC drugs are the cornerstone of treating GERD & CC patients. Though the
Sa1088 Novel Use of Social Network Data to Map the Geographical Distribution of the Gastroenterology Workforce in the United States Hafiz Muhamamd Sharjeel Arshad, Joumana Chaiban, Krishna Patel, Armand Krikorian Purpose Prevalence and mortality data published by the National Cancer Institute (NCI) indicate higher colon cancer incidence and mortality rates in the Midwest and Southern United States. While this discrepancy is multifactorial, it highlights the need for access to the appropriate number of qualified gastroenterologists in these areas to ensure proper screening and management. Little has been done in past 20 years to map the gastroenterology workforce in the USA, with the last attempt made by Meyer et al. in 1996. We propose to use social network data to assist in planning targeted interventions to meet population health care needs at a local level. Methods De-identified data about the number of board-certified gastroenterologists by zip code was obtained from the Doximity physician database. This database is refreshed monthly and contains up-to-date data from a variety of sources (AMA,
AGA Abstracts
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