- Email: [email protected]
Sa1088 Novel Use of Social Network Data to Map the Geographical Distribution of the Gastroenterology Workforce in the United States
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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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
X : 10052$CH01 03-28-16 00:57:27 PDFd : 10052B : e
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