This population-based study found that palliative care substantially decreased health-care use among Medicare beneficiaries with advanced cancer. Given the increasing number of elderly patients with advanced cancer, this study emphasizes the importance of early integration of palliative care alongside standard oncologic care.

Summary Background Central neuromodulators are an effective treatment for irritable bowel syndrome (IBS) but may be used less frequently than other therapies. Aims To survey gastroenterologists in the United States (US) about their use of neuromodulators in patients with IBS. Methods A 23‐question survey was distributed to gastroenterologists in the United States. Comparisons in prescribing practices were conducted between (a) gastroenterologists who were “high prescribers” versus “low prescribers” of neuromodulators in patients with IBS and (b) gastroenterologists and “gastroenterology experts” in the use of neuromodulators using descriptive statistics and multivariable logistic regression analyses. Results The 525 gastroenterologists who were surveyed used neuromodulators for a median range of 21%‐30% of their patients with IBS. Neuromodulators were described as extremely/very important in managing IBS by 55% of clinicians. Significant predictors of high‐prescribing behaviour were academic versus clinical practice setting (odds ratio [OR] 2.60 [95% CI 1.61‐4.20]), disorders of brain‐gut interaction focused practice (OR 4.80 [2.60‐8.84]), and greater perceived effectiveness of neuromodulators (OR 2.75 [1.30‐5.84]). Compared to gastroenterologists, experts prescribed neuromodulators to a higher percentage of their patients with IBS (41%‐50% vs 21%‐30%; P = 0.019) and more frequently found neuromodulators effective (70% vs 27%; P = 0.003). However, concern about side effects was the most common barrier to neuromodulator use (59%). Conclusions The majority of US gastroenterologists believe central neuromodulators are important in treating IBS, and 27% believe they are effective in most patients. High prescribers are in academic practice, focus in IBS and perceive central neuromodulators as effective. Education is needed to improve gastroenterologists' prescribing behaviour.

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INTRODUCTION: Pain control is an important management approach for many gastrointestinal conditions. Because of the ongoing opioid crisis, public health efforts have focused on limiting opioid prescriptions. This study examines national opioid prescribing patterns and factors associated with opioid prescriptions for gastrointestinal conditions. METHODS: We conducted a repeated cross-sectional study using the National Ambulatory Medical Care Survey data from 2006 to 2016. The International Classification of Diseases codes were used to identify ambulatory visits with a primary gastrointestinal diagnosis. Data were weighted to calculate national estimates for opioid prescriptions for gastrointestinal disease. Joinpoint regression was used to analyze temporal trends. Multivariable logistic regression was used to examine factors associated with opioid prescriptions. RESULTS: We analyzed 12,170 visits with a primary gastrointestinal diagnosis, representing 351 million visits. The opioid prescription rate for gastrointestinal visits was 10.1% (95% confidence interval [CI] 9.0%–11.2%). Opioid prescription rates for gastrointestinal disease increased by 0.5% per year from 2006 to 2016 (P = 0.04). Prescription rates were highest for chronic pancreatitis (25.1%) and chronic liver disease (13.9%) visits. Seventy-one percent of opioid prescriptions were continuations of an existing prescription. Patient characteristics associated with continued opioid prescriptions included rural location (adjusted odds ratio [aOR] 1.46; 95% CI 1.11–1.93), depression (aOR 1.83; 95% CI 1.33–2.53), and Medicaid insurance (aOR 1.57; 95% CI 1.15–2.13). DISCUSSION: Opioid prescription rates for gastrointestinal disease visits increased from 2006 to 2016. Our findings suggest an inadequate response to the opioid epidemic by providers managing gastrointestinal conditions. Further clinical interventions are needed to limit opioid use for gastrointestinal disease. JOURNAL/ajgast/04.03/00000434-202104000-00033/inline-graphic1/v/2023-07-18T070751Z/r/image-tiff