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Laxative use an example of 'low value health care'

Researchers found that use of particular laxatives was 'wasteful,' according to a research letter published in JAMA Internal Medicine.

Todd C. Lee, MD, MPH, from the McGill University Health Centre, Montreal, and colleagues wrote that patients frequently continue laxative use after initiation in a hospital, despite uncertain benefit.

"Constipation is common: Present in up to 15% of healthy adults, 39% of medical inpatients on admission, and develops over the course of hospitalization in 43%," Lee and colleagues wrote. "Given the frequency of bowel symptoms and provider diligence in treating constipation, laxative use in the hospital is common. While relatively inexpensive themselves, the indirect costs of laxatives include: Pharmacy inventory management and distribution; nursing administration time; a contribution to polypharmacy; and downstream investigations (eg, Clostridium difficile testing) in the case of laxative-induced diarrhea."

They also noted that some laxatives lack evidence that supports efficacy, particularly docusate sodium/calcium.

They used pharmacy distribution data from the McGill University Health Centre, Quebec base salary for nurses and data from the Right Rx clinical trial to assess laxative use patterns and associated costs for 2015.

Results showed that it took an estimated 3,233 nursing hours to dispense more than 258,000 laxative doses. Of these, docusate laxatives were the most common, recording 2,065 nursing hours and more than 165,000 doses.

The researchers also reported that of the 1,480 patients who were discharged, 142 (9.6%) recieved prescriptions for lactulose, 163 (11%) for sennosides, and 738 (49.9%) for docusates.

Lee and colleagues noted that these pills can create a burden for patients and the health care system.

"Inpatient laxative use is common and frequently persists following discharge," they concluded. "While seemingly trivial, the routine use of docusate products in a constrained health care system is wasteful. Perhaps it is time for a trial to address the efficacy and clinical benefit of inpatient laxative use so that we might avoid flushing good money down the toilet." – by Chelsea Frajerman Pardes

Disclosures: The researchers report no relevant financial disclosures.