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Research Letter | Less Is More

Pattern of Inpatient Laxative Use Waste Not, Want Not

Todd C. Lee, MD, MPH1; Emily G. McDonald, MD, MSc1; Andre Bonnici, BPharm, MSc2; Robyn Tamblyn, PhD3
[+] Author Affiliations
1Clinical Practice Assessment Unit, Department of Medicine, McGill University Health Centre, Montréal, Canada
2Pharmacy Department, McGill University Health Centre, Montréal, Canada
3Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Canada
JAMA Intern Med. 2016;176(8):1216-1217. doi:10.1001/jamainternmed.2016.2775.
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Using data from a single Canadian health center, this study examines the annual costs of prescribing laxatives in medical and surgical units.

Constipation is common: present in up to 15% of healthy adults,1 39% of medical inpatients on admission, and develops over the course of hospitalization in 43%2 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. Evidence supporting the efficacy of certain laxatives is lacking, particularly docusate sodium/calcium,3 and so we quantified local patterns of laxative use, and estimated some of the associated costs.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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