Missed Opportunity to Deprescribe: Docusate for Constipation in Medical Inpatients

Thomas E MacMillan; Reza Kamali; Rodrigo B Cavalcanti

doi:10.1016/j.amjmed.2016.04.008

Missed Opportunity to Deprescribe: Docusate for Constipation in Medical Inpatients

Am J Med. 2016 Sep;129(9):1001.e1-7. doi: 10.1016/j.amjmed.2016.04.008. Epub 2016 May 3.

Authors

Thomas E MacMillan¹, Reza Kamali², Rodrigo B Cavalcanti³

Affiliations

¹ Division of General Internal Medicine, University Health Network, Toronto, Ontario, Canada; Division of General Internal Medicine, Department of Medicine, University of Toronto, Ontario, Canada; HoPingKong Centre for Excellence in Education and Practice, University Health Network, Toronto, Ontario, Canada. Electronic address: tom.macmillan@uhn.ca.
² HoPingKong Centre for Excellence in Education and Practice, University Health Network, Toronto, Ontario, Canada.
³ Division of General Internal Medicine, University Health Network, Toronto, Ontario, Canada; Division of General Internal Medicine, Department of Medicine, University of Toronto, Ontario, Canada; HoPingKong Centre for Excellence in Education and Practice, University Health Network, Toronto, Ontario, Canada.

PMID: 27154771
DOI: 10.1016/j.amjmed.2016.04.008

Abstract

Background: Hospital admissions provide an opportunity to deprescribe ineffective medications and reduce pill burden. Docusate sodium is a stool softener that is frequently prescribed to treat constipation despite poor evidence for efficacy, thus providing a good target for deprescription. The aims of this study were to characterize rates of use and discontinuation of docusate among internal medicine inpatients, as well as use of other laxatives.

Methods: We conducted a retrospective observational study over 1 year on all patients admitted to internal medicine at 2 urban academic hospitals to determine rates of docusate use. We also evaluated laxative and opioid medication use on a random sample of 500 inpatients who received docusate to characterize patterns of prescription and deprescription.

Results: Fifteen percent (1169/7581) of all admitted patients received 1 or more doses of docusate. Among our random sample, 53% (238/452) received docusate before admission, and only 13% (31/238) had docusate deprescribed. Among patients not receiving docusate before admission, 33.2% (71/214) received a new prescription for docusate on discharge. Patients receiving opioids were frequently prescribed no laxatives or given docusate monotherapy (28%, 51/185).

Conclusions: Docusate was frequently prescribed to medical inpatients despite its known ineffectiveness, with low deprescription and high numbers of new prescriptions. Docusate use was common even among patients at high risk of constipation. One third of patients not receiving docusate before admission were prescribed docusate on discharge, potentially exacerbating polypharmacy. Among patients already receiving docusate, 80% had it continued on discharge, indicating significant missed opportunities for deprescribing. Given the availability of effective alternatives, our results suggest that quality-improvement initiatives are needed to promote evidence-based laxative use in hospitalized patients.

Keywords: Constipation; Deprescribing; Docusate; Inpatients; Polypharmacy.

Publication types

Observational Study

MeSH terms

Aged
Constipation / drug therapy*
Deprescriptions*
Dioctyl Sulfosuccinic Acid / therapeutic use*
Female
Hospitalization / statistics & numerical data
Humans
Laxatives / therapeutic use*
Length of Stay / statistics & numerical data
Male
Patient Discharge / statistics & numerical data
Retrospective Studies

Substances

Laxatives
Dioctyl Sulfosuccinic Acid