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Interferon research abs 1 || Hemoglobin research abs || Stem cell research abs || Nucleic acid research abs || Herpes research abs || Bronchitis research abs || Schizophrenia research abs || Tuberculosis research abs || Pneumonia research abs || Constipation research abs || Laxative research abs

J Am Med Dir Assoc. 2002 Jul-Aug;3(4):224-228.
The Cost of Chronic Constipation.

Pekmezaris R, Aversa L, Wolf-Klein G, Cedarbaum J, Reid-Durant M.

Director and assistant director, Nerken Center for Research; chief of geriatric medicine, Long Island Jewish Medical Center (G. W-K), New Hyde Park, New York; Regeneron Pharmaceuticals, Inc., Tarrytown, New Jersey; and Union Health Center (M. R.-D.), New York, New York.

OBJECTIVES: This study investigates the cost of chronic constipation care. Design and Participants: A consecutive sample of 31 chronically constipated elderly patients. SETTING: A not-for-profit long-term care facility in New Hyde Park, New York. Measurements: Patient demographics and functional status, including activity of daily living scores, diagnosis, and medications were recorded. All constipation medication costs were obtained using the average wholesale price obtained from the Redbook (November 1999). All subjects were closely monitored for constipation care during two shifts a day (from 7:00 AM to 11:00 PM), over a 6-week period resulting in the collection of 1,860 shift reports. Each component of constipation treatment cost, namely drugs and staff time for drug administration, was identified and analyzed. RESULTS: The average number of nursing interactions for constipation treatment was 23.3 per month. The average cost per day for care specifically for the treatment of constipation was $2.11. Fleet Enema trade mark and milk of magnesia accounted for 49% of all treatments. Administration (staffing) costs accounted for 70% of total drug costs. CONCLUSIONS: Although laxatives are the most frequently prescribed drugs used in long-term care settings, drug utilization patterns and associated costs in the treatment of chronic constipation have not been systematically reported. Our study identified staffing as the major cost factor in constipation care.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12807642&dopt=Abstract [PubMed - as supplied by publisher]

J Am Med Dir Assoc. 2001 Jul-Aug;2(4):149-54.
Assessment of constipation management in long-term care patients.

Phillips C, Polakoff D, Maue SK, Mauch R.

Medical Director, Long Term Care Services, Sutter Health, Sacramento, CA; Chief Medical Officer, Mariner Post-Acute Network; Director, and Senior Managing Consultant, Applied Health Outcomes: A Division of Navigant Consulting, Inc.

OBJECTIVES: To determine the prevalence of diagnosed constipation among nursing home patients; to assess the prevalence of routine (at least one time per week for 4 consecutive weeks) laxative use; and to investigate prescribing practices. DESIGN: A retrospective multi-center medical record evaluation. SETTING: Any one of 25 nursing facilities representative of a long-term care pharmaceutical provider's geographical coverage. PARTICIPANTS: All patients under the age of 65, and/or who had resided in the facility for less than 4 weeks, and/or who were placed in a specialty care bed (eg, Alzheimer's disease, hospice, HIV/AIDS) were excluded. RESULTS: A total of 712 resident charts meeting initial inclusion criteria were screened, 392 (55%) of which had a documented diagnosis of constipation and/or routine laxative use. Approximately 28% (CI +/- 3.3) of residents had a documented diagnosis of constipation. The rate of laxative use within the same sample population of 712 patients was 53.8% (CI +/- 3.7). Of the 392 patients with a diagnosis of constipation and/or routine laxative use, over 72% had at least one diagnosis or medication known to precipitate constipation. The most commonly prescribed laxatives were stool softeners (26.2%), saline laxatives (18.4%) and stimulant/irritant laxatives (15.6%). Almost half of the laxative users were prescribed more than one agent. CONCLUSION: This study supports the concern that there is often a gap between documentation of symptoms and constipation treatment decisions. No correlation was found between the specific laxative prescribed and the presence or absence of a documented diagnosis of constipation. Treatment decisions should be based on thorough examination and individualized patient needs. Furthermore, there is a need to increase monitoring for drug effectiveness.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12812571&dopt=Abstract [PubMed]

Drugs Aging. 2003;20(9):643-53.
Quality use of medicines in aged-care facilities in Australia.

Roughead EE, Semple SJ, Gilbert AL.

School of Pharmaceutical Molecular and Biomedical Sciences, Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, South Australia. libby.rougheanisa.edu.au

Medication-related problems are most commonly reported in elderly patients. It is for this reason that the development of services supporting appropriate medication management in the elderly is paramount; particularly for those living in residential care facilities. In 1991, Australia had very limited services supporting the quality use of medicines for residents of aged-care facilities. Over 11 years, from 1991-2002, the range of services has expanded considerably. Federally funded medication review services are now available, with over 80% of residents provided with the service. Medication advisory committees, in accordance with national practice guidelines, have been established in many facilities to address issues concerning medication management. Fifty percent of Australian's pharmacies are registered to provide services, with over 10% of the country's pharmacists accredited to provide the service. National practice guidelines for medication management in aged-care facilities have been incorporated into accreditation standards for aged-care facilities, further integrating activity into the wider health system. The environment was created for these activities through the formation of the Pharmaceutical Health and Rational Use of Medicines (PHARM) Committee, an expert advisory committee, and the Australian Pharmaceutical Advisory Council (APAC), a representative council. Both groups had responsibility for advising the Federal Minister of Health. They both identified medication misadventure in residential aged care as a priority issue and through their recommendations the Government devoted funds to the development of best practice guidelines and research activity. Clinical pharmacy services in nursing-home and hostel settings were found to reduce the use of benzodiazepines, laxatives, NSAIDs and antacids leading to cost savings to the health system. Dose-administration aids were found to reduce error rates during medication administration, and the alteration of medications for administration to residents was found to be common practice and potentially problematic. Research in the Australian setting demonstrating effectiveness, as measured by changes in medication use or health outcomes, as well as actual or potential cost savings has been a critical success factor. In addition, prioritisation by government advisory committees, inquiries and policy documents, have assisted in the development of services from ideas in 1991 to nationally funded realities in 2002.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12831289&dopt=Abstract [PubMed - in process]

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