How Much Does It Cost a Specialist Palliative Care Unit to Manage Constipation in Patients Receiving Opioid Therapy?

Abstract

The burden of constipation from the patient's perspective has been well described. The aim of this study was to evaluate the cost of managing constipation in patients taking opioids in a specialist palliative care inpatient unit. A retrospective review of the medical records of 58 patients (70 admissions) who died during a six-month period was undertaken to identify prescribing patterns for opioids and oral laxatives and tasks associated with managing constipation in these patients. A prospective time and motion study also was undertaken, whereby staff recorded the time and resources required to perform each task. These data were then applied to the actual frequency recorded in the retrospective review to calculate the direct cost of managing constipation in those 70 admissions during that six-month period. There was no discernable pattern in oral laxative prescribing. The mean cost of managing constipation was 29.81 pounds (48.74 USD) per admission, with staff time accounting for 85% of the cost. The most time-consuming activity was staff discussion about bowel management, which occurred at least once daily for doctors and twice for nurses and involved up to eight members of staff at a time. The cost of managing constipation is skewed in that it costs 30 pounds (49 USD) or less in 71% of admissions but exceeded 100 pounds (163 USD) in 5%. In the latter group, earlier and/or more effective intervention for constipation could lead to clinical and economic benefits.

Assessment and management of constipation for patients receiving palliative care in specialist palliative care settings: A systematic review of the literature

“…The designs of the included studies were three randomised trials (19)(20)(21), four observational designs (22)(23)(24)(25), and six descriptive designs (26)(27)(28)(29)(30)(31). Drawing on the Joanna Briggs Institutes' Levels of evidence for effectiveness, two articles were ranked at level one, six at level three, and five at level four, showing a broad range of evidence within the review.…”

“…Four of the studies were conducted in Canada (20,23,27,28), four in the USA (19,21,24,29), and one study was conducted in each of Australia (22), China (26), Norway (31), Taiwan (25), and the UK (30). Specialist palliative care (SPC) units within medical centres (26), hospitals (23,27,28), and teaching hospitals (22,25) were the most common locations of research.…”

“…Palliative care outcomes including symptom prevalence or severity (25,31), were the focus of two studies, both of which identified constipation as a key symptom or outcome within the abstract. Finally, one study considered the financial cost of managing constipation in patients taking opioids (30).…”

“…Five further studies included inpatients who either were prescribed laxatives (22), had constipation scores recorded (24), or were on opioids (19,21,30). Three studies included all inpatients (20), or inpatients and outpatients (27,31), irrespective of diagnosis or report of constipation.…”

Constipation in palliative care : Prevalence, definitions, symptom distress and risk-factors

“…In turn, this could lead to increased discomfort and might compromise patients' quality of life, which is not in line with the goal of palliative care (Hjalte, Berggren et al 2010). Therefore, it is important to study this area so that constipation will be highlighted (Wee, Adams et al 2010).…”