The cost of chronic constipation

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™ 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.