Academic detailing of pharmacists significantly reduced a health care system's administration of docusate, a Canadian study found.
The pre-post study included all acute care (n=111) and continuing care (n=24,000) facilities serviced by Alberta Health Systems in Alberta, Canada. In December 2014, a backgrounder was distributed to pharmacists at all the facilities. It described the lack of evidence for docusate and called for docusate to be discontinued and not replaced with another medication unless clinically necessary. The backgrounder was supported by two interactive webinars. The study assessed docusate use between June 1, 2014, and May 31, 2016. Results were published by JAMA Internal Medicine on Aug. 7.
The average number of defined daily doses of docusate dispensed per 1,000 patient-days decreased from 474 before the intervention to 321 at three months after the intervention to 296 at six months. After six months, the rate of decline leveled off, but use of docusate continued to decrease (251 doses per 1,000 patient-days at 12 months, 214 doses per 1,000 patient-days at 18 months). Researchers also evaluated the use of comparable laxatives and found no significant changes associated with the intervention.
The authors noted that the slowing of the rate of decrease was to be expected, as no additional reminders were provided about the lack of evidence for docusate. They also reported that this was the first step in a plan to eventually remove docusate from the health care system's formulary. The system's annual spending on docusate declined from about $100,000 before the intervention to $30,000 at the conclusion of follow-up, the study found.
This intervention model could potentially be generalized to other high-use, low-value medications, according to the authors. “Significant systemic change can be achieved without extensive and complex interventions if the evidence and messaging are aligned,” they concluded.