Usage and Costs of Regular Acetaminophen (Paracetamol) in Canadian Long-Term Care Facilities.

Abstract

Objectives: Evidence suggests that the use of regular acetaminophen (paracetamol) in long-term care (LTC) is a low-value intervention, that it does not improve pain or quality of life, and that it has the potential for adverse effects. Our objective was to assess the usage of regular acetaminophen in Canadian LTC facilities as well as the costs associated with its use.

Design: Cross-sectional study.

Setting and participants: Canadian LTC facilities serviced by a national LTC pharmacy provider in 2022.

Methods: Descriptive statistics were used to characterize prevalence, dosing, dispensation frequency, type, and costs of regular acetaminophen dispensations (cost of tablets, carbon emissions, and nursing dispensation time).

Results: The data set included 49,419 residents (median age: 86, women: 65%) from British Columbia (5.5%), Alberta (7.1%), Manitoba (23.0%), and Ontario (64.4%). The mean prevalence of regular acetaminophen dispensations was 45.7%. Among residents dispensed regular acetaminophen, 85% of residents were dispensed >1000 mg of acetaminophen/day, the mean defined daily dose per 1000 residents per 1 day was 317 (standard deviation [SD] 56), 59.3% were dispensed acetaminophen ≥3 times per day, and dispensations were approximately evenly split between 325- and 500-mg tablets. The 27.8 million tablets of acetaminophen dispensed in 2022 cost $870,000; had a carbon footprint of 54.8 tonnes of carbon dioxide equivalents (CO₂e); and required 191,000 nursing hours, the equivalent of 92 nurses working full-time for 1 year.

Conclusion and implications: Regular acetaminophen use is highly prevalent in LTC and has substantial costs. It would be advantageous to re-examine acetaminophen use in LTC facilities.