Appropriateness of gastric antisecretory therapy in hospital practice

Sebastian, S; Kernan, Nancy A.; Qasim, Asghar; O'Moráin, C; Buckley, Mary

doi:10.1007/bf02914494

Cited by 28 publications

(17 citation statements)

References 18 publications

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“…The rate of guideline compliance among non-academic hospitalists was significantly lower than that of academic hospitalists in this study (29% and 50%, respectively). Both rates were within the range reported by other groups, namely 19% to 78% (8,10,11,(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39). GIP in low risk patients has also been identified in other studies as the major reason for non-compliance (38), in addition to relief of nonspecific abdominal symptoms (33,35,39) or indeterminate chest pain (35), prevention of medication-associated complications (36) and mild forms of gastroesophageal reflux (30).…”

Section: Discussionsupporting

confidence: 82%

“…Four other studies have attempted to identify independent risk factors for non-compliance (28,32,34,38), only two of which adjusted for possible confounding variables through multivariate logistic regression and found good functional status, a prescription initiated by a general practitioner, and a history of an endoscopy evaluation (38) as independent predictors of compliance with the PPI prescription guidelines. Age and gender, similar to our results, were not significant independent predictors (28).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Patterns and Predictors of Proton Pump Inhibitor Overuse among Academic and Non-Academic Hospitalists

Eid

Boueiz²,

Paranji

et al. 2010

Intern. Med.

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Objective In the hospital setting, several studies have reported proton pump inhibitor (PPI) overuse, a majority of which is continued after discharge. In addition to being expensive, PPIs are associated with an increased risk of infections, osteoporosis and serious drug interactions. We examined the trends and predictors of PPI guidelines non-compliance among academic and non-academic hospitalists in USA. Methods and Patients Oral PPI prescriptions initiated by 2 academic and 2 non-academic hospitalist groups were reviewed. Prescription indications were recorded when explicitly stated in the chart. Otherwise, qualified physicians reviewed the chart to make such determination. Indications were then compared to the published guidelines. Several variables were tested to determine independent predictors of initiation and post discharge continuation of guideline non-compliant prescriptions. Results Of the 400 PPI prescriptions 39% were guideline compliant. Academic hospitalists were significantly more compliant with PPI prescription guidelines (50 vs 29%). Gastrointestinal ulcer bleeding prophylaxis (GIP) for low risk patients was the most common indication for non-compliant prescriptions, while that of guideline compliant prescriptions was dyspepsia treatment. Independent predictors of the initiation of guideline non-compliant prescriptions were non-academic hospitalist group, PPI indication not documented in the chart, and GIP as part of the admission orderset. The latter was an independent predictor of those prescriptions continuation post-discharge (protective) in addition to non-academic hospitalists group. Conclusion Hospitalists overprescribe PPI to a level comparable to that of the non-hospitalist providers in the literature. Understanding the determinants of increased compliance among academic groups is instrumental to design interventions aimed at increasing PPI prescription compliance.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Patterns and Predictors of Proton Pump Inhibitor Overuse among Academic and Non-Academic Hospitalists

Eid

Boueiz²,

Paranji

et al. 2010

Intern. Med.

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show abstract

“…Similar results have been described in previous studies and in different countries (USA, Sweden, UK) showing that a PPIs considerably excessive usage does exist in inpatient settings, 6,7 that the frequency of PPIs discontinuation is low in long-term users, 8 that there are more difficulties in discontinuing PPIs in GERD than in non-GERD patients 8 and that an educational intervention employed to reduce PPIs inappropriate prescription in the community had no effect on the proportion of patients taking these drugs at the time of hospital admission. 9 In addition, the list of Haroon et al provides another important and exact result: of note, to the majority of medical inpatients PPIs were prescribed with an inappropriate or a poor indication, being lower than expected the number of patients who had endoscopy before starting PPIs therapy.…”

Section: Overutilization Of Proton Pump Inhibitors Therapy In Hospitasupporting

confidence: 91%

Proton pump inhibitors overuse: only inappropriate prescriptions or further iatrogenic damage?

Visconti¹

2015

Ital J Med

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Proton pump inhibitors (PPIs) are the most potent drugs for reducing gastric acid secretion; so, since their release in the late 1980s, they have been recommended as the first therapeutic choice for many gastroesophageal diseases, risk reduction in or healing of non-steroidal anti-inflammatory drugs-associated ulcer disease and stress ulcer prophylaxis in intensive care unit patients. Thus PPIs account for a significant proportion of pharmaceutical health-care expenditure. Much of this high expenditure results from overuse of PPIs in account of inappropriate indications or prolongation of therapies for excessive time compared to real need. PPIs overutilization occurs in all medical care settings: in the majority of hospitalized patients with low risks for gastrointestinal bleeding, in patients healed at discharge from hospital, in outpatients in ambulatory practice. However potential adverse effects associated with PPIs therapy have been described, including enteric (especially by Clostridium difficile in elderly patients) and pneumonia infections, nutritional deficiencies, rebound acid hypersecretion, acute interstitial nephritis, gastric neoplasms, bone fractures. Caution is required for some coprescription, particularly with clopidogrel.

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“…Naunton et al [8] published a paper which reported that 63% of patients receiving a PPI did not fulfil the Australian Schedule of Pharmaceutical Benefits criteria. An Irish study conducted by Sebastian et al [9] had an identical finding whereby an appropriate indication for PPI therapy was not apparent in 63% of cases. Work carried out by Van Vliet et al [10] in the Netherlands stated that 40% of patients on PPI therapy did not have a registered indication for use.…”

Section: Discussionmentioning

confidence: 84%

Inappropriate use of proton pump inhibitors

Molloy

Molloy²,

O’Loughlin³

et al. 2009

Ir J Med Sci

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Appropriateness of gastric antisecretory therapy in hospital practice

Abstract: There appears to be a widespread and inappropriate use of PPIs in hospital practice.

Cited by 28 publications

References 18 publications

Patterns and Predictors of Proton Pump Inhibitor Overuse among Academic and Non-Academic Hospitalists

Patterns and Predictors of Proton Pump Inhibitor Overuse among Academic and Non-Academic Hospitalists

Proton pump inhibitors overuse: only inappropriate prescriptions or further iatrogenic damage?

Inappropriate use of proton pump inhibitors

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