Overuse of acid-suppressive therapy in hospitalized patients

Nardino, Robert J.

doi:10.1016/s0002-9270(00)02052-9

“…As shown by our study, more than 70% of newly prescribed AST each year during hospitalization was inappropriate, with similar rates each year over the study period from January 2011 to December 2013 (71.88 in 2011, 85.25% in 2012, and 78.72% in 2013) at our community hospital. This percentage was greater than what has been reported by others (in the range of 27%–71%) [3, 4]. Of the patients included in the study period, 34.04% received AST without an indication, followed by GI prophylaxis (26.24%) and GI bleeding (8.51%) as major indications to start AST during hospitalization both in ICU and in non-ICU settings.…”

Section: Discussionmentioning

confidence: 66%

“…Nardino et al [3] reported the overuse of AST in a large community hospital in the United States where 54% of hospitalized patients received AST, 65% of whom were inappropriate cases. Parente et al [4] reported that, in hospitalized patients receiving AST, 68% of prescriptions were inappropriate, most of which were for SUP in low-risk patients.…”

Section: Discussionmentioning

confidence: 99%

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Identifying Risk Factors Associated with Inappropriate Use of Acid Suppressive Therapy at a Community Hospital

Singh

¹

,

Bodukam

²

,

Saigal

³

et al. 2016

Gastroenterology Research and Practice

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Purpose. By examining the prescribing patterns and inappropriate use of acid suppressive therapy (AST) during hospitalization and at discharge we sought to identify the risk factors associated with such practices. Methods. In this retrospective observational study, inpatient records were reviewed from January 2011 to December 2013. Treatment with AST was considered appropriate if the patient had a known specific indication or met criteria for stress ulcer prophylaxis. Results. In 2011, out of 58 patients who were on AST on admission, 32 were newly started on it and 23 (72%) were inappropriate cases. In 2012, out of 97 patients on AST, 61 were newly started on it and 51 (84%) were inappropriate cases. In 2013, 99 patients were on AST, of which 48 were newly started on it and 36 (75%) were inappropriate cases. 19% of the patients inappropriately started on AST were discharged on it in three years. Younger age, female sex, and 1 or more handoffs between services were significantly associated with increased risk of inappropriate AST. Conclusion. Our findings reflect inappropriate prescription of AST which leads to increase in costs of care and unnecessarily puts the patient at risk for potential adverse events. The results of this study emphasize the importance of examining the patient's need for AST at each level of care especially when the identified risk factors are present.

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“…Our results agree with previous reports on the overuse of AST in hospitalized patients. Nardino et al [3] reported the overuse of AST in a large community hospital in the United States where 54% of hospitalized patients received AST, 65% of whom were inappropriate cases. Parente et al [4] reported that, in hospitalized patients receiving AST, 68% of prescriptions were inappropriate, most of which were for SUP in low-risk patients.…”

Section: Discussionmentioning

confidence: 99%

“…Appropriate administration of SUP was derived from an internal guideline that is based on the ASHP guidelines. Prophylaxis was considered appropriate if a patient had one absolute indication [coagulopathy (defined as platelet count <50,000 mm 3 or an international normalization ratio of >1.5, or a partial thromboplastin time >2 times the control value, or requiring mechanical ventilation for more than 48 h)] or 2 or more relative indications [sepsis, occult bleeding, use of high dose corticosteroids (>250 mg/d of hydrocortisone or the equivalent), recent use of NSAIDs for more than 3 months, renal failure (end-stage renal disease or kidney transplantation), liver failure (cirrhosis or liver transplantation), enteral feeding, and anticoagulant use].…”

Section: Appropriateness Of Astmentioning

confidence: 99%

Identifying Risk Factors Associated With Inappropriate Use of Acid-Suppressive Therapy at a Community Hospital

Singh¹,

Wang²,

Lu³

et al. 2014

American Journal of Gastroenterology

0

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Purpose. By examining the prescribing patterns and inappropriate use of acid suppressive therapy (AST) during hospitalization and at discharge we sought to identify the risk factors associated with such practices. Methods. In this retrospective observational study, inpatient records were reviewed from January 2011 to December 2013. Treatment with AST was considered appropriate if the patient had a known specific indication or met criteria for stress ulcer prophylaxis. Results. In 2011, out of 58 patients who were on AST on admission, 32 were newly started on it and 23 (72%) were inappropriate cases. In 2012, out of 97 patients on AST, 61 were newly started on it and 51 (84%) were inappropriate cases. In 2013, 99 patients were on AST, of which 48 were newly started on it and 36 (75%) were inappropriate cases. 19% of the patients inappropriately started on AST were discharged on it in three years. Younger age, female sex, and 1 or more handoffs between services were significantly associated with increased risk of inappropriate AST. Conclusion. Our findings reflect inappropriate prescription of AST which leads to increase in costs of care and unnecessarily puts the patient at risk for potential adverse events. The results of this study emphasize the importance of examining the patient's need for AST at each level of care especially when the identified risk factors are present.

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