The impact of pharmaceutical interventions on the rational use of proton pump inhibitors in a Chinese hospital

Abstract

BackgroundThe prescriptions of proton pump inhibitors (PPIs) have raised concern due to both huge increase in medical expenditure and the possible long-term adverse events caused by them; therefore, an approach to taper off the irrational use of PPIs by patients is clinically warranted. The aim of this study was to evaluate the impact of pharmaceutical interventions on the rational use of PPIs.Patients and methodsA single-center, pre- to post-intervention study (pharmaceutical interventions group and control group) was performed in a Chinese hospital. Pharmaceutical interventions were performed in the post-intervention group, including educative group activities, real-time monitoring of clinical records and making recommendations to doctors on PPI prescriptions based on the criteria set at the beginning of the study. The number of patients with rational indication, the accuracy rate of administration route, the duration of therapy and the changes in total PPI costs, mean PPI costs, mean total drug costs and mean hospitalization costs were the main outcome measures.ResultsA total of 285 patients were included in the study. After 6 months of interventions, significant improvements in the number of patients with rational indication were found (96.5% in the pharmaceutical interventions group vs 71.8% in the control group, P<0.01). The accuracy rate of administration route was increased (99.3% vs 73.2%, P<0.05), while the duration of therapy was decreased (7.9±0.5 vs 14.3±0.8, P<0.01). Pharmaceutical interventions led to significant reductions in mean PPIs costs, mean total drug costs and mean hospitalization costs (P<0.001).ConclusionThis study provides important evidence on the beneficial effect of pharmaceutical interventions on enhancing the rational use of PPIs and substantial cost saving by increasing the number of patients with rational indication and reducing the risk for long-term adverse events.

Reducing Inappropriate Proton Pump Inhibitors Use for Stress Ulcer Prophylaxis in Hospitalized Patients: Systematic Review of De-Implementation Studies

“…A number of studies were performed at specific non-ICU hospital departments, such as the internal medicine department 32 , general ward 33 , infectious disease ward 34 , or a pulmonary medicine ward 35 (Table 2 ). In other studies, various departments were included in the study and either ICU participants were excluded 36 , 37 , or data for non-ICU participants were separately reported 38 , 39 . Two studies included multiple departments and did not report exclusion of ICU participants 13 , 40 .…”

“…In all but one, de-implementation strategies contained an educational component (meetings and/or materials), which was combined with implementation of a clinical practice guideline in five studies [33][34][35][36][37] , reminders in one study 33 , audit feedback in three studies 33,37,40 , an organizational culture intervention in three studies 32,33,35 , and an inter-professional education in one study 39 . The one study without an educational intervention combined implementation of a clinical practice guideline with an organizational intervention 13 .…”

“…Most studies scored "unclear risk" of bias for blinding of outcome assessment as they did not report how outcome assessment was performed [32][33][34][35][37][38][39][40] . Only two studies scored "low risk" of bias as outcome assessment was automated or standardized 13,36 .…”

“…Del Giorno et al reported that admission for and diagnosis of GI bleeding during hospital stay did not increase significantly during the study 37 . Xin et al reported that several adverse effects (specified in C. difficile infections, respiratory 39 .…”

Clostridium difficile-associated diarrhea following the therapy with antibiotic and proton pump inhibitors in a 77-year-old man with several comorbidities

“…Owing to their high efficacy and relative safety, an excess of drug prescriptions has been widespread in Chinese hospitals. [6] However, recent studies have shown that PPIs are associated with an increased risk of some adverse reactions including osteoporotic-related fractures, C difficile infection, community-acquired pneumonia, Vitamin B 12 deficiency, and so on. [7] This case emphasizes the necessity to improve the appropriate and rational use of PPIs for pharmacists.…”