Year 2015 / Volume 107 / Number 11
Original
Reasons for initiation of proton pump inhibitor therapy for hospitalised patients and its impact on outpatient prescription in primary care

652-658

DOI: 10.17235/reed.2015.3882/2015

Elena Villamañán, Margarita Ruano, Catalina Lara, José Manuel Suárez-de-Parga, Eduardo Armada, Rodolfo Álvarez-Sala, Ester Pérez, Alicia Herrero,

Abstract
Background: Proton-pump-inhibitors are often prescribed unnecessarily in hospitals, which in turn induces their prescriptions after discharge. Objective: To evaluate patients starting treatment with proton-pump-inhibitors during hospitalisation and proportion of inappropriate prescriptions. Patient risk factors and whether initiation in hospital induced their continuation in ambulatory care were also analyzed. Methods: An observational, cross-sectional study in a tertiary hospital (1350 beds) was carried out on the first Tuesday in February 2015. Pharmacists screened admitted patients treated with proton-pump-inhibitors using an electronic prescription program (FarmaTools®-5.0). They also checked patients’ home medications before admission by accessing a primary care program (Horus®). Authorized indications according to Spanish-Medicines-Agency and those recommended in Spanish-Clinical-Practice-Guidelines were considered appropriate. Hospital-medical-records were checked to know whether proton-pump-inhibitors were prescribed at discharge. Results: Three hundred seventy nine patients were analysed. Two hundred ninety four of them were prescribed proton-pump-inhibitors (77.6%). Treatment was initiated during admission for 143 patients (48.6%, 95% CI: 42.8-54.5). Of them, 91 (63.6%, 95% CI: 55.2-71.5) were inappropriate, mainly due to its inclusion unnecessarily in protocols associated with surgeries or diseases (56 cases of 91, 61.5%). Additional inappropriate indications were surgical stress ulcer prophylaxis for surgeries without bleeding risks (19.8%) and polypharmacy without drugs that increase the risk of bleeding (18.7%). Of 232 discharge reports assessed, in 153 (65.9%, 95% CI: 59.5-72), proton-pump-inhibitor continuation was recommended, of them, 51 (33.3%) were initiated at admission. Conclusion: In hospitalized patients there is a high prevalence of prescription of proton-pump-inhibitors unnecessarily. The superfluous use is often associated with the prescription of treatment protocols. Those treatments started in the hospital generally did not contribute to over-use existing primary care, most of them were removed at discharge.
Share Button
New comment
Comments
No comments for this article
References
1 Sánchez Cuén JA, Irineo Cabrales AB, Bernal Magaña G, et al. Indicaciones inadecuadas en el consumo crónico de inhibidores de bomba de protones en un hospital de México. Estudio transversal. Rev Esp Enferm Dig 2013;105: 131-7.
2 Ponce J, Vegazo O, Beltrán B, et al. Prevalence and factors associated with gastro-oesophageal reflux disease (GORD) in Spain. Aliment Pharmacol Ther 2006;23:175-83.
3 Ponce J, Esplugues JV. Racionalizar el uso de IBP: una asignatura pendiente. Rev Esp Enf Dig 2013;105: 121-4 (doi:10.4321/S1130-01082013000300001).
4 Bashford JN, Norwood J, Chapman SR. Why are patients prescribed proton pump inhibitors? Retrospective analysis of link between morbidity and prescribing in the General Practice Research Database. BMJ 1998;317:452-6 (doi:10.1136/bmj.317.7156.452).
5 García del Pozo J. Estudio de utilización de antiulcerosos en España (2000-2008). IT del Sistema Nacional de Salud 2009;33, no 2.
6 Thomson A, Sauve M, Kassam N, et al. Safety of the long-term use of proton pump inhibitors. World J Gastroenterol 2010;16:2323-30 (doi: 10.3748/wjg.v16.i19.2323).
7 Yang YX, Lewis JD, Epstein S, et al. Long-term proton pump inhibitor therapy and risk of hip fracture. J Am Med Assoc 2006;296: 2947-53. doi=10.1001/jama.296.24.2947
8 Roux C, Briot K, Gossec L, et al. Increase in vertebral fracture risk in postmenopausal women using omeprazole. Calcif Tissue Int 2009; 84: 13-9.
9 Pasina L, Nobili A, Tettamanti M, et al. Prevalence and appropriateness of drug prescriptions for peptic ulcer and gastro-esophageal reflux disease in a cohort of hospitalized elderly. Eur J Intern Med 2011;22:205-11 (doi:10.1016/j.ejim.2010.11.009).
10 Cahir C, Fahey T, Teeling M, et al. Potentially inappropriate prescribing and cost outcomes for older people: a national population study. Br J Clin Pharmacol 2010;69:543-52 (doi: 10.1111/j.1365-2125.2010.03628.x).
11 Hanzat H, Sun H, Ford JC, et al. Inappropriate prescribing of proton pump inhibitors in older patiens. Effects on an educational strategy. Drugs Aging 2012;29:681-90 (doi: 10.2165/11632700-000000000-00000).
12 Product Characteristics. Spanish Agency of Medicines and Medical Devices. Available at: http://www.aemps.gob.es/cima/fichasTecnicas.do?metodo=detalleForm (accessed 08/05/2015).
13 Selection criteria of proton-pump inhibitor. Working Group on pharmacotherapy recommendations of Madrid Health Service System. Available at: http://www.madrid.org/cs/Satellite?blobcol=urldata&blobheader=application%2Fpdf&blobheadername1=Content-Disposition&blobheadervalue1=filename%3DN3_01_2012.PDF&blobkey=id&blobtable=MungoBlobs&blobwhere=1352858361243&ssbinary=true. (accessed 08/05/2015).
14 Ahrens D, Chenot JF, Behrens G, et al. Appropriateness of treatment recommendations for PPI in hospital discharge letters. Eur J Clin Pharmacol. 2010; 66: 1265–71 (doi: 10.1007/s00228-010-0871-9).
15 Ramirez E1, Lei SH, Borobia AM, et al. Overuse of PPIs in patients at admission, during treatment, and at discharge in a tertiary Spanish hospital.Curr Clin Pharmacol 2010;5:288-97 (doi:10.2174/157488410793352067).
16 Mat Saad AZ, Collins N, Lobo MM, et al. Proton pump inhibitors: a survey of prescribing in an Irish general hospital. Int J Clin Pract 2005;59:31–4. (doi: 10.1111/j.1742-1241.2004.00298).
17 Niklasson A, Bajor A, Bergendal L, et al. Overuse of acid suppressive therapy in hospitalised patients with pulmonary diseases. Respir Med 2003;97:1143–50 (doi:10.1016/S0954-6111(03)00187-2).
18 Ho PM, Maddox TM, Wang L, et al. Risk of adverse outcomes associated with concomitant use of clopidogrel and proton pump inhibitors following acute coronary syndrome. JAMA 2009;301:937–44 (doi:10.1001/jama.2009.261).
19 Durand C, Willet K, Desilets A. Proton Pump Inhibitor use in hospitalized patients: Is overutilization becoming a problem? Clinical Medicine Insights: Gastroenterology 2012;5:65-76 (doi: 10.4137/CGast.S9588).
20 Walker NM, McDonald J. An evaluation of the use of proton pump inhibitors. Pharm World Sci 2001;23:116-7 (doi: 10.1136/bmj.39406.449456.BE).
21 Martín-Echevarría E, Pereira A, Torralba M, et al. Evaluación del uso de los inhibidores de la bomba de protones en un servicio de medicina interna. Rev Esp Enferm Dig 2008;100:76-81.
22 Batuwitage BT, Kingham JG, Morgan NE, et al. Inappropriate prescribing of proton pump inhibitors in primary care. Postgrad Med J 2007;83:66-8.
Citation tools
Villamañán E, Ruano M, Lara C, Suárez-de-Parga J, Armada E, Álvarez-Sala R, et all. Reasons for initiation of proton pump inhibitor therapy for hospitalised patients and its impact on outpatient prescription in primary care . 3882/2015


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 229 visits.
This article has been downloaded 120 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 07/06/2015

Accepted: 22/07/2015

Online First: 08/09/2015

Published: 30/10/2015

Article revision time: 33 days

Article Online First time: 93 days

Article editing time: 145 days


Share
This article has been rated by 2 readers.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology