Do hospitalists overuse proton pump inhibitors? Data from a contemporary cohort

Albugeaey, Mohammed; Alfaraj, Naimah; Garb, Jane; Seiler, Adrianne; Lagu, Tara

doi:10.1002/jhm.2249

Cited by 7 publications

(6 citation statements)

References 10 publications

(30 reference statements)

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“…Our population's rates of PPI prescription were consistent with previous reports, [11][12][13]15,[25][26][27][28] and it is clear that many hospitalized patients continue their PPIs at discharge without clear indications. We propose that hospitalization can serve as an opportunity to reassess the necessity of continuous PPI use.…”

Section: Discussionsupporting

confidence: 90%

“…Because they are generally thought of as outpatient medications, PPIs are frequently continued in hospitalized patients, and inappropriate outpatient therapy is rarely addressed. [11][12][13] Likewise, inappropriate de novo use can also be observed during hospitalization and may continue on discharge. [13][14][15] Hospitalization may consequently present an opportunity to employ meaningful interventions targeting outpatient medication use.…”

Section: Measurementsmentioning

confidence: 99%

“…Nevertheless, despite numerous cautionary publications, PPI use for non–evidence‐based indications remains common. Because they are generally thought of as outpatient medications, PPIs are frequently continued in hospitalized patients, and inappropriate outpatient therapy is rarely addressed . Likewise, inappropriate de novo use can also be observed during hospitalization and may continue on discharge .…”

mentioning

confidence: 99%

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Reduction of inappropriate exit prescriptions for proton pump inhibitors: A before‐after study using education paired with a web‐based quality‐improvement tool

McDonald

Jones

Green

et al. 2015

Journal of Hospital Medicine

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BACKGROUND Proton pump inhibitors (PPIs) are overprescribed despite concerns regarding associated adverse drug events. OBJECTIVE To reduce inappropriate PPI prescriptions using hospitalization as the point of contact to effect meaningful change. DESIGN Before‐after study design. SETTING Forty‐six–bed medical clinical teaching unit in a 417‐bed university teaching hospital in Montreal, Canada. PATIENTS Four hundred sixty‐four consecutively admitted patients in the preintervention control group, and 640 consecutively admitted patients in the intervention group. INTERVENTION A monthly educational intervention paired with a Web‐based quality improvement tool. MEASUREMENTS We determined the proportion of patients admitted on PPIs, their indications, and appropriateness of use. We then compared the proportion of patients whose PPIs were discontinued at discharge before and after our intervention. RESULTS Forty‐four percent of patients were already using a PPI prior to their hospitalization. In evaluated patients, only 54% of these patients had an evidence‐based indication for ongoing use. The proportion of PPIs discontinued at hospital discharge increased from 7.7% per month in the 6 months prior to intervention, to 18.5% per month postintervention (P = 0.03). CONCLUSIONS Strategies to combat PPI overuse are needed to improve the overall quality of patient care. We significantly reduced discharge prescriptions for PPIs through the implementation of an educational initiative paired with a Web‐based quality improvement tool. An active interventional strategy is likely required considering the increasingly recognized and preventable adverse events associated with PPI misuse. Journal of Hospital Medicine 2015;10:281–286. © 2015 Society of Hospital Medicine

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Section: Discussionsupporting

confidence: 90%

Section: Measurementsmentioning

confidence: 99%

mentioning

confidence: 99%

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Reduction of inappropriate exit prescriptions for proton pump inhibitors: A before‐after study using education paired with a web‐based quality‐improvement tool

McDonald

Jones

Green

et al. 2015

Journal of Hospital Medicine

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“…The recent literature (2012-2015) reported rates of inappropriate prescribing that ranged from 19% to 86%. [5][6][7][8][9][10][11][12][13] However, all but 2 of these reports involved retrospective chartbased studies. Since the indication for PPI use may not be rigorously documented in patient charts, use of this type of study design may have led to overestimation of inappropriate prescribing.…”

Section: Introductionmentioning

confidence: 99%

Inappropriate Prescription of Proton Pump Inhibitors in a Community Setting

Nguyen

Tamaz

2018

CJHP

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ABSTRACTBackground: Proton pump inhibitors (PPIs) are widely prescribed for gastrointestinal conditions, such as gastroesophageal reflux disease and dyspepsia, and for prevention of gastric ulcer. Although previous reports have described inappropriate prescription of PPIs in the hospital setting, data from the community are lacking.Objective: To assess PPI prescriptions in the ambulatory setting.Methods: Patients presenting to the emergency department of a teaching hospital between June 2016 and March 2017 were prospectively assessed for use of a PPI at home. The appropriateness of PPI prescription was evaluated on the basis of an interview with the patient and review of the medical record. The indication for PPI therapy was verified against current guidelines for the province of Quebec.Results: Over the 9-month study period, 2417 patients were screened, of whom 871 were included in the study. In relation to the Quebec guidelines, PPI prescription was inappropriate for 267 (30.7%) of the patients. When prescription of PPI for ulcer prevention in certain groups of patients (age ≥ 65 years and using acetylsalicylic acid or platelet aggregation inhibitors; age ≥ 75 years and using celecoxib) was re-classified as appropriate, the proportion of inappropriate PPI prescriptions declined to 20.3% (177/871).Conclusions: These findings suggest that inappropriate prescribing of PPIs remains problematic in the community setting in the province of Quebec.RÉSUMÉContexte : Les inhibiteurs de la pompe à protons (IPP) sont largement prescrits pour traiter les troubles gastro-intestinaux, comme le reflux gastro-oesophagien et la dyspepsie, et pour prévenir l’ulcère gastrique. Bien que des rapports antérieurs aient parlé de la prescription inadéquate des IPP dans les établissements de santé, il n’y a pas de données provenant de la communauté.Objectif : Évaluer la pertinence des prescriptions d’IPP dans un milieu ambulatoire.Méthodes : Les patients se présentant au service des urgences d’un hôpital universitaire entre juin 2016 et mars 2017 ont été évalués de façon prospective relativement à l’utilisation d’un IPP à la maison. La pertinence de la prescription d’un IPP a été jugée d’après une entrevue avec le patient et l’analyse du dossier médical. On a vérifié si l’indication pour un traitement par IPP respectait les lignes directrices actuelles du Québec.Résultats : Sur une période de neuf mois, 2 417 patients ont été évalués et 871 d’entre eux ont été admis à l’étude. Par rapport aux lignes directrices du Québec, la prescription d’IPP était inadéquate pour 267 (30,7 %) des patients. Or, si la prescription d’IPP pour prévenir l’ ulcère gastrique chez certains groupes de patients (âgés de 65 ans ou plus et prenant de l’acide acétylsalicylique ou un antiagrégant plaquettaire; âgés de 75 ans ou plus et prenant du célécoxib) était reclassée comme adéquate, la proportion de prescriptions d’IPP inadéquates reculait à 20,3 % (177/871).Conclusions : Ces résultats laissent croire que les prescriptions inadéquates d’IPP demeurent un problème dans le contexte communautaire au Québec.

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“…(11) Some studies showed that more than 50% of indications for PPI, both by oral route (PO) and by IV route at hospitals are inappropriate. (12,13) There is no evidence as to the superiority of PPI administered PO in comparison with the IV route. Additionally, their PO administration is even more cost-effective, since it contributed to a decrease in the hospital inpatient stay.…”

Section: ❚ Introductionmentioning

confidence: 99%

Pharmaceutical intervention in the rational use of intravenous omeprazole

Araújo

Modesto

Ferreira

et al. 2019

Einstein (São Paulo)

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Objective: To describe the pharmaceutical interventions of a vertical clinical pharmacy service to promote the rational use of intravenous omeprazole. Methods: A prospective and descriptive study carried out at a university hospital in the Midwestern Region of Brazil, from November 2014 to May 2015. The service consisted of the analysis of adequacy of the route of administration of omeprazole in relation to the clinical conditions of the patient, as well as the use of the appropriate diluent. Interventions were recorded in medical records and subsequently evaluated for acceptance. Results: A total of 770 prescriptions were evaluated. Interventions related to diluent replacement were more accepted (p<0.001), and surgeons were the specialty that used the intravenous route inappropriately (p<0.001). Conclusion: Although partially accepted, pharmaceutical interventions could contribute to improve patient safety, since they allowed the use of a safer route of administration.

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Do hospitalists overuse proton pump inhibitors? Data from a contemporary cohort

Cited by 7 publications

References 10 publications

Reduction of inappropriate exit prescriptions for proton pump inhibitors: A before‐after study using education paired with a web‐based quality‐improvement tool

Reduction of inappropriate exit prescriptions for proton pump inhibitors: A before‐after study using education paired with a web‐based quality‐improvement tool

Inappropriate Prescription of Proton Pump Inhibitors in a Community Setting

Pharmaceutical intervention in the rational use of intravenous omeprazole

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