Estudio de prescripción-indicación de inhibidores de la bomba de protones

Lunar, C. de Burgos; Castillo, S. Novo del; Díaz, E. Llorente; Salinero-Fort, Miguel Á.

doi:10.1157/13088585

Cited by 23 publications

(12 citation statements)

References 9 publications

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“…These factors might have influenced our data with regard to the appropriateness of the prescription. The usage rate by PPI type was similar to that reported in other Spanish studies (11,12,17). Omeprazole was the most widely used, at around 75%, although the rate should approach 100% as it is the first choice agent based on local recommendations (8).…”

Section: Discussionsupporting

confidence: 79%

“…Our results are in line with those of similar studies that demonstrate PPI overuse and inappropriate prescriptions, both in the inpatient and outpatient setting. The percentage of patients with a PPI prescription before visiting the ED (23.2%) was similar to patients seen in Primary Care (11,17) and inpatients admitted to the hospital (13,15,19); the prevalence of PPI prescription ranged from 18.6% to 34.6%. The proportion of patients admitted to the ED who were prescribed a PPI (71.4%) was similar to PPI usage studies among inpatients (12)(13)(14)(15)18,19); the prevalence of PPI use ranges from 64.8% to 82.6%.…”

Section: Discussionmentioning

confidence: 64%

“…The most recent studies have been performed in both the inpatient and outpatient setting (11)(12)(13)(14)(15)(16)(17)(18)(19)(20) and demonstrate the existence of PPI overuse. Furthermore, an important percentage of prescriptions (estimated at 25% in the European Union and 70% in the United States [3,18]) are not based on approved indications.…”

Section: Introductionmentioning

confidence: 99%

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Appropriateness of the use of proton pump inhibitors in the Emergency Department of a Spanish university hospital

et al. 2018

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Background: the use of proton pump inhibitors (PPI) has increased substantially during the last years, possibly due to a significant proportion of prescriptions that do not follow the approved indications. Objective: to assess the prevalence of PPI prescription and the appropriateness of the prescription within the Emergency Department (ED) of a Spanish university hospital. Materials and methods: a cross-sectional, retrospective prescription-indication drug-use study was performed, which selected 384 patients that presented to the ED over two days in January 2016. Results: of the total cohort, 23.2% were taking PPI before their hospital visit and only 20.2% had a correct indication and dosage; 2.9% of the patient cohort had an indication for PPI treatment but had not been prescribed them. A drug other than omeprazole was used in 25% of cases; 30.47% of the patients were discharged with a PPI and only 28.2% of them had the correct indication and dosage. Finally, 5.7% were not prescribed PPI even though it was warranted. PPI prescription increased with age whereas the indication for the prescription decreased. Furthermore, the use of these drugs was higher in hospitalized patients compared to discharged patients. Conclusions: these results are in line with similar studies, which demonstrate the existence of an over-prescription of PPI. PPI prescription needs to be improved, thereby reducing drug interactions, adverse effects and unnecessary economical expenses.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 64%

Section: Introductionmentioning

confidence: 99%

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Appropriateness of the use of proton pump inhibitors in the Emergency Department of a Spanish university hospital

et al. 2018

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“…In a study conducted at the Hospital de Guadalajara, Martín-Echevarría et al found that among patients taking PPIs at admission, 73% had an inadequate indication and 38% of patients were discharged with this medication even without correct indication (13). In outpatient clinics, a cross-sectional study conducted in the IV area of Madrid showed that only 36.4% of PPIs consumers meet the criteria of adequate indication of PPIs (14). In patients hospitalized in the US treated with gastric antisecretory there has been an inadequate indication in 60% of the cases; the most frequent prescription error was the prophylaxis of gastrointestinal lesions in patients with low gastrolesive risk (15,16).…”

Section: Overuse and Its Consequencesmentioning

confidence: 99%

Practical considerations in the management of proton-pump inhibitors

Aguilera¹,

Martín-de-Argila-dePrados²,

Albillos-Martínez³

2015

Rev Esp Enferm Dig

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Proton-pump inhibitors (PPIs) are one of the most active ingredients prescribed in Spain. In recent decades there has been an overuse of these drugs in both outpatient clinics and hospitals that has lead to a significant increase in healthcare spending and to an increase in the risk of possible side effects. It is important for health professionals to know the accepted indications and the correct doses for the use of these drugs. On the market there are different types of PPI: omeprazole, pantoprazole, lansoprazole, rabeprazole and esomeprazole. Omeprazole is the oldest and most used PPI, being also the cheapest. Although there are no important differences between PPIs in curing diseases, esomeprazole, a newgeneration PPI, has proved to be more effective in eradicating H. pylori and in healing severe esophagitis compared to other PPIs. In recent years the use of generic drugs has spread; these drugs have the same bioavailability than the original drugs. In the case of PPIs, the few comparative studies available in the literature between original and generic drugs have shown no significant differences in clinical efficacy.Key words: Proton-pump inhibitor. PPI. Omeprazole. Pantoprazole. Lansoprazole. Rabeprazole. Esomeprazole. INTRODUCTIONProton-pump inhibitors (PPIs) represent a family of drugs widely used in our country. The advent in the nineties of PPIs was a great revolution in the treatment of ulcer disease and gastroesophageal reflux. The main problems of PPIs at present time are its overuse and the errors in the therapeutic indication. This fact leads to a considerable health economic cost and the risk of long-term side effects. In this review the main problems of PPIs prescription, their indications, the differences between PPIs and tips on their use are discussed. Brief historical memory: since alkaline diets until PPIsThe treatment of ulcer disease and gastroesophageal reflux disease (GERD) in the early twentieth century was the prescription of alkaline foods like milk, eggs and puree (1). Later, there were products as sodium bicarbonate that improved symptoms but did not prevent complications. Surgical treatment consisted of different types of gastric surgeries for peptic ulcer disease and Nissen fundoplication for GERD (2).In the mid twentieth century the use of muscarinic antagonists was introduced, atropine being its main active ingredient. Acids secretion was partially inhibited by blocking the muscarinic receptor of the parietal cell. However, these drugs had little effectiveness and numerous adverse effects due to the amount of muscarinic receptors distributed throughout the body. E-type prostaglandin was discovered later, but, again, the limitations of these substances were their short half life and side effects. An important progress in gastric antisecretory therapy was the appearance of H 2 receptors antagonists (H 2 blockers) (3). The most used were ranitidine and famotidine. These drugs established a substantial change by blocking the action of histamine receptor in gastric parietal ...

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“…According to the aforementioned studies, deficiencies in PPI indication not only remain unresolved but even increase when patients are attended to in the various healthcare scenarios (primary care, specialized care, emergency care, critical care), whatever the reason may be. Consensus action protocols have been proposed to improve prescription appropriateness (9). In view of the widespread nature of the problem, which affects all levels of care, a wider-reaching though tailored policy seems necessary.…”

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confidence: 99%

Rationalizing the use of PPIs: An unresolved matter

Ponce¹,

Esplugues

2013

Rev. esp. enferm. dig.

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The abnormally high use of proton-pump inhibitors (PPIs) has been repeatedly denounced for many years (1), and attention has been drawn towards the economic burden it represents (2,3). Multiple scientific publications have reported this problem in many countries. In the present issue of the Journal an observational, prospective study based on a survey to analyze the inappropriate (not recommended by clinical guidelines) indication of chronic PPI use (daily for over one year) in outpatients seen at a specialty hospital in Mexico is reported (4). The authors find an overall rate of inappropriateness of 35.3 %, a figure within the lower range of those reported, which exceed 60 % in many countries including Australia (5,6), United Kingdom (7), and Greece (8), and in four studies performed in Spain (9,10-12). All these studies discuss oral therapy with PPIs, but inappropriateness is also very high (above 75 %) in terms of dosage and length of intravenous therapy (13).The introduction of antisecretory agents in clinical practice, initially H 2 antagonists and then PPIs, has brought in the treatment of conditions associated with gastric acid secretion. The indisputable greater effectiveness of PPIs makes them preferable progress to H 2 antagonists . In a study that examined the indication of antisecretory agents at hospital admission and discharge for gastro-esophageal reflux disease (GERD) and peptic ulcer, two conditions where prescription is appropriate, PPIs were chosen in over 95 % of cases (14).PPI prescription is quantitatively high because of factors inherent to these drugs (high therapeutic efficacy and safety) and the high prevalence of diseases where they are appropriately indicated. GERD -the paradigm here-accounts for almost all appropriate PPI prescriptions for chronic use, and is followed by the prophylaxis of gastric disease by non-steroidal anti-inflammatory drugs (NSAIDs). Sánchez Cuén et al. (4) note that GERD is the most common appropriate indication (31,3 %), representing over 70 % of all appropriate indications.Disease-related factors that account for a high use of PPIs include the high prevalence and chronic nature of GERD, as well as the frequent need for prophylaxis of NSAID-related gastropathy, which is presumably increasing (population ageing associated with comorbidity and a higher number of therapies representing risk factors, including anticoagulants, antiaggregants, etc.). These factors justify a high number of prescriptions for continous PPI therapy, as reported by health agencies. According to the latest official data, PPI use in Spain increased by 227 % during the 2004-2010 period; however, the cost for the Treasury only increased by 21.3 %, from €516 to €626 million, which is increased, nevertheless, a significant sum of money. It is of note that the increased expense principally in the first two years and has remained virtually identical (€626 million in 2006) during the last five years of the mentioned above period. Thus, costs per prescription have decreased, most likely

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Estudio de prescripción-indicación de inhibidores de la bomba de protones

Cited by 23 publications

References 9 publications

Appropriateness of the use of proton pump inhibitors in the Emergency Department of a Spanish university hospital

Appropriateness of the use of proton pump inhibitors in the Emergency Department of a Spanish university hospital

Practical considerations in the management of proton-pump inhibitors

Rationalizing the use of PPIs: An unresolved matter

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