Évaluation de la prescription des inhibiteurs de la pompe à protons chez la personne âgée de 75 ans et plus dans un service de gériatrie aiguë

Dipanda, Mélanie; Pioro, Laureline; Buttard, M.; d’Athis, Philippe; Asgassou, Sanaa; Putot, Sophie; Deidda, Martha; Laborde, Caroline; Putot, Alain; Manckoundia, Patrick

doi:10.1016/j.therap.2017.06.003

Cited by 13 publications

(5 citation statements)

References 23 publications

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“…Moreover, PPI prescriptions do not always seem to comply with the guidelines. In France, PPI misuse measured in specific subpopulations, regarding age or healthcare setting, has been reported to reach 40% to more than 80% depending on the definition used [11][12][13][14][15][16][17][18][19][20][21][22]. In our study, more than half of adult new users initiated a NSAID therapy together with a PPI, 80% of them being young patients without any measurable risk factor of GI complications.…”

Section: Discussionmentioning

confidence: 70%

“…The estimated rate of inappropriate use reaches 50% [10]. In France, previous studies on PPI use were limited to specific subpopulations or healthcare settings [11][12][13][14][15][16][17][18][19][20][21][22]. The objective of this study was to describe PPI use, and its appropriateness, at the whole French population level, based on data from national medico-administrative databases.…”

Section: Introductionmentioning

confidence: 99%

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Use of proton pump inhibitors in adults in France: a nationwide drug utilization study

Lassalle

Tri

Bardou

et al. 2019

Eur J Clin Pharmacol

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Purpose Proton pump inhibitor (PPI) drugs are approved for the management of gastric acid-related diseases, mainly treatment of gastroesophageal reflux disease, treatment of nonsteroidal anti-inflammatory drugs (NSAID)-related gastrointestinal complications and prevention in at-risk patients, Helicobacter pylori eradication, and treatment of ulcers. PPIs are one of the most commonly prescribed drug class worldwide, and off-label use is widespread. The aim of this study was to describe outpatient PPI use of the whole adult population in France, based on the French National Health Data System (SNDS). Methods All individuals aged 18 years or older, with at least one dispensing for PPI between January 1, 2015 and December 31, 2015, were identified as PPI users. PPI users were considered as new users if they received no dispensing for PPI in the prior year. New users were followed until treatment discontinuation or up to 1 year, whichever occurred first. Characteristics of new users and of their PPI treatment were described, overall and separately by treatment indication. Results In total, 15,388,419 PPI users were identified in 2015 (57.0% women; mean age 57.0 years), accounting for 29.8% of the French adult population. Of them, 7,399,303 were new PPI users; mean treatment duration was 40.9 days, and 4.1% received a continuous PPI therapy lasting more than 6 months (10.2% among new users > 65 years versus 2.4% among those 18-65 years). For 53.5% of new users, indication for PPI therapy was a co-prescription with NSAID; in this indication, the large majority of patients (79.7%) had no measurable risk factor supporting a systematic prophylactic co-prescription of PPI. A proportion of 32.4% of new users did not have any identified comedication or inpatient diagnosis supporting an indication for PPI therapy; among them, only a small proportion (7.3% overall, and 8.4% of patients aged > 65 years) underwent a procedure investigating the digestive tract at the time of PPI initiation. Conclusion The results of this study suggest PPI overuse in France, not always in line with the French guidelines. In particular, inappropriate co-prescription with NSAID was frequent. Efforts should be made to limit PPI treatment to appropriate indications and durations.

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Section: Discussionmentioning

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Use of proton pump inhibitors in adults in France: a nationwide drug utilization study

Lassalle

Tri

Bardou

et al. 2019

Eur J Clin Pharmacol

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“…A French population-based study showed that 25% of the study population had a medical prescription for PPIs and that approximately 31% of the prescriptions for people 65 years and older had an unknown indication 48 . Cohorts of patients hospitalized in geriatric units also showed that 40% to 60% of the prescriptions did not comply with French recommendations 49,50 . Faced with the challenge of improving the overall quality of drug prescribed for older individuals, recommendations have been published to improve care by reducing exposure to potentially inappropriate medications with an unfavorable benefit-risk ratio (including the chronic use of PPIs) 51,52 .…”

Section: Discussionmentioning

confidence: 99%

“…48 Cohorts of patients hospitalized in geriatric units also showed that 40% to 60% of the prescriptions did not comply with French recommendations. 49,50 Faced with the challenge of improving the overall quality of drug prescribed for older individuals, recommendations have been published to improve care by reducing exposure to potentially inappropriate medications with an unfavorable benefit-risk ratio (including the chronic use of PPIs). 51,52 Despite this, in-hospital medication reconciliation is not wholly complied with postdischarge, especially among long-term care residents.…”

Section: Discussionmentioning

confidence: 99%

The Trigger Tool Method for Routine Pharmacovigilance: A Retrospective Cohort Study of the Medical Records of Hospitalized Geriatric Patients

Marseau¹,

Prud'Homm

Bouzillé

et al. 2021

J Patient Saf

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“…This association is clinically relevant as these two therapeutic classes have the same main indications (i.e., primary or secondary atherosclerosis prevention). Prevention of PAI-induced hemorrhagic risk by proton pump inhibitors in older patients, although not systematically recommended, is also common in practice [39] and increases the risk of polypharmacy in patients on PAI.…”

Section: Factors Associated With Pai Prescriptionsmentioning

confidence: 99%

Impact of Age, Multimorbidity and Frailty on the Prescription of Preventive Antiplatelet Therapy in Older Population

Laborde

Barben

Mihai

et al. 2020

IJERPH

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Platelet aggregation inhibitors (PAI) have widely proven their efficiency for the prevention of ischemic cardiovascular events. We aimed to describe PAI prescription in an elderly multimorbid population and to determine the factors that influence their prescription, including the impact of age, comorbidities and frailty, evaluated through a comprehensive geriatric assessment. This cross-sectional study included all patients admitted to the acute geriatric department of a university hospital from November 2016 to January 2017. We included 304 consecutive hospitalized patients aged 88.7 ± 5.5 years. One third of the population was treated with PAI. A total of 133 (43.8%) patients had a history of cardiovascular disease, 77 of whom were on PAI. For 16 patients, no indication was identified. The prescription or the absence of PAI were consistent with medical history in 61.8% of patients. In the multivariate analysis, among the 187 patients with an indication for PAI, neither age (odds ratio (OR) = 1.00; 95% confidence interval (CI): [0.91–1.08], per year of age), nor comorbidities (OR = 0.97; 95% CI: [0.75–1.26], per point of Charlson comorbidity index), nor cognitive disorders (OR = 0.98; 95% CI [0.91–1.06] per point of Mini Mental State Examination), nor malnutrition (OR = 1.07; 95% CI [0.96–1.18], per g/L of albumin) were significantly associated with the therapeutic decision. PAI were less prescribed in primary prevention situations, in patients taking anticoagulants and in patients with a history of bleeding. In conclusion, a third of our older comorbid population of inpatients was taking PAI. PAI prescription was consistent with medical history for 61.8% of patients. Age, multimorbidity and frailty do not appear to have a significant influence on therapeutic decision-making. Further research is needed to confirm such a persistence of cardiovascular preventive strategies in frail older patients from other settings and to assess whether these strategies are associated with a clinical benefit in this specific population.

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Évaluation de la prescription des inhibiteurs de la pompe à protons chez la personne âgée de 75 ans et plus dans un service de gériatrie aiguë

Cited by 13 publications

References 23 publications

Use of proton pump inhibitors in adults in France: a nationwide drug utilization study

Use of proton pump inhibitors in adults in France: a nationwide drug utilization study

The Trigger Tool Method for Routine Pharmacovigilance: A Retrospective Cohort Study of the Medical Records of Hospitalized Geriatric Patients

Impact of Age, Multimorbidity and Frailty on the Prescription of Preventive Antiplatelet Therapy in Older Population

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