Patterns of High-Dose and Long-Term Proton Pump Inhibitor Use: A Cross-Sectional Study in Six South Australian Residential Aged Care Services

Hendrix, Ivanka; Page, Amy; Korhonen, Maarit Jaana; Bell, Jane; Tan, Edwin C.K.; Visvanathan, Renuka; Cooper, Tina; Robson, Leonie; Sluggett, Janet K.

doi:10.1007/s40801-019-0157-1

Cited by 14 publications

(11 citation statements)

References 32 publications

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“…Given that GPs in our study reported discussing these topics, the PPI deprescribing practices of these GPs appeared to generally align with patient views surrounding PPI deprescribing discussions. Patients in our study were generally open to discussing deprescribing, which is consistent with a recent Australian study of PPI users [16].…”

Section: Comparison With Existing Literaturesupporting

confidence: 89%

Discussing proton pump inhibitor deprescribing: the views of Danish GPs and older patients

et al. 2020

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Background: Deprescribing of proton pump inhibitors (PPIs) can be considered in situations where the drug may no longer be necessary; however, this requires a careful discussion between patients and healthcare providers, often general practitioners (GPs). The aim of our study was to explore how GPs discuss PPI deprescribing with patients and compare that to how older patients would like to discuss this decision. Methods: We conducted a qualitative study using semi-structured interviews with GPs (n = 11) and patients aged ≥65 years who were taking PPIs (n = 4). Analysis of interviews was based on systematic text condensation. Results: We identified four main themes: (1) Reasons PPI deprescribing comes up, (2) Considering PPI deprescribing, (3) Discussion topics, and (4) Incorporating patient preferences into PPI deprescribing decisions. We found that PPI deprescribing often comes up during consultations for other problems or due to concern about medication burden in general. GPs discussed topics related to symptom control, such as the possibility of rebound symptoms, the need to taper PPIs, and what to do if symptoms returned. This aligned with what patients felt was important to discuss. Some GPs routinely incorporated patient preferences into decisions, whereas others did not. Conclusion: When discussing PPI deprescribing, the GPs in our study generally focused on topics related to symptom control. There was variability in how and if patient preferences were discussed. Greater focus may be needed on developing mechanisms to elicit and incorporate patient preferences into PPI deprescribing decisions. Future research could also explore more systematic approaches to reassess ongoing PPI use in an effort to curb unnecessary long-term use of PPIs.

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Section: Comparison With Existing Literaturesupporting

confidence: 89%

Discussing proton pump inhibitor deprescribing: the views of Danish GPs and older patients

et al. 2020

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“…Study designs included observational studies (n=31), experimental studies (n=6), qualitative studies (n=2), and a methodological study (n=1) (Table 1 ). Six articles utilized data from an Australian cohort study ( 23 , 25 , 26 , 29 – 31 ), five from an Australian randomized controlled trial (RCT) ( 22 , 27 , 28 , 32 , 33 ), three from a Spanish longitudinal study ( 41 – 43 ), and three from a Chinese cross-sectional study ( 35 – 37 ). The number of participants ranged from 13 to 571,139, with a mean age range of 79.0 ± 8.8 to 89.4 ± 4.6 years.…”

Section: Resultsmentioning

confidence: 99%

The FRAIL-NH Scale: Systematic Review of the Use, Validity and Adaptations for Frailty Screening in Nursing Homes

Liau

Lalic

Visvanathan

et al. 2021

The Journal of nutrition, health and aging

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Objectives To investigate frailty prevalence, cross-sectional associations, predictive validity, concurrent validity, and cross-cultural adaptations of the FRAIL-NH scale. Design Systematic review. Setting and Participants Frail residents living in nursing homes. Methods MEDLINE, EMBASE, CINAHL, and Cochrane Library were searched from January 2015 to June 2021 for primary studies that used the FRAIL-NH scale, irrespective of study designs and publication language. Results Overall, 40 studies conducted across 20 countries utilized the FRAIL-NH scale; majority in Australia (n=14), followed by China (n=6), United States (n=3), and Spain (n=3). The scale has been translated and back-translated into Brazilian Portuguese, Chinese, and Japanese. Various cut-offs have been used, with ≥2 and ≥6 being the most common cut-offs for frail and most frail, respectively. When defined using these cut-offs, frailty prevalence varied from 15.1–79.5% (frail) to 28.5–75.0% (most frail). FRAIL-NH predicted falls (n=2), hospitalization or length of stay (n=4), functional or cognitive decline (n=4), and mortality (n=9) over a median follow-up of 12 months. FRAIL-NH has been compared to 16 other scales, and was correlated with Fried’s phenotype (FP), Frailty Index (FI), and FI-Lab. Four studies reported fair-to-moderate agreements between FRAIL-NH and FI, FP, and the Comprehensive Geriatric Assessment. Ten studies assessed the sensitivity and specificity of different FRAIL-NH cutoffs, with ≥8 having the highest sensitivity (94.1%) and specificity (82.8%) for classifying residents as frail based on FI, while two studies reported an optimal cut-off of ≥2 based on FI and FP, respectively. Conclusion In seven years, the FRAIL-NH scale has been applied in 20 countries and adapted into three languages. Despite being applied with a range of cut-offs, FRAIL-NH was associated with higher care needs and demonstrated good agreement with other well-established but more complex scales. FRAIL-NH was predictive of adverse outcomes across different settings, highlighting its value in guiding care for frail residents in nursing homes. Electronic Supplementary Material Supplementary material is available for this article at 10.1007/s12603-021-1694-3 and is accessible for authorized users.

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“… 35 In our study, we found that high-dose therapy was most frequently prescribed (73%) compared with standard (23%) and low-dose therapy (3.6 %), which was similar to the findings of the result in Australia in 2017 16 but higher than other studies. 12 The effect of dose and type of PPI research has shown that high doses of PPIs could increase the risk of chronic kidney disease at an impressive level (92%) for any kind of PPI exposure, and this risk increased even more when doing the follow-up. 36 There are pieces of evidence to suggest that high-dose PPIs can lead to the development of hypomagnesemia, 37 and increase the risk of osteoporotic fractures 38 and serious cardiovascular disease.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, once symptoms were adequately relieved, a ‘step down’ therapy is recommended to reduce the dose to the lowest effective dose through a periodic reassessment of patients. 12 42 Together, these collective shreds of evidence highlight the importance of doctors in collaborative practices with supervisor pharmacists to develop innovative practices to provide economic, effective and safe pharmacotherapy.…”

Section: Discussionmentioning

confidence: 99%

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Proton pump inhibitor utilisation and potentially inappropriate prescribing analysis: insights from a single-centred retrospective study

Liu

Zhu

et al. 2020

BMJ Open

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ObjectivesThis study aimed to characterise the prescribing patterns and evaluate the appropriateness of the prescribed proton pump inhibitors (PPIs) in adult patients via a review of electronic medical records in a single-centred hospital.DesignAll patients admitted to the outpatient department of Jinshan Hospital, Fudan University, Shanghai, between 1 January 2018 and 31 December 2018 were evaluated. Individuals aged 18 years or above and with at least one dispensing for PPIs were identified as PPI users. New PPI users were defined as a subject who did not receive any dispensing for PPIs in the year prior to the index date. Baseline characteristics of PPI users and their therapies were described by treatment indication, economic indicators and co-prescription, overall and separately.SettingThe prescription database was retrieved from the hospital information system of Jinshan Hospital, Fudan University.ResultsAmong 18 435 identified PPI users in 2018, 14 219 patients (aged 18 years or above) who had at least one dispensing PPIs were new users (77%), and among them, men accounted for 47%. The mean treatment duration was 23 days. Omeprazole was the most commonly prescribed drug. PPIs are inappropriately prescribed in 50% (13 589/25 850) of prescriptions. Prescription appropriateness analysis indicated that the unapproved indications for PPI new users accounted for 47%; among them, the proportion of gastritis diagnosis was 34%. The proportion of PPI new users with co-prescription of glucocorticosteroids (GCs) who have risk factors accounted for 24% and lower than other co-prescription. A majority of PPI users (73%) reported high-dose PPI prescription. The defined daily dose of oral pantoprazole was the highest, and injectable omeprazole had the highest defined daily cost. In contrast, only the drug utilisation index value of oral esomeprazole was less than 1.0.ConclusionThe results indicate the challenge of PPI use was accompanied by unapproved indications, frequent inappropriate co-prescription with GCs and excessive dosages. Efforts should be paid to promote rational use and ensure the choice of suitable PPI therapy in the future.

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Patterns of High-Dose and Long-Term Proton Pump Inhibitor Use: A Cross-Sectional Study in Six South Australian Residential Aged Care Services

Cited by 14 publications

References 32 publications

Discussing proton pump inhibitor deprescribing: the views of Danish GPs and older patients

Discussing proton pump inhibitor deprescribing: the views of Danish GPs and older patients

The FRAIL-NH Scale: Systematic Review of the Use, Validity and Adaptations for Frailty Screening in Nursing Homes

Proton pump inhibitor utilisation and potentially inappropriate prescribing analysis: insights from a single-centred retrospective study

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