Proton Pump Inhibitor use in Hospitalized Patients: Is Overutilization Becoming a Problem?

Durand, Cheryl; Willett, Kristine C.; Desilets, Alicia R

doi:10.4137/cgast.s9588

Cited by 34 publications

(38 citation statements)

References 54 publications

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“…Our results are concordant with prior studies assessing the rate of potentially low-value PPI prescriptions among older adults (range = 20%-40%). 9,10 Previous research highlights inpatient prescriptions as a major source of potentially low-value PPI prescriptions, 19 suggesting that this is a major problem for post-acute care and primary care providers who are trying to determine if and when the PPI can be discontinued and is a major reason for ongoing low-value use. This work also suggests that requiring indications on post-acute care transfer forms could curb potentially low-value PPI prescriptions.…”

Section: Discussionmentioning

confidence: 99%

Low‐Value Proton Pump Inhibitor Prescriptions Among Older Adults at a Large Academic Health System

Mafi

May

Kahn

et al. 2019

J American Geriatrics Society

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BACKGROUND Older adults are particularly vulnerable to complications from proton pump inhibitor (PPI) drugs. We sought to characterize the prevalence of potentially low‐value PPI prescriptions among older adults to inform a quality improvement (QI) intervention. METHODS We created a cohort of patients, aged 65 years or older, receiving primary care at a large academic health system in 2018. We identified patients currently prescribed any PPI using the electronic health record (EHR) medication list (current defined as September 1, 2018). A geriatrician, a gastroenterologist, a QI expert, and two primary care physicians (PCPs) created multidisciplinary PPI appropriateness criteria based on evidenced‐based guidelines. Supervised by a gastroenterologist and PCP, two internal medicine residents conducted manual chart reviews in a random sample of 399 patients prescribed PPIs. We considered prescriptions potentially low value if they lacked a guideline‐based (1) short‐term indication (gastroesophageal reflux disease [GERD]/peptic ulcer disease/Helicobacter pylori gastritis/dyspepsia) or (2) long‐term (>8 weeks) indication (severe/refractory GERD/erosive esophagitis/Barrett esophagus/esophageal adenocarcinoma/esophageal stricture/high gastrointestinal bleeding risk/Zollinger‐Ellison syndrome). We used the Wilson score method to calculate 95% confidence intervals (CIs) on low‐value PPI prescription prevalence. RESULTS Among 69 352 older adults, 8729 (12.6%) were prescribed a PPI. In the sample of 399 patients prescribed PPIs, 63.9% were female; their mean age was 76.2 years, and they were seen by 169 PCPs. Of the 399 prescriptions, 143 (35.8%; 95% CI = 31.3%‐40.7%) were potentially low value—of which 82% began appropriately (eg, GERD) but then continued long term without a guideline‐based indication. Among 169 PCPs, 32 (18.9%) contributed to 59.2% of potentially low‐value prescriptions. CONCLUSION One in eight older adults were prescribed a PPI, and over one‐third of prescriptions were potentially low‐value. Most often, appropriate short‐term prescriptions became potentially low value because they lacked long‐term indications. With most potentially low‐value prescribing concentrated among a small subset of PCPs, interventions targeting them and/or applying EHR‐based automatic stopping rules may protect older adults from harm. J Am Geriatr Soc 67:2600–2604, 2019

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Section: Discussionmentioning

confidence: 99%

Low‐Value Proton Pump Inhibitor Prescriptions Among Older Adults at a Large Academic Health System

Mafi

May

Kahn

et al. 2019

J American Geriatrics Society

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“…The observed difference between the risk of CA-CDI and HA-CDI with gastric-acid suppressive medication can be explained by the overuse of these medications in healthcare facilities. 33 Exposure to corticosteroids was associated with CA-CDI. In contrast to antimicrobials that disrupt the normal gut microbiome, facilitating the proliferation of C. difficile, 34 and in contrast to gastricacid suppressive medication that may allow survival of vegetative forms of C. difficile, 35 a plausible biological mechanism for the observed association could be the negative impact of corticosteroids on the gastrointestinal mucosal integrity.…”

Section: Discussionmentioning

confidence: 99%

Comorbidities, Exposure to Medications, and the Risk of Community-Acquired Clostridium difficile Infection: A Systematic Review and Meta-analysis

Furuya‐Kanamori

Stone

Clark³

et al. 2014

Infect. Control Hosp. Epidemiol.

142

103

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background. Clostridium difficile infection (CDI) has been extensively described in healthcare settings; however, risk factors associated with community-acquired (CA) CDI remain uncertain. This study aimed to synthesize the current evidence for an association between commonly prescribed medications and comorbidities with CA-CDI. methods. A systematic search was conducted in 5 electronic databases for epidemiologic studies that examined the association between the presence of comorbidities and exposure to medications with the risk of CA-CDI. Pooled odds ratios were estimated using 3 meta-analytic methods. Subgroup analyses by location of studies and by life stages were conducted.

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“…Compared to other antacid drugs, PPIs were initially thought to have an excellent safety profile, resulting in their widespread use in both inpatient and ambulatory settings [1,2]. After more than 25 years of clinical postmarketing experience, improved reporting, and closer scrutiny, several serious adverse effects associated with the long-term use of PPIs have emerged.…”

Section: Introductionmentioning

confidence: 99%

Increased Risk of Spontaneous Bacterial Peritonitis in Cirrhotic Patients Using Proton Pump Inhibitors

Elzouki

Neffati

Rasoul

et al. 2018

GE Port J Gastroenterol

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Background:The association between bacterial infections and proton pump inhibitors (PPIs) has recently been studied with debatable results. Aim: The aim of this study was to investigate the relationship between PPIs and the development of spontaneous bacterial peritonitis (SBP) or other bacterial infections in cirrhotic patients. Materials and Methods: Consecutive cirrhotic patients hospitalized from 2007 through 2012 to Hamad General Hospital-, Doha, Qatar, were enrolled and classified as PPI users or non-users according to PPI consumption in the 90 days prior to hospitalization. Cirrhosis was clinically diagnosed by a combination of physical, biochemical, radiological, and endoscopic findings, or by liver biopsy. Results: A total of 333 patients were included in this study, of whom 171 (51.4%) used PPIs and 162 (48.6%) did not use PPIs. PPI users were significantly older in age (p = 0.001). There was no statistical difference between the 2 groups in sex distribution and etiology of cirrhosis (p > 0.05 for both parameters). PPI users had a significantly higher incidence of overall bacterial infection (38%) than non-PPI users (13.6%), p = 0.0001. Statistical significance is observed specifically for SBP and chest infection (p = 0.0006 and p = 0.01, respectively). In multivariate analysis, older age (> 60 years; OR = 1.246, 95% CI 1.021-08.486; p = 0.02), and PPI use (OR = 2.149, 95% CI 1.124-06.188; p = 0.01) were independent predicting factors for SBP and overall bacterial infection. Conclusion: The present study shows that PPI use, as well as older age (> 60 years), was an independent predicting factor for the development of overall infection and SBP in hospitalized cirrhotic patients. Unless it is indicated, PPI therapy should be avoided in this group of patients, particularly in those older than 60 years of age. Resumo Introdução: A associação entre infeções bacterianas e os Inibidores da bomba de protões (IBPs) tem vindo a ser estudada com resultados discutíveis. Objetivo: O objetivo deste estudo foi investigar a relação entre IBPs e o desenvolvimento de peritonite bacteriana espontânea (PBE) ou outras infeções bacterianas em doentes cirróticos. Material e Métodos: Doentes consecutivos com cirrose hospitalizados entre 2007 e 2012 no Hamad General HospitalQatar foram selecionados e classificados como utilizadores ou não utilizadores de IBPs de acordo com o seu consumo nos 90 dias prévios ao internamento. A cirrose foi clinicamente diagnosticada por uma combinação de achados no exame físico, no estudo bioquímico, radiológico e endoscópico; ou por biopsia hepática. Resultados: Um total de 333 doentes foi incluído neste estudo, 171 (51.4%) medicados com IBPs e 162 não (48.6%). Os utilizadores de IBPs eram significativamente mais velhos (p = 0.001). Não se observaram diferenças estatísticas entre os dois grupos no que se refere ao sexo ou etiologia da cirrose (p > 0.05 para os dois parâmetros). A incidência global de infeções bacterianas foi significativamente superior nos utilizadores de IBPs (38%) do ...

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Proton Pump Inhibitor use in Hospitalized Patients: Is Overutilization Becoming a Problem?

Cited by 34 publications

References 54 publications

Low‐Value Proton Pump Inhibitor Prescriptions Among Older Adults at a Large Academic Health System

Low‐Value Proton Pump Inhibitor Prescriptions Among Older Adults at a Large Academic Health System

Comorbidities, Exposure to Medications, and the Risk of Community-Acquired Clostridium difficile Infection: A Systematic Review and Meta-analysis

Increased Risk of Spontaneous Bacterial Peritonitis in Cirrhotic Patients Using Proton Pump Inhibitors

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