Survey of Prescriptions for Peptic Ulcer Drugs (ACT Class AOB2) in Iceland

Thors, Hildur; Sigurðsson, Helgi; Oddsson, Einar; Þjóðleifsson, Bjarni

doi:10.3109/00365529409094875

Cited by 18 publications

(10 citation statements)

References 25 publications

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“…Despite this, studies such as this one indicate that there is widespread leakage outside the subsidized indications, particularly in the less severe forms of gastro‐oesophageal disease (25, 30, 31). Similar findings have been reported internationally (27, 32, 36).…”

Section: Discussionsupporting

confidence: 92%

“…Despite this, studies such as this one indicate that there is widespread leakage outside the subsidized indications, particularly in the less severe forms of gastro-oesophageal disease (25,30,31). Similar ®ndings have been reported internationally (27,32,36). The results demonstrated that proton pump inhibitors were prescribed in accordance with the Australian Schedule of Pharmaceutical Bene®ts criteria in only slightly more than one-third the cases studied, a very similar ®nding from the recent study in Brisbane, which found only 31% met the same criteria (30).…”

Section: Discussionsupporting

confidence: 86%

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Overuse of proton pump inhibitors

Naunton

Peterson

Bleasel

2008

Journal of Clinical Pharmacy and Therapeutics

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Background: There have been concerns raised about the potential adverse effects of proton pump inhibitors, especially with long‐term use. In particular, their potent action can suppress the features and delay the diagnosis of gastric cancer, while prolonged exposure may hasten the development of gastric carcinoids. Aim: To examine the use of proton pump inhibitors in patients at the major teaching hospital in Tasmania, Australia, principally to determine the appropriateness of the therapy according to published guidelines. Methods: A retrospective review of the medical records of all patients prescribed any of the proton pump inhibitors at the hospital over a 7‐month period, was performed. An extensive range of demographic and clinical variables was recorded for each patient. The patients were also asked a series of questions during their hospitalization to extract some of the relevant information – in particular, if and when they had undergone endoscopy. Results: The 200 patients (52% males) had a mean age of 69 ± 16·4 years. The most common indications for using proton pump inhibitors were acute gastrointestinal bleeding (20·9%), severe refractory ulcerating oesophagitis (17·3%), mild/moderate oesophageal reflux (17·3%) and refractory peptic ulcer (11·7%). A large number of patients were using a proton pump inhibitor for ‘other’ indications (39·6%). The prescribing of proton pump inhibitors satisfied the approved indications, as outlined in the Australian Schedule of Pharmaceutical Benefits, in only 37·1% of cases. Endoscopy had been performed in 54·1% of patients prior to commencing therapy with a proton pump inhibitor and within the next 7 days in another 12·8% of patients. Only 59% of patients had previously been treated with an H2‐receptor antagonist before commencing therapy with a proton pump inhibitor. Even worse, only 58·5% of patients had used an H2‐receptor antagonist before a proton pump inhibitor for mild/moderate oesophagitis. The median duration of proton pump inhibitor therapy for patients admitted to the hospital and already receiving one of the drugs was 450 days. Over half of the patients were being concurrently treated with other drugs which are known to cause or exacerbate gastro‐oesophageal disease, and 18% were smokers. Conclusions: Whereas the proton pump inhibitors are undoubtedly effective agents, studies of their prescribing in practice consistently suggest over‐use prior to endoscopy, use in patients who do not fit the approved criteria, and prescribing for indications in which ‘less powerful’ agents should have been sufficiently effective for the patient’s symptoms. This poses economic and safety concerns, particularly in light of the suggestion that these drugs could delay the diagnosis of gastric cancer.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 86%

Overuse of proton pump inhibitors

Naunton

Peterson

Bleasel

2008

Journal of Clinical Pharmacy and Therapeutics

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“…Therefore, we estimate that the present data reflect the use of antiasthma drugs at the time the survey was performed. The proportion of prescriptions from general practitioners and specialists was similar to the results of a previous study on the use of antiulcer drugs carried out in Iceland in April 1991 [7]. The response rate for the patients' questionnaires was higher in the present study, probably because, at the time of purchase, the option to post replies was available.…”

Section: Discussionsupporting

confidence: 75%

Users of antiasthma drugs in Iceland: a drug utilization study

Gislason

Olafsson²,

Sigvaldason³

1997

Eur Respir J

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There has been an increasing consensus worldwide on how to treat asthma, and, simultaneously, an increase in the sales of antiasthma drugs. However, little is known about actual drug use, dosage, combinations of drugs, etc., or about the clinical characteristics of patients using these drugs.All individuals with prescriptions for antiasthma drugs, who came to Icelandic pharmacies during March 1994, were invited to participate. By means of questionnaires, the pharmacists recorded the age and gender of the patient, the speciality of the prescribing doctor, as well as the name of the drug, total amount prescribed, and dosage. The patients were asked to answer another questionnaire on their clinical diagnosis, usage of other antiasthma drugs, etc.The pharmacists registered 2,026 individuals, with 2,687 prescriptions: 1,574 for beta 2 -agonists, 838 for inhaled corticosteroids, 208 for theophylline, 48 for anticholinergic drugs, and 19 for cromoglycates. One thousand, three hundred and fifty one patients answered the questionnaires. The majority (67%) claimed to have asthma, 18% chronic bronchitis, 11% emphysema and 5% other diseases or symptoms. Among those aged ≥16 yrs with asthma, 93% used beta 2 -agonists, 62% inhaled corticosteroids, 19% theophylline, and very few used other drugs. The most commonly used combination (57%) was beta 2 -agonists with inhaled corticosteroids. Thirty one per cent used beta 2 -agonists as monotherapy, and 5% used only inhaled corticosteroids. Theophylline was used mainly in combination with beta 2 -agonists and inhaled corticosteroids.In conclusion, our data suggest that two thirds of antiasthma drug users have asthma and that most are treated according to present guidelines. The use of inhaled corticosteroids, however, seems somewhat less than optimal.

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“…Although most, but not all, large well-conducted trials with potent acid secretion inhibitors show a better effect of these drugs than placebo, the overall difference is modest (9,10,12,13). The modest effect is in contrast to the widespread use of these drugs in patients with FD (15)(16)(17). However, with a multi-crossover method it has been shown that these drugs are highly effective in a subgroup of patients with FD, but it has not been possible to characterize the responders on the basis of symptoms or signs, and the multi-crossover method is not fit for daily practice (11).…”

Section: Discussionmentioning

confidence: 99%