Appropriateness of Acid Suppression Therapy. (February 2017)

• Record Type: Journal Article
• Authors: De Rijdt, Thomas; Spriet, Isabel; Willems, Ludo; Blanckaert, Marianne; Hiele, Martin; Wilmer, Alexander; Simoens, Steven
• Is Part Of: Annals of pharmacotherapy. Volume 51:Number 2(2017:Feb.)
• Page Start: 125
• Page End: 134
• Publication Date: 2017-02
• Subjects: AST -- acid suppression -- start-up -- initiation -- hospital -- appropriate therapy -- PPI -- H2A -- long-term -- economic -- cost saving; Chemotherapy -- Periodicals; Pharmacology -- Periodicals; 615.5805
• DOI: 10.1177/1060028016670414
• Languages: English
• ISSNs: 1060-0280

Abstract

Background: The inappropriate startup of long-term acid suppressive therapy (AST) can have clinical and pharmacoeconomic impacts on ambulatory care.Objective: To assess the proportion of patients with appropriate initiation of long-term AST in non–critically ill patients. To describe possible risk factors for nonappropriate AST. To calculate the potential savings when eliminating the nonappropriate startup of AST.Method: This observational, retrospective study evaluated the appropriateness of startup of long-term AST in medical records using a broad variety of international criteria and guidelines and using a validated screening instrument.Results: A sample of 597 patients was included in the analysis. In 57% of them, AST was appropriately initiated. No specific risk profile could be defined. There was some indication that the availability of a clinical pharmacist and the use of standing orders were correlated to the outcome. Extrapolation to the total population (ie, 2836 patients) led to a total cost of €8880 during hospital stay plus an extra €40 391 per month after discharge. Avoiding inappropriate initiation of AST could lead to a saving of €3805 plus €17 441 per month.Conclusion: In all, 43% of initiation of long-term AST in the hospital was inappropriate. The potential savings from avoiding this could be substantial from a health care payer perspective. No patient characteristics that could predict for inappropriate initiation of AST were identified. A correlation between inappropriate initiation and medical disciplines using standing orders that include AST was seen.