Appropriateness of proton pump inhibitors treatment in clinical practice: Prospective evaluation in outpatients and perspective assessment of drug optimisation. Issue 8 (August 2020)

• Record Type: Journal Article
• Authors: Giannini, Edoardo G.; Crespi, Mattia; Djahandideh, Afscin; Demarzo, Maria Giulia; Moscatelli, Alessandro; Bodini, Giorgia; Furnari, Manuele; Marabotto, Elisa; Plaz Torres, Maria Corina; Zentilin, Patrizia; Savarino, Vincenzo
• Is Part Of: Digestive and liver disease. Volume 52:Issue 8(2020)
• Page Start: 862
• Page End: 868
• Publication Date: 2020-08
• Subjects: Proton pump inhibitors -- Gastro-oesophageal reflux disease -- Prescription -- Long-term -- Outcomes; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; 616.33005
• DOI: 10.1016/j.dld.2020.05.005
• Languages: English
• ISSNs: 1590-8658

Abstract

Abstract: Background: High rates of inappropriate proton pump inhibitor (PPI) prescriptions have been reported in retrospective database analyses. Assessing the appropriateness of long-term PPIs in outpatients, with a proactive approach at drug optimisation may enhance treatment adequacy. Aims: To describe the characteristics of outpatients who are on long-term PPIs, to assess the magnitude of inappropriate PPI prescriptions, and to evaluate the rate of drug optimisation following specialist recommendations. Methods: Appropriateness of long-term (>8weeks) PPI prescription was prospectively assessed in 249 consecutive patients referred to a Gastroenterology outpatient clinic. We recorded reason for prescription, dose, modality, duration of therapy, and attempts at PPI optimisation. Results: PPIs were inappropriately prescribed in 96/249 patients (38.6%). Gastro-oesophageal reflux disease (50/143, 35.0%) and prophylaxis of anti-platelet/non-steroidal anti-inflammatory drugs (5/49, 10.2%) were the most common PPI indications and those with the lowest rate of inappropriateness, while the highest rates were observed for treatment of dyspepsia (10/12, 83.3%) and anti-coagulant therapy (21/21, 100%). PPI treatment was optimised in 112 patients (45.0%). Conclusions: PPIs are inappropriately used in about 40% of outpatients, reflecting scant attention to guidelines. A proactive approach may improve therapeutic adequacy in approximately half of patients. Educational efforts to guide PPI prescription should be further pursued.