Francesca Lodato1, Elisabetta Poluzzi2, Emanuel Raschi3, Carlo Piccinni4, Ariola Koci5, Valentina Olivelli6, Chiara Napoli7, Giulia Corvalli8, Elena Nalon9, Fabrizio De Ponti10, Marco Zoli11. 1. Unit of Internal Medicine, S. Orsola-Malpighi Hospital and Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. Electronic address: francesca.lodato@aosp.bo.it. 2. Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. Electronic address: elisabetta.poluzzi@unibo.it. 3. Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. Electronic address: emanuel.raschi@unibo.it. 4. Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. Electronic address: carlo.piccinni@unibo.it. 5. Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. Electronic address: ariola.koci@unibo.it. 6. Unit of Internal Medicine, S. Orsola-Malpighi Hospital and Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. Electronic address: valentina.olivelli@aosp.bo.it. 7. Unit of Internal Medicine, S. Orsola-Malpighi Hospital and Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. Electronic address: chiara.napoli@aosp.bo.it. 8. Unit of Internal Medicine, S. Orsola-Malpighi Hospital and Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. Electronic address: giulia.corvalli@aosp.bo.it. 9. Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. Electronic address: nalonelena@gmail.com. 10. Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. Electronic address: fabrizio.deponti@unibo.it. 11. Unit of Internal Medicine, S. Orsola-Malpighi Hospital and Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. Electronic address: marco.zoli@unibo.it.
Abstract
INTRODUCTION: Proton pump inhibitor (PPI) prescriptions have raised concern for both huge increase of health expenditure and possible long-term adverse effects. OBJECTIVE: To evaluate appropriateness of PPI prescription in ambulatory and hospital care. DESIGN: Observational cohort study. PATIENTS: Patients admitted to the Internal Medicine Unit of Bologna S. Orsola Hospital between 15/09/2013 and 15/12/2013. Data on clinical condition and drug therapy were collected at three time points: admission (reflecting GP's prescription), hospital stay and discharge. MAIN MEASURES: Appropriateness of PPI use was evaluated as follows: (1) agreement between PPI use/non-use and appropriate clinical condition; (2) in PPI users, assessment of Medication Appropriateness Index (MAI). Differences in appropriateness among time points were analyzed by chi-square test. Logistic regression model was used to identify possible determinants of PPI appropriateness. KEY RESULTS: Among 280 patients, 56% received PPI at least once in the three time points. Appropriateness, according to indication of use, was similar between admission and hospital stay (61% vs. 62%; p=0.82) and between hospital stay and discharge (62% vs. 59%; p=0.94). MAI score showed important, although statistically non-significant, change in appropriateness between admission and hospital stay (20% vs. 28%; p=0.16). Age≥65 was always associated with appropriate PPI use (up to OR=4.37; p<0.01), whereas cardiovascular comorbidity and conditions requiring analgesic treatment influenced appropriateness only at admission (OR=3.84; p<0.01 and OR=0.34; p<0.01, respectively). CONCLUSIONS: Hospital clinicians only rarely reconsidered GP's choice to prescribe PPI. Room for improvement in PPI appropriateness is represented by (1) assessing gastrointestinal risk in each patient under analgesics and anti-inflammatory drugs, and (2) short-term re-evaluation of PPI prescription after discharge.
INTRODUCTION:Proton pump inhibitor (PPI) prescriptions have raised concern for both huge increase of health expenditure and possible long-term adverse effects. OBJECTIVE: To evaluate appropriateness of PPI prescription in ambulatory and hospital care. DESIGN: Observational cohort study. PATIENTS: Patients admitted to the Internal Medicine Unit of Bologna S. Orsola Hospital between 15/09/2013 and 15/12/2013. Data on clinical condition and drug therapy were collected at three time points: admission (reflecting GP's prescription), hospital stay and discharge. MAIN MEASURES: Appropriateness of PPI use was evaluated as follows: (1) agreement between PPI use/non-use and appropriate clinical condition; (2) in PPI users, assessment of Medication Appropriateness Index (MAI). Differences in appropriateness among time points were analyzed by chi-square test. Logistic regression model was used to identify possible determinants of PPI appropriateness. KEY RESULTS: Among 280 patients, 56% received PPI at least once in the three time points. Appropriateness, according to indication of use, was similar between admission and hospital stay (61% vs. 62%; p=0.82) and between hospital stay and discharge (62% vs. 59%; p=0.94). MAI score showed important, although statistically non-significant, change in appropriateness between admission and hospital stay (20% vs. 28%; p=0.16). Age≥65 was always associated with appropriate PPI use (up to OR=4.37; p<0.01), whereas cardiovascular comorbidity and conditions requiring analgesic treatment influenced appropriateness only at admission (OR=3.84; p<0.01 and OR=0.34; p<0.01, respectively). CONCLUSIONS: Hospital clinicians only rarely reconsidered GP's choice to prescribe PPI. Room for improvement in PPI appropriateness is represented by (1) assessing gastrointestinal risk in each patient under analgesics and anti-inflammatory drugs, and (2) short-term re-evaluation of PPI prescription after discharge.