Lamuela L J Calvo1, P García Cámara1, M Llorente Barrio1, O Sierra Gabarda1,2, R Monzón Baez1, J M Arbonés Mainar2,3, J Alcedo González1,2, V Bernal Monterde4,5. 1. Gastroenterology Department, Miguel Servet University Hospital, Zaragoza, Spain. 2. Instituto de Investigación Sanitaria (IIS), Aragón, Zaragoza, Spain. 3. Translational Research Unit, CIBER Physiopathology of Obesity and Nutrition, Miguel Servet University Hospital, Instituto Aragones de Ciencias de La Salud (IACS), Carlos III Health Institute, Zaragoza, Madrid, Spain. 4. Gastroenterology Department, Miguel Servet University Hospital, Zaragoza, Spain. vbernalm@gmail.com. 5. Instituto de Investigación Sanitaria (IIS), Aragón, Zaragoza, Spain. vbernalm@gmail.com.
Abstract
BACKGROUND: Proton-pump inhibitors (PPIs) are among the most frequently prescribed drugs, but they are being overprescribed. OBJECTIVE: To evaluate the applicability of a deprescription algorithm in hospitalized patients with chronic PPI use. METHODS: A prospective study including consecutive gastroenterology department hospitalized patients with chronic PPI use. The prescription was reassessed and a deprescribing algorithm was applied. Follow-up was carried out at 4, 12, and 24 weeks. RESULTS: A total of 513 (44.22%) of 1160 had chronic PPI use; 371 met inclusion criteria and were evaluated: 285 (76.82%) with appropriate prescription and 86 (23.18%) with inappropriate, mainly (52.30%) due to polypharmacy. Seventy-five patients accepted the deprescribing process. Sixty-one (81.33%) maintained deprescription at week 4, 56 (74.66%) at week 12, and 54 (72.00%) at week 24. Eleven of 21 restarted the PPI because of symptoms. No differences were found between the successful deprescription group and the unsuccessful one, regarding sex (p = 0.877), age (p = 0.635), PPI indication (p = 0.663), or deprescription regimen (p = 0.805). No patient had any adverse event attributable to deprescription. CONCLUSION: There is a high inappropriate indication for PPIs in patients admitted to the gastroenterology department. The application of a patient-centered deprescribing algorithm is a safe and effective strategy to reduce their inappropriate consumption in the medium term.
BACKGROUND: Proton-pump inhibitors (PPIs) are among the most frequently prescribed drugs, but they are being overprescribed. OBJECTIVE: To evaluate the applicability of a deprescription algorithm in hospitalized patients with chronic PPI use. METHODS: A prospective study including consecutive gastroenterology department hospitalized patients with chronic PPI use. The prescription was reassessed and a deprescribing algorithm was applied. Follow-up was carried out at 4, 12, and 24 weeks. RESULTS: A total of 513 (44.22%) of 1160 had chronic PPI use; 371 met inclusion criteria and were evaluated: 285 (76.82%) with appropriate prescription and 86 (23.18%) with inappropriate, mainly (52.30%) due to polypharmacy. Seventy-five patients accepted the deprescribing process. Sixty-one (81.33%) maintained deprescription at week 4, 56 (74.66%) at week 12, and 54 (72.00%) at week 24. Eleven of 21 restarted the PPI because of symptoms. No differences were found between the successful deprescription group and the unsuccessful one, regarding sex (p = 0.877), age (p = 0.635), PPI indication (p = 0.663), or deprescription regimen (p = 0.805). No patient had any adverse event attributable to deprescription. CONCLUSION: There is a high inappropriate indication for PPIs in patients admitted to the gastroenterology department. The application of a patient-centered deprescribing algorithm is a safe and effective strategy to reduce their inappropriate consumption in the medium term.
Authors: Barbara Farrell; Kevin Pottie; Wade Thompson; Taline Boghossian; Lisa Pizzola; Farah Joy Rashid; Carlos Rojas-Fernandez; Kate Walsh; Vivian Welch; Paul Moayyedi Journal: Can Fam Physician Date: 2017-05 Impact factor: 3.275