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Plehhova K, Paquette N, Gould J, Coyle C. Understanding the Patient PPI Journey: Results of a Survey on PPI Treatment Initiation and Patient Experience. J Prim Care Community Health 2022; 13:21501319221088688. [PMID: 35323078 PMCID: PMC8961351 DOI: 10.1177/21501319221088688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Proton pump inhibitors (PPIs) used in the management of gastro-esophageal reflux disease (GORD) are among the most frequently prescribed classes of drug worldwide. Currently, however, physicians are prescribing PPIs for extended periods, often without an indication, which is not in line with current guidance and therefore preventing appropriate reflux management. Inappropriate or excessive PPI prescribing is becoming increasingly visible, yet there is currently little research available on the impact such current practice has on the patient experience. This study aims to understand patient attitudes toward their PPI treatment and the impact current PPI prescribing patterns have on the patient experience. METHODS An online survey of current and previous users of PPI for GORD was conducted in the UK and Germany. Topics covered included prior steps taken before first consultation with a physician, initial recommendations, PPI treatment initiation and duration, use of PPI, management of reflux whilst taking a PPI, stopping PPI treatment, and patient attitudes. RESULTS Among 566 patient participants (UK, n = 372; Germany, n = 194) 69% to 79% reported being prescribed medication at their first visit to a physician, of which 61% to 68% were prescribed a PPI either alone or combined with another treatment. 41% to 48% of patients answered "don't know" when asked how long they expected to continue taking their PPI. 49% to 50% of patients currently on PPIs also reported having concerns with regards to long-term treatment. 70% of patients recalled being well informed on dosage and treatment regimens. However, other safety and usage information was reported as being less frequently discussed. CONCLUSIONS Although patients reported concerns regarding ongoing long-term PPI treatment, this was not reflected in the prescribing pattern from physicians. More can be done to ensure patients are fully informed about their PPI treatment at consultation. Findings also suggest a disconnect exists between standard treatment guidelines and prescribing patterns, as experienced by patients.
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Affiliation(s)
| | | | - James Gould
- Reckitt Benckiser Healthcare UK Ltd., Slough, UK
| | - Cathal Coyle
- Reckitt Benckiser Healthcare UK Ltd., Slough, UK
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[Evaluation of the implantation of a de-prescribing process for proton pump inhibitor (PPI) using an algorithm within an internal medicine department]. Rev Med Interne 2020; 42:535-540. [PMID: 33323294 DOI: 10.1016/j.revmed.2020.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/11/2020] [Accepted: 11/20/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The prescription of proton pump inhibitors (PPIs) seems excessive. Taken over the long term, PPIs can cause serious side effects. It therefore turns out to be justified to suspend treatments whose expected benefit seems too low compared to the risks involved : it is deprescription. The objective of this study is to assess a process for the deprescription of PPIs in a hospital internal medicine department. METHOD After collegial deliberation, an algorithm for assisting in the deprescription of PPIs was validated. If necessary, the PPI was phased out over 1 month. A telephone follow-up at 1, 2 and 3 months was carried out in order to assess the maintenance of deprescription and the occurrence of digestive symptoms. The evaluation criteria were the rate of deprescription and the rate of maintenance of deprescription at 3 months following reports from patients, their caregivers or a family member. RESULTS 105 patients with a mean age of 72 years were included over a period of 21 weeks, and in 31 cases (29%), deprescription was performed. After 3 months of follow-up, there was 71% maintenance of deprescription. Three patients were lost to follow-up and 6 patients resumed PPI. CONCLUSION The approach undertaken resulted in the suspension of PPI intake in almost 3 out of 10 cases. This result was maintained at least three months for a large majority of patients. It will be interesting to continue this process and extend the monitoring over longer periods, in order to ensure that PPI de-prescription is maintained in the long term.
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Gramont B, Bertoletti L, Roy M, Roblin X, Tardy B, Cathébras P. [Use and management of proton pump inhibitors: An observational study]. Therapie 2020; 75:649-662. [PMID: 32591130 DOI: 10.1016/j.therap.2020.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/09/2020] [Accepted: 03/17/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Proton pump inhibitors (PPIs) have improved the management and prevention of digestive diseases, leading to a heavy prescription of this therapy. In 2015, nearly one quarter of the French population had consumed a PPI and half of them were long-term users. The main objective of this study was to analyze, in patients hospitalized in several medical departments, the adequacy of long-term PPI prescriptions to recommendations. METHOD The Use and management of proton pump inhibitors: an observational study project (UTOPPIA) is a longitudinal observational study conducted at the University Hospital of Saint-Étienne in the departments of hepato-gastroenterology, infectious and tropical diseases, internal medicine, vascular medicine and nephrology. All patients with PPI treatment on their usual outpatient prescription were interviewed. RESULTS Over a 3-month period, 334 of hospitalized patients (30.7%) had received a long-term PPI prescription and 181 patients (54.2%) could be included in the study for a total of 274 indications. Ninety-nine patients (54.7%) had a long-term PPI prescription in accordance with the recommendations. The most frequent indication (70 prescriptions) was the prescription of an antiplatelet drug or anticoagulant for subjects at high risk of bleeding in 70 prescriptions. Fifty-three PPI treatments were amended during the hospital stay, including 9 discontinuations. The justification for the change was documented in the patients' chart in only 17% of cases. Individual interviews of patients revealed that 75.1% of them were in favour of discontinuing their PPI treatment. CONCLUSIONS About one-third of hospitalized patients in medical wards in France have long-term PPI treatment and half of these prescriptions do not comply with good practice recommendations. A majority of patients report being willing to try to stop PPI therapy.
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Affiliation(s)
- Baptiste Gramont
- Service de médecine interne, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France.
| | - Laurent Bertoletti
- Service de médecine vasculaire et thérapeutique, CHU de Saint-Étienne, 42055 Saint-Étienne, France
| | - Michel Roy
- Centre régional de pharmacovigilance, CHU de Saint-Étienne, 42055 Saint-Étienne, France
| | - Xavier Roblin
- Service d'hépato-gastro-entérologie, CHU de Saint-Étienne, 42055 Saint-Étienne, France
| | - Bernard Tardy
- Centre d'investigation clinique, Inserm CIC 1408, 42055 Saint-Étienne, France
| | - Pascal Cathébras
- Service de médecine interne, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
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Lassalle M, Le Tri T, Bardou M, Biour M, Kirchgesner J, Rouby F, Dumarcet N, Zureik M, Dray-Spira R. Use of proton pump inhibitors in adults in France: a nationwide drug utilization study. Eur J Clin Pharmacol 2019; 76:449-457. [PMID: 31838548 DOI: 10.1007/s00228-019-02810-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/27/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE Proton pump inhibitor (PPI) drugs are approved for the management of gastric acid-related diseases, mainly treatment of gastroesophageal reflux disease, treatment of nonsteroidal anti-inflammatory drugs (NSAID)-related gastrointestinal complications and prevention in at-risk patients, Helicobacter pylori eradication, and treatment of ulcers. PPIs are one of the most commonly prescribed drug class worldwide, and off-label use is widespread. The aim of this study was to describe outpatient PPI use of the whole adult population in France, based on the French National Health Data System (SNDS). METHODS All individuals aged 18 years or older, with at least one dispensing for PPI between January 1, 2015 and December 31, 2015, were identified as PPI users. PPI users were considered as new users if they received no dispensing for PPI in the prior year. New users were followed until treatment discontinuation or up to 1 year, whichever occurred first. Characteristics of new users and of their PPI treatment were described, overall and separately by treatment indication. RESULTS In total, 15,388,419 PPI users were identified in 2015 (57.0% women; mean age 57.0 years), accounting for 29.8% of the French adult population. Of them, 7,399,303 were new PPI users; mean treatment duration was 40.9 days, and 4.1% received a continuous PPI therapy lasting more than 6 months (10.2% among new users > 65 years versus 2.4% among those 18-65 years). For 53.5% of new users, indication for PPI therapy was a co-prescription with NSAID; in this indication, the large majority of patients (79.7%) had no measurable risk factor supporting a systematic prophylactic co-prescription of PPI. A proportion of 32.4% of new users did not have any identified comedication or inpatient diagnosis supporting an indication for PPI therapy; among them, only a small proportion (7.3% overall, and 8.4% of patients aged > 65 years) underwent a procedure investigating the digestive tract at the time of PPI initiation. CONCLUSION The results of this study suggest PPI overuse in France, not always in line with the French guidelines. In particular, inappropriate co-prescription with NSAID was frequent. Efforts should be made to limit PPI treatment to appropriate indications and durations.
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Affiliation(s)
- Marion Lassalle
- EPI-PHARE, Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products [ANSM], and French National Health Insurance [CNAM]), Saint-Denis, France.
| | - Thien Le Tri
- EPI-PHARE, Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products [ANSM], and French National Health Insurance [CNAM]), Saint-Denis, France
| | - Marc Bardou
- Department of Hepato-gastroenterology, CHU de Dijon, Dijon, France
| | - Michel Biour
- Regional Pharmacovigilance Center, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Julien Kirchgesner
- Department of Gastroenterology and Nutrition, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Frank Rouby
- Regional Pharmacovigilance Center, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Nathalie Dumarcet
- Department of Dermatology, Hepato-gastroenterology and Rare Metabolic Diseases, French National Agency for the Safety of Medicines and Health Products, Saint-Denis, France
| | - Mahmoud Zureik
- EPI-PHARE, Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products [ANSM], and French National Health Insurance [CNAM]), Saint-Denis, France
| | - Rosemary Dray-Spira
- EPI-PHARE, Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products [ANSM], and French National Health Insurance [CNAM]), Saint-Denis, France
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Snapshot of proton pump inhibitors prescriptions in a tertiary care hospital in Switzerland: less is more? Int J Clin Pharm 2019; 41:1634-1641. [DOI: 10.1007/s11096-019-00929-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 10/17/2019] [Indexed: 12/11/2022]
Abstract
Abstract
Background Proton pump inhibitors are among the most widely prescribed drugs in the world, but more than half of the indications for prescription are unjustified. The misuse of this therapeutic class has heavy consequences such as additional health costs, adverse drug reactions following long-term use and gastric acid rebound when the proton pump inhibitor is discontinued. Objective The overprescription of proton pump inhibitors is therefore becoming a public health problem, which led us to evaluate their use within the Geneva University Hospitals. Setting Patients hospitalized in two divisions of the department of internal medicine of the Geneva University Hospitals on a single day. Methods This is a register-based cross-sectional study and it collected data about the prescription pattern of proton pump inhibitors by consulting the electronic records of patients included. Main outcome measure To determine if the proton pump inhibitors prescription is made according to the market authorization and the available guidelines. Results Hundred-eighty patients were included. 54% of patients were on proton pump inhibitors, 29% of whom had their treatment initiated at hospital. Of the indications for treatment, 72% were not justified and 63% of the justified indications did not have an adequate dosage. Therefore, in all patients with a proton pump inhibitor at hospital, only 11% had a justified indication with an adequate dose. Finally, 87% of known home prescriptions were renewed on admission and among them, 71% did not have a justified or possibly justified indication according to the guidelines. Conclusion Indication for treatment inside the hospital was not justified in 72% of patients and only 11% had a justified indication with an adequate dosage. Precise guidelines with evidence-based indications and adequate daily doses would help to correctly prescribe proton pump inhibitors. Moreover, patients should benefit from a thorough evaluation of their treatment.
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Daumas A, Garros E, Mendizabal H, Gayet S, Bernard F, Bagnères D, Demoux AL, Rossi P, Villani P, Granel B. Impact d’une évaluation des pratiques professionnelles sur la pertinence des prescriptions d’inhibiteurs de la pompe à protons à l’hôpital. Rev Med Interne 2018; 39:618-626. [DOI: 10.1016/j.revmed.2018.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 01/05/2018] [Accepted: 03/03/2018] [Indexed: 02/08/2023]
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Dipanda M, Pioro L, Buttard M, d’Athis P, Asgassou S, Putot S, Deïdda M, Laborde C, Putot A, Manckoundia P. Évaluation de la prescription des inhibiteurs de la pompe à protons chez la personne âgée de 75 ans et plus dans un service de gériatrie aiguë. Therapie 2017; 72:669-675. [DOI: 10.1016/j.therap.2017.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/22/2017] [Accepted: 06/01/2017] [Indexed: 01/09/2023]
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Thorel J, McCambridge C, Piau A, Secher M, Magre É, Montastruc JL, Bagheri H. Les inhibiteurs de pompe à protons : vraie indication ou prescription banalisée ? Therapie 2016; 71:589-593. [DOI: 10.1016/j.therap.2016.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 05/19/2016] [Indexed: 12/18/2022]
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Schonheit C, Le Petitcorps H, Pautas É. [Prescription for proton pump inhibitors in geriatrics]. SOINS. GERONTOLOGIE 2015; 20:39-44. [PMID: 26574132 DOI: 10.1016/j.sger.2015.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Proton pump inhibitors are widely prescribed, notably for the over 65s, despite there being significant side effects in the geriatric population. It is therefore important that doctors, caregivers and patients are fully aware of the recognised indications of PPIs and on the less well-known problems inherent to their prescription.
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Affiliation(s)
- Claire Schonheit
- Service de court séjour gériatrique, hôpital Charles-Foix, 7 avenue de la République, 94205 Ivry-sur-Seine cedex, France
| | - Hélène Le Petitcorps
- Service de court séjour gériatrique, hôpital Charles-Foix, 7 avenue de la République, 94205 Ivry-sur-Seine cedex, France
| | - Éric Pautas
- Service de court séjour gériatrique, hôpital Charles-Foix, 7 avenue de la République, 94205 Ivry-sur-Seine cedex, France; UFR de médecine Pierre et Marie-Curie, université Paris 6, 4 place Jussieu, 75005 Paris, France.
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Teixeira MZ. Rebound acid hypersecretion after withdrawal of gastric acid suppressing drugs: new evidence of similitude. HOMEOPATHY 2011; 100:148-56. [PMID: 21784332 DOI: 10.1016/j.homp.2011.05.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Accepted: 05/12/2011] [Indexed: 12/16/2022]
Abstract
BACKGROUND Homeopathy is based on the principle of similitude (similia similibus curentur) using medicines that cause effects similar to the symptoms of disease in order to stimulate the reaction of the organism. Such vital, homeostatic or paradoxical reaction of the organism is closely related to rebound effect of drugs. METHOD Review of the literature concerning the rebound effects of drugs used to suppress gastric acidity, particularly proton pump inhibitors (PPIs). RESULTS The mechanism of action of these effects is discussed. Rebound in terms of clinical symptoms and physiological effects occur in about 40% of people taking PPIs, their timing depends on the half-life of the drug and the adaptation period of the physiological mechanisms involved. The wide use of PPIs may be linked to the rising incidence of carcinoid tumours. CONCLUSIONS These findings support Hahnemann's concept of secondary action of drugs. We are developing a homeopathic materia medica and repertory of modern drugs on the basis of reported rebound effects.
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Affiliation(s)
- Marcus Zulian Teixeira
- Department of Internal Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
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Fuzier R, Maguès JP, Dupuis E, Pomiès S, Segui S, Sénard JM. [Proton pump inhibitors: impact of professional practice evaluation on prescriptions pertinence]. ACTA ACUST UNITED AC 2011; 30:814-8. [PMID: 21981846 DOI: 10.1016/j.annfar.2011.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 07/19/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To improve the quality of proton pump inhibitors (PPI) prescription in an orthopaedic department. STUDY DESIGN Prospective professional practice evaluation study. PATIENTS AND METHODS A specific protocol concerning the best practice for using PPI in the perioperative period was established by anaesthesiologists and validated by all prescribers, according to recent recommendations published by French Afssaps. PPI prescription pertinence, mainly using the oral route, was based upon the presence of clearly identified risk factors. PPI mensual consumption and severe gastric complications were analyzed and compared with those obtained from the previous year. Ten months after the beginning of the protocol, the pertinence of PPI prescription was analyzed in 20 randomly selected medical records. Data are expressed in defined daily dose (DDD). RESULTS After one year, a 35.5% decrease in oral PPI consumption was noted (901 ± 211 before vs 581 ± 235 DDD, after, P<0.05). A similar trend to a decrease in intravenous PPI consumption was observed (40 ± 23 vs 22 ± 26, P=0.06). During the same period, the overall incidence of severe gastric complication remained stable. The PPI prescription was pertinent in 85% of selected medical records. CONCLUSION This study confirmed the interest of professional practice evaluation protocols to improve PPI prescription. A strong implication of all medical staff members is mandatory to maintain such benefits over time.
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Affiliation(s)
- R Fuzier
- Service orthopédie, pôle anesthésie-réanimation, faculté de médecine, CHU Purpan, université Toulouse-III, place Dr.-Baylac, TSA40031, 31059 Toulouse cedex 9, France.
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Chromogranin A measurement in metastatic well-differentiated gastroenteropancreatic neuroendocrine carcinoma: screening for false positives and a prospective follow-up study. Int J Biol Markers 2011; 26:94-101. [PMID: 21574156 DOI: 10.5301/jbm.2011.8327] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2011] [Indexed: 12/21/2022]
Abstract
BACKGROUND Multiple causes of false-positive chromogranin A (CgA) measurement have been reported that may affect its impact as a surrogate marker of RECIST progression in well-differentiated gastroenteropancreatic neuroendocrine tumors (WDGEPNET). ? AIMS 1) To evaluate the frequency of false-positive CgA results. 2) To prospectively compare CgA variations with RECIST morphological changes in patients without known causes of false-positive CgA measurements.? METHODS First, the conditions responsible for potentially false-positive CgA measurements were screened in 184 consecutive patients with metastatic WDGEPNET. Secondly, a variation in CgA at a 6-month interval was compared to RECIST results at 6 months in 46 patients.? RESULTS Among 184 patients, elevated CgA was found in 130 cases (71%) including 99 patients with at least one cause of a false-positive result. Impaired kidney function as well as medication with proton pump inhibitors were found to be the 2 major causes of false-positive results. The sensitivity and specificity of CgA measurements compared with morphological tumor changes according to the RECIST criteria were 71% and 50%, respectively, at 6 months.? CONCLUSION Routine screening for the causes of false-positive CgA measurements is mandatory in WDGEPNET patients. Our study does not validate the use of CgA as a surrogate marker of tumor progression.
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Seite F, Delelis-Fanien AS, Valero S, Pradère C, Poupet JY, Ingrand P, Paccalin M. Compliance with guidelines for proton pump inhibitor prescriptions in a department of geriatrics. J Am Geriatr Soc 2010; 57:2169-70. [PMID: 20121973 DOI: 10.1111/j.1532-5415.2009.02540.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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