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Assessment of Prescriptions in Elderly Patients Hospitalized in Medicine Departments. J Clin Med 2021; 10:jcm10225343. [PMID: 34830625 PMCID: PMC8621875 DOI: 10.3390/jcm10225343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/29/2021] [Accepted: 11/11/2021] [Indexed: 11/17/2022] Open
Abstract
Drug-related iatrogenesis is an important issue in the elderly population, and preventing iatrogenic accidents helps to reduce hospitalizations. Our study’s objective was to evaluate prescriptions in the geriatric population of our establishment. The study conducted is a targeted clinical audit. Ten criteria were tested on the hospital prescriptions of people over 75 years old in 11 medical departments, before and after improvement actions. The non-compliance threshold was set at 10% of prescriptions for each criterion. In each phase, 165 patients were included. Four criteria were non-compliant (NC) in the first phase: the presence of Potentially Inappropriate Medications for the Elderly (PIMs) (NC = 57.6%), the adaptation of the medication to renal clearance (NC = 24.9%), the presence of illogical combination (NC = 9.7%), and the total anti-cholinergic score of the prescription (NC = 12.1%). After the implementation of improvement actions, the number of non-compliant criteria decreased between the two phases, from four to two. We obtained a significant improvement for three of the four criteria found to be non-compliant in the first phase. The criterion adaptation to renal function is close to compliance (NC = 10.1%) and the PIMs criterion remained non-compliant after reassessment (NC = 32.1%). Vigilance must be ongoing in order to limit drug iatrogeny, particularly in frail elderly patients.
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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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Rochoy M, Dubois S, Glantenet R, Gautier S, Lambert M. Le rebond d’acidité gastrique après arrêt d’un inhibiteur de la pompe à protons : revue narrative de littérature. Therapie 2018; 73:237-246. [DOI: 10.1016/j.therap.2017.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 08/31/2017] [Indexed: 12/12/2022]
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Duwicquet F, Gras-Champel V, Masmoudi K. Hyperprolactinémie avec galactorrhée induites par le lansoprazole : à propos d’un cas. Therapie 2017; 72:691-693. [DOI: 10.1016/j.therap.2017.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 05/30/2017] [Accepted: 06/01/2017] [Indexed: 12/12/2022]
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Selby K, Cornuz J, Cohidon C, Gaspoz JM, Senn N. How do Swiss general practitioners agree with and report adhering to a top-five list of unnecessary tests and treatments? Results of a cross-sectional survey. Eur J Gen Pract 2017; 24:32-38. [PMID: 29168409 PMCID: PMC5795744 DOI: 10.1080/13814788.2017.1395018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND In 2014, the 'Smarter Medicine' campaign released a top five list of unnecessary tests and treatments in Swiss primary care, such as imaging for acute low-back pain and long-term prescribing of proton pump inhibitors. OBJECTIVES Measure general practitioners' (GPs) agreement with the recommendations and self-reported adherence. METHODS Cross-sectional, online survey of GPs in the 'Swiss primary care active monitoring' (SPAM) network, which assessed awareness of 'Smarter Medicine' and views on each recommendation. Questions included whether the clinical situation is common, whether the recommendation is followed, whether GPs agree with the recommendation and reasons why the recommendation would not be followed. RESULTS One-hundred-and-sixty-seven of 277 GPs from the SPAM network participated (60%), of which 104 (62%) knew of 'Smarter Medicine', including 79% in German areas, 49% in French areas and 38% in Italian areas (P < 0.001). Agreement with the five recommendations was high, with scores around nine out of 10. The proportion saying they typically follow each recommendation was 68 to 74%, except not continuing long-term PPI prescriptions without attempting dose reduction, with only 34%. Common reasons for not following the recommendations were patient or other provider requests and situations that might suggest the need for more aggressive care. CONCLUSION Two years after the launch of the campaign, awareness and acceptance of 'Smarter Medicine' appear to be high among Swiss GPs. By self-report, the recommendations are adhered to by most of the respondents but there may be room for improvement, especially for long-term PPI prescriptions.
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Affiliation(s)
- Kevin Selby
- a Department of Ambulatory Care and Community Medicine , University of Lausanne , Lausanne , Switzerland.,b Division of Research , Kaiser Permanente Northern California , Oakland , CA , USA
| | - Jacques Cornuz
- a Department of Ambulatory Care and Community Medicine , University of Lausanne , Lausanne , Switzerland
| | - Christine Cohidon
- a Department of Ambulatory Care and Community Medicine , University of Lausanne , Lausanne , Switzerland.,c Institute of Family Medicine , University of Lausanne , Lausanne , Switzerland
| | - Jean-Michel Gaspoz
- d Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine , Geneva University Hospitals and Faculty of Medicine, University of Geneva , Geneva , Switzerland
| | - Nicolas Senn
- a Department of Ambulatory Care and Community Medicine , University of Lausanne , Lausanne , Switzerland.,c Institute of Family Medicine , University of Lausanne , Lausanne , Switzerland
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Sauvaget L, Rolland L, Dabadie S, Desblaches J, Bernard N, Vandenhende MA, Bonnet F, Pédeboscq S, Morlat P. Rapport sur l’utilisation des inhibiteurs de la pompe à protons : les recommandations françaises sont-elles respectées ? Rev Med Interne 2015; 36:651-7. [DOI: 10.1016/j.revmed.2015.04.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 04/07/2015] [Accepted: 04/29/2015] [Indexed: 12/13/2022]
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Kim JH, Park SH, Cho CS, Lee ST, Yoo WH, Kim SK, Kang YM, Rew JS, Park YW, Lee SK, Lee YC, Park W, Lee DH. Preventive efficacy and safety of rebamipide in nonsteroidal anti-inflammatory drug-induced mucosal toxicity. Gut Liver 2013; 8:371-9. [PMID: 25071901 PMCID: PMC4113040 DOI: 10.5009/gnl.2014.8.4.371] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 06/16/2013] [Accepted: 07/05/2013] [Indexed: 11/30/2022] Open
Abstract
Background/Aims The use of proton pump inhibitors or misoprostol is known to prevent the gastrointestinal complications of nonsteroidal anti-inflammatory drugs (NSAIDs). Rebamipide is known to increase the mucosal generation of prostaglandins and to eliminate free oxygen radicals, thus enhancing the protective function of the gastric mucosa. However, it is unknown whether rebamipide plays a role in preventing NSAID-induced gastropathy. The aim of this study was to determine the effectiveness of rebamipide compared to misoprostol in preventing NSAID-induced gastrointestinal complications in patients requiring continuous NSAID treatment. Methods We studied 479 patients who required continuous NSAID treatment. The patients were randomly assigned to groups that received 100 mg of rebamipide three times per day or 200 μg of misoprostol three times per day for 12 weeks. The primary endpoint of the analysis was the occurrence rate of gastric ulcers, as determined by endoscopy after 12 weeks of therapy. Results Of the 479 patients in the study, 242 received rebamipide, and 237 received misoprostol. Ultimately, 44 patients (18.6%) withdrew from the misoprostol group and 25 patients (10.3%) withdrew from the rebamipide group. There was a significant difference in withdrawal rate between the two groups (p=0.0103). The per protocol analysis set was not valid because of the dropout rate of the misoprostol group; thus, the intention to treat (ITT) analysis set is the main set for the efficacy analysis in this study. After 12 weeks, the occurrence rate of gastric ulcers was similar in the rebamipide and misoprostol groups (20.3% vs 21.9%, p=0.6497) according to ITT analysis. In addition, the therapeutic failure rate was similar in the rebamipide and misoprostol groups (13.6% vs 13.1%, p=0.8580). The total severity score of the gastrointestinal symptoms was significantly lower in the rebamipide group than in the misoprostol group (p=0.0002). The amount of antacid used was significantly lower in the rebamipide group than in the misoprostol group (p=0.0258). Conclusions Rebamipide can prevent gastric ulcers when used with NSAIDs and can decrease the gastrointestinal symptoms associated with NSAID administration. When the possibility of poor compliance and the potential adverse effects of misoprostol are considered, rebamipide appears to be a clinically effective and safe alternative.
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Affiliation(s)
- Jeong Ho Kim
- Department of Gastroenterology, Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Soo-Heon Park
- Department of Gastroenterology, Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Chul-Soo Cho
- Department of Rheumatology, Yeouido St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Soo Teik Lee
- Department of Gastroenterology, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea
| | - Wan-Hee Yoo
- Department of Rheumatology, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea
| | - Sung Kook Kim
- Department of Gastroenterology, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Young Mo Kang
- Department of Rheumatology, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jong Sun Rew
- Department of Gastroenterology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Yong-Wook Park
- Department of Rheumatology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Soo Kon Lee
- Department of Rheumatology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Chan Lee
- Department of Gastroenterology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Won Park
- Department of Rheumatology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Don-Haeng Lee
- Department of Gastroenterology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
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