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Fuentes-Valenzuela E, Díez Redondo P, Tejedor-Tejada J, Nájera-Muñoz R, Sánchez-Delgado L, Maroto-Martín C. [Proton-pump inhibitors treatment. Does your patient really need it?]. Semergen 2021; 48:82-87. [PMID: 34728148 DOI: 10.1016/j.semerg.2021.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 08/08/2021] [Accepted: 08/19/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Proton-pump inhibitors (PPI) are frequently prescribed for wide gastrointestinal disorders. The indications are well established, although a high rate of misuse has been reported. METHODS Observation cross-sectional study conducted a tertiary hospital. Adult patients who attended the emergency department were eligible. The appropriate indication was evaluated. Also, the prescription period, dosage and the prescribing clinician were reviewed. RESULTS 300 patients were included. The indication was adequate in 142 patients (47.3%). The main indication was the primary prophylaxis for NSAIDs/ASA-induced enteropathy (n=95 patients, 31.7%). Polypharmacy was the main misuse indication (n=82 patients, 27.3%). The median prescription duration was 31 months (IQR 9-72), ranging from one month to 360 months. The duration was lower in those with correct indication (42.3 vs 59.6 months, P=.02). The primary care physician was the main responsible for prescription (n=165 patients, 55%), followed by gastroenterologist (n=38 patients, 12.7%) without significant differences in appropriateness by speciality. CONCLUSIONS Studies like this raise awareness about the PPI overuse and misuse. Deprescribing should be considered as essential to reduce iatrogenic risk and redundant health expenditure.
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Affiliation(s)
| | - P Díez Redondo
- Servicio de Digestivo, Hospital Universitario Rio Hortega, Valladolid, España
| | - J Tejedor-Tejada
- Servicio de Digestivo, Hospital Universitario Rio Hortega, Valladolid, España
| | - R Nájera-Muñoz
- Servicio de Digestivo, Hospital Universitario Rio Hortega, Valladolid, España
| | - L Sánchez-Delgado
- Servicio de Digestivo, Hospital Universitario Rio Hortega, Valladolid, España
| | - C Maroto-Martín
- Servicio de Digestivo, Hospital Universitario Rio Hortega, Valladolid, España
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Granero-Melcon B, Morrás I, Galán-DeJuana M, Abad-Santos F. Appropriateness of the use of proton pump inhibitors in the Emergency Department of a Spanish university hospital. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2018; 110:755-761. [PMID: 30362359 DOI: 10.17235/reed.2018.5468/2018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND the use of proton pump inhibitors (PPI) has increased substantially during the last years, possibly due to a significant proportion of prescriptions that do not follow the approved indications. OBJECTIVE to assess the prevalence of PPI prescription and the appropriateness of the prescription within the Emergency Department (ED) of a Spanish university hospital. MATERIALS AND METHODS a cross-sectional, retrospective prescription-indication drug-use study was performed, which selected 384 patients that presented to the ED over two days in January 2016. RESULTS of the total cohort, 23.2% were taking PPI before their hospital visit and only 20.2% had a correct indication and dosage; 2.9% of the patient cohort had an indication for PPI treatment but had not been prescribed them. A drug other than omeprazole was used in 25% of cases; 30.47% of the patients were discharged with a PPI and only 28.2% of them had the correct indication and dosage. Finally, 5.7% were not prescribed PPI even though it was warranted. PPI prescription increased with age whereas the indication for the prescription decreased. Furthermore, the use of these drugs was higher in hospitalized patients compared to discharged patients. CONCLUSIONS these results are in line with similar studies, which demonstrate the existence of an over-prescription of PPI. PPI prescription needs to be improved, thereby reducing drug interactions, adverse effects and unnecessary economical expenses.
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[Facing a dilemma in elderly complex and vulnerable patients: to stop or not to stop prevention?]. Aten Primaria 2017; 50:583-589. [PMID: 29221946 PMCID: PMC6837059 DOI: 10.1016/j.aprim.2017.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/16/2017] [Accepted: 05/29/2017] [Indexed: 11/30/2022] Open
Abstract
Objetivo a) Conocer la prescripción preventiva (estatinas, antiagregantes, bifosfonatos, calcio/vitamina D y vitamina B12) de los pacientes con patología crónica compleja (PCC) y de los pacientes con enfermedad crónica avanzada (ENCA) y esperanza de vida inferior a 12 meses que fallecieron durante el 2015. b) Valorar la correcta indicación en el uso de inhibidores de la bomba de protones (IBP) para determinar medicación evitable. Diseño Estudio transversal retrospectivo. Emplazamiento Cuatro centros de salud de Castellar del Vallès, Barcelona. Participantes Un total de 128 pacientes (70 ENCA y 58 PCC). Variables Fármacos activos en el momento de morir de los 6 grupos seleccionados, desprescripción (6 meses previos a la muerte por motivos de enfermedad crónica avanzada), indicación en prevención primaria o secundaria y adecuación en la prescripción IBP. Resultados Edad media en el momento de la muerte: 85,3 (10,3) años. El 40% de PCC/ENCA tomaban un antiagregante. En el 60% de los ENCA que tomaban un antiagregante no había evento cardiovascular previo. El 20% de PCC/ENCA tomaban una estatina y en el 48% de los casos por prevención primaria. La prescripción total de IBP fue del 67%, con indicación inadecuada del 49%. El 20% tomaban calcio/vitamina D y un 1,6% de los ENCA un bifosfonato. Hubo un 16% de desprescripción. Conclusiones Un porcentaje elevado de pacientes con enfermedad crónica avanzada y esperanza de vida corta siguen tomando tratamientos preventivos hasta sus últimos días, evitables en muchos casos y no exentos de efectos secundarios. Deberíamos aumentar la desprescripción de medicamentos con beneficios a largo plazo en este grupo de pacientes.
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Hernández-Arroyo MJ, Díaz-Madero A, Enríquez-Gutiérrez E, Teijeiro-Bermejo MC, Sáez-Rodríguez E, Gutiérrez-Martín MR. [Analysis of the use of proton pump inhibitors in primary health care]. Semergen 2017; 44:316-322. [PMID: 29153640 DOI: 10.1016/j.semerg.2017.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 07/20/2017] [Accepted: 08/16/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The increase in the consumption of anti-ulcer drugs is accompanied by a high rate of incorrect use. The objectives of this study were to analyse the adequacy of repeat prescriptions of proton pump inhibitors (PPIs) in a Medical Centre, and to evaluate the efficacy of an improvement intervention. MATERIAL AND METHOD A cross-sectional, descriptive and observational study of prevalence was conducted on patients in a medical centre under treatment with PPIs for at least 3consecutive months (November 2016-January 2017). An analysis was performed that included the indication, dosage and time of treatment with PPIs, drug interactions, and possible risks that could be related with their use. An intervention was carried out to optimise rational and efficient prescribing of these medicines. RESULTS A total of 703 patients were included in the study, which is 5.4% of the total adult patients that are assigned to the centre. Adequacy criteria were not met by 436 (62.0%). Of these, 52.5% were women, 70.0% were over 65 years old, and had been on treatment for a mean of 2.7 ± 1.9 years. Interactions were observed in 48.1%, and 29.0% had some risk factors. After the intervention, the inadequate prescribing was corrected in 112 (25.7%) patients, which was a reduction of 46.1% (P<.001). CONCLUSIONS There is a high prevalence of prescription and inadequacy of PPIs in the long term. This suggests that it is necessary to improve training of professionals to strengthen rational use and to reduce risks. The launch of an intervention programme has led to the revision and optimisation of treatments.
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Affiliation(s)
- M J Hernández-Arroyo
- Servicio de Farmacia de Atención Primaria, Gerencia de Asistencia Sanitaria de Zamora, Zamora, España.
| | - A Díaz-Madero
- Servicio de Farmacia de Atención Primaria, Gerencia de Asistencia Sanitaria de Zamora, Zamora, España
| | | | - M C Teijeiro-Bermejo
- Unidad Docente de Medicina Familiar y Comunitaria, Gerencia de Asistencia Sanitaria de Zamora, Zamora, España
| | - E Sáez-Rodríguez
- Unidad Docente de Medicina Familiar y Comunitaria, Gerencia de Asistencia Sanitaria de Zamora, Zamora, España
| | - M R Gutiérrez-Martín
- Unidad Docente de Medicina Familiar y Comunitaria, Gerencia de Asistencia Sanitaria de Zamora, Zamora, España
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Mares-García E, Palazón-Bru A, Martínez-Martín Á, Folgado-de la Rosa DM, Pereira-Expósito A, Gil-Guillén VF. Non-guideline-recommended prescribing of proton pump inhibitors in the general population. Curr Med Res Opin 2017; 33:1725-1729. [PMID: 28318318 DOI: 10.1080/03007995.2017.1308921] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To determine the magnitude of non-guideline-recommended prescribing (NGRP) of proton pump inhibitors (PPIs) in the general population, its associated factors and expense. METHODS We undertook a cross-sectional observational study in three community pharmacies in a Spanish region in 2013 involving a total of 302 patients with a prescription for PPIs. The main variable was the NGRP of PPIs. Secondary variables were: gender, age, antidepressants, osteoporosis, osteoarthritis, prescription cost per month and total number of chronic diseases. The cost associated with NGRP was calculated. To evaluate the associated factors, a multivariate binary logistic regression model was constructed and the adjusted odds ratios (OR) were obtained. RESULTS NGRP was observed in 192 cases (63.6%). The average cost associated with NGRP per prescription was 3.24 euros per month. The factors significantly associated with NGRP (p < .05) were: antidepressants (OR = 2.66, p = .001), osteoporosis (OR = 3.53, p = .001), osteoarthritis (OR = 3.57, p < .001) and number of chronic diseases (OR = 0.73, p = .003). CONCLUSION A novel approach was used to quantify the NGRP of PPIs in a Spanish community, as well as the associated economic costs. Qualitative studies are needed to better understand the causes of NGRP of PPIs. This analysis will aid in designing interventions to minimize this problem. LIMITATIONS Qualitative studies are needed to better understand the attitude of health professionals when prescribing PPIs.
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Affiliation(s)
- Emma Mares-García
- a Department of Clinical Medicine , Miguel Hernández University , San Juan de Alicante , Alicante , Spain
| | - Antonio Palazón-Bru
- a Department of Clinical Medicine , Miguel Hernández University , San Juan de Alicante , Alicante , Spain
| | - Álvaro Martínez-Martín
- a Department of Clinical Medicine , Miguel Hernández University , San Juan de Alicante , Alicante , Spain
| | | | | | - Vicente Francisco Gil-Guillén
- a Department of Clinical Medicine , Miguel Hernández University , San Juan de Alicante , Alicante , Spain
- b Research Unit, General University Hospital of Elda , Elda , Alicante , Spain
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de la Coba Ortiz C, Argüelles Arias F, Martín de Argila de Prados C, Júdez Gutiérrez J, Linares Rodríguez A, Ortega Alonso A, Rodríguez de Santiago E, Rodríguez-Téllez M, Vera Mendoza MI, Aguilera Castro L, Álvarez Sánchez Á, Andrade Bellido RJ, Bao Pérez F, Castro Fernández M, Giganto Tomé F. Proton-pump inhibitors adverse effects: a review of the evidence and position statement by the Sociedad Española de Patología Digestiva. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2017; 108:207-24. [PMID: 27034082 DOI: 10.17235/reed.2016.4232/2016] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION In the last few years a significant number of papers have related the use of proton-pump inhibitors (PPIs) to potential serious adverse effects that have resulted in social unrest. OBJECTIVE The goal of this paper was to provide a literature review for the development of an institutional position statement by Sociedad Española de Patología Digestiva (SEPD) regarding the safety of long-term PPI use. MATERIAL AND METHODS A comprehensive review of the literature was performed to draw conclusions based on a critical assessment of the following: a) current PPI indications; b) vitamin B12 deficiency and neurological disorders; c) magnesium deficiency; d) bone fractures; e) enteric infection and pneumonia; f) interactions with thienopyridine derivatives; e) complications in cirrhotic patients. RESULTS Current PPI indications have remained unchanged for years now, and are well established. A general screening of vitamin B12 levels is not recommended for all patients on a PPI; however, it does seem necessary that magnesium levels be measured at therapy onset, and then monitored in subjects on other drugs that may induce hypomagnesemia. A higher risk for bone fractures is present, even though causality cannot be concluded for this association. The association between PPIs and infection with Clostridium difficile is mild to moderate, and the risk for pneumonia is low. In patients with cardiovascular risk receiving thienopyridines derivatives it is prudent to adequately consider gastrointestinal and cardiovascular risks, given the absence of definitive evidence regardin potential drug-drug interactions; if gastrointestinal risk is found to be moderate or high, effective prevention should be in place with a PPI. PPIs should be cautiously indicated in patients with decompensated cirrhosis. CONCLUSIONS PPIs are safe drugs whose benefits outweigh their potential side effects both short-term and long-term, provided their indication, dosage, and duration are appropriate.
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Affiliation(s)
| | | | | | - Javier Júdez Gutiérrez
- Departamento de Gestión del Conocimiento, Sociedad Española de Patología Digestiva SEPD, España
| | | | - Aida Ortega Alonso
- UGC Enfermedades Digestivas, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, España
| | | | - Manuel Rodríguez-Téllez
- UGC Intercentros de Aparato Digestivo , Hospital Universitario Virgen de la Macarena (HUVM), España
| | | | | | - Ángel Álvarez Sánchez
- Servicio de Aparato Digestivo, Hospital Clínico San Carlos. Universidad Complutense de Madrid., España
| | - Raúl Jesús Andrade Bellido
- Unidad de Gestión Clinica de Aparato Digestivo, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, España
| | | | | | - Froilán Giganto Tomé
- Servicio de Aparato Digestivo, Hospital Universitario Central de Asturias, España
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Aguilera-Castro L, Martín-de-Argila-dePrados C, Albillos-Martínez A. Practical considerations in the management of proton-pump inhibitors. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2017; 108:145-53. [PMID: 26666270 DOI: 10.17235/reed.2015.3812/2015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Proton-pump inhibitors (PPIs) are one of the most active ingredients prescribed in Spain. In recent decades there has been an overuse of these drugs in both outpatient clinics and hospitals that has lead to a significant increase in healthcare spending and to an increase in the risk of possible side effects. It is important for health professionals to know the accepted indications and the correct doses for the use of these drugs. On the market there are different types of PPI: omeprazole, pantoprazole, lansoprazole, rabeprazole and esomeprazole. Omeprazole is the oldest and most used PPI, being also the cheapest. Although there are no important differences between PPIs in curing diseases, esomeprazole, a new-generation PPI, has proved to be more effective in eradicating H. pylori and in healing severe esophagitis compared to other PPIs. In recent years the use of generic drugs has spread; these drugs have the same bioavailability than the original drugs. In the case of PPIs, the few comparative studies available in the literature between original and generic drugs have shown no significant differences in clinical efficacy.
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Margüello MS, Garrastazu R, Ruiz-Nuñez M, Helguera JM, Arenal S, Bonnardeux C, León C, Miravitlles M, García-Rivero JL. Independent effect of prior exacerbation frequency and disease severity on the risk of future exacerbations of COPD: a retrospective cohort study. NPJ Prim Care Respir Med 2016; 26:16046. [PMID: 27604472 PMCID: PMC5015428 DOI: 10.1038/npjpcrm.2016.46] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 05/17/2016] [Accepted: 06/06/2016] [Indexed: 01/26/2023] Open
Abstract
Few studies have researched the independent effect of COPD severity on the risk of future exacerbations adjusted by previous exacerbation frequency. We aimed to analyse the independent effect of COPD severity on the risk of exacerbations in the following year, and whether this effect was stronger or not than the effect of a previous history of exacerbations. We conducted a retrospective population-based cohort study including 900 patients with confirmed COPD. Exacerbation frequency was observed for the previous year and for the following year. Patients were defined as ‘Frequent Exacerbator’ (FE) phenotype if they suffered ⩾2 exacerbations in a year, and were categorised according to the severity of COPD (GOLD Grades 1–4). Odds ratios (ORs) were estimated by logistic regression adjusting for age, gender, smoking status, severity of COPD and being FE in the previous year. The main predictor of being FE among all grades of COPD severity was a history of frequent exacerbations in the previous year: adjusted OR 4.97; 95% confidence interval (CI) (3.54–6.97). COPD severity was associated with a higher risk of being FE: Crude OR GOLD Grade 4 3.86; 95% CI (1.50–9.93). However, this association diminished after adjusting for being FE in the previous year: adjusted OR 2.08; 95% CI (0.75–5.82). Our results support that a history of frequent exacerbations in the previous year is the most important independent predictor of exacerbations in the following year, also among the most severe COPD patients. Severity of COPD would be associated with a higher risk of exacerbations, but this effect would be partly determined by the exacerbations suffered in the previous year.
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Affiliation(s)
| | - Roberto Garrastazu
- Centro de Salud de Gama, Servicio Cántabro de Salud, Bárcena de Cicero, Spain
| | - Mario Ruiz-Nuñez
- Centro de Salud de Liérganes, Servicio Cántabro de Salud, Miera, Spain
| | | | - Sandra Arenal
- Centro de Salud de Suances, Servicio Cántabro de Salud, Suances, Spain
| | - Cristina Bonnardeux
- Centro de Salud Campoo-Los Valles, Servicio Cántabro de Salud, Mataporquera, Spain
| | - Carlos León
- Centro de Salud de Suances, Servicio Cántabro de Salud, Suances, Spain
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron; CIBER of respiratory diseases (CIBERESP), Barcelona, Spain
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Padilla Luz A, Reyes Rodríguez JF, Gómez Rodríguez de Acuña A, González Gómez CM, Álvarez Dorta I, Pérez Cánovas ME. [Prescription appropriateness: Indication of citicoline in Primary Care]. Semergen 2014; 41:199-205. [PMID: 25016945 DOI: 10.1016/j.semerg.2013.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 09/24/2013] [Accepted: 09/29/2013] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The economic situation has made it necessary to optimize resources by adjusting the pharmaceutical expenditure. Citicoline was (2011) the 10th drug by rank of billed amount. Its approved indications are stroke (acute and sub-acute) and head injury, but not cognitive decline associated with age, the presumed indication for most of its use. OBJECTIVES To assess the conditions of use of citicoline in the Health Area of Tenerife, in order to detect deviations from the indications of use as stipulated in the prescribing information sheet and the pattern of prescription, with emphasis on the analysis of its use in dementia where currently it has no indication or evidence to support it. METHOD Cross-sectional study of prescription-indication. A 680 patient sample, segmented by reference hospital (error±5%; CI: 0.95%; P=0.5) was taken from the 4036 patients with a prescription of citicoline billed during august-october 2011 (obtained from the prescription database program, Farmacanarias). RESULTS We found that 123 patients (18.1%) had an appropriate indication. By including the prescription regimen, 28 patients (4.1%) had adequate indication and dose levels, and in only 2 patients (0.2%) an appropriate indication, dosage and duration were found. CONCLUSIONS "The correct prescription-indication" of citicoline is inappropiate in almost all patients studied. Impact actions are needed in order to optimize prescription, improve patient safety by reducing potential interactions, and the occurrence of adverse effects, and improve efficiency by promoting savings.
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Affiliation(s)
- A Padilla Luz
- Departamento de Farmacia, Gerencia de Atención Primaria, Área de Salud de Tenerife, Servicio Canario de la Salud, Santa Cruz de Tenerife, España.
| | - J F Reyes Rodríguez
- Área Técnica de Salud Pública, Gerencia de Atención Primaria, Área de Salud de Tenerife, Servicio Canario de la Salud, Santa Cruz de Tenerife, España
| | - A Gómez Rodríguez de Acuña
- Departamento de Farmacia, Gerencia de Atención Primaria, Área de Salud de Tenerife, Servicio Canario de la Salud, Santa Cruz de Tenerife, España
| | - C M González Gómez
- Departamento de Farmacia, Gerencia de Atención Primaria, Área de Salud de Tenerife, Servicio Canario de la Salud, Santa Cruz de Tenerife, España
| | - I Álvarez Dorta
- Departamento de Farmacia, Gerencia de Atención Primaria, Área de Salud de Tenerife, Servicio Canario de la Salud, Santa Cruz de Tenerife, España
| | - M E Pérez Cánovas
- Dirección Médica, Gerencia de Atención Primaria, Área de Salud de Tenerife, Servicio Canario de la Salud, Santa Cruz de Tenerife, España
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Zamorano JL, García-Moll X, Ferrari R, Greenlaw N. Características demográficas y clínicas de los pacientes con enfermedad coronaria estable: resultados del registro CLARIFY en España. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.10.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Valoración de la idoneidad de los criterios STOPP/START en el ámbito de atención primaria en España por el método RAND. Semergen 2013; 39:413-20. [DOI: 10.1016/j.semerg.2013.01.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 12/21/2012] [Accepted: 01/13/2013] [Indexed: 01/09/2023]
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López-Dóriga Bonnardeaux P, Neira Álvarez M, Mansilla Laguía S. [Proton bomb inhibitors: a study of the prescription in a functional recovery unit]. Rev Esp Geriatr Gerontol 2013; 48:269-71. [PMID: 24099902 DOI: 10.1016/j.regg.2013.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Revised: 07/18/2013] [Accepted: 07/22/2013] [Indexed: 01/12/2023]
Abstract
INTRODUCTION The use of proton pump inhibitors (PPI) has increased exponentially since they were introduced. However concerns have been raised regarding the appropriateness of these prescriptions, and the potential side effects, particularly in frail elderly people, as well as the cost of this treatment. The aim of this study was to assess the extent and appropriateness of PPI prescribing in a group of patients over 65 years old admitted to the functional recovery unit of a medium-stay hospital. MATERIALS AND METHODS A retrospective review of inpatient prescribing of PPI was carried out in a functional recovery unit in Hospital de la Fuenfría, selecting those older than 65 years, who were admitted during 2011. Data obtained from medical records included, prescription of a PPI before admission and at the time of discharge from hospital (both acute care hospital and Hospital de la Fuenfría), type of PPI, and indications for their prescription. RESULTS Inclusion criteria were met by 296 patients (mean age 78.8 years, 70.6% females). A total of 45.3, 79.1 and 75.5% of patients were on PPIs before admission, and at the time of being discharge from acute care hospital, and Hospital de la Fuenfría, respectively. A valid indication for therapy was not apparent in 62.7, 30.8 and 54.2% of them. Omeprazole was the most widely prescribed PPI. CONCLUSIONS There appears to be a widespread and inappropriate use of PPIs in hospital practice. Interventions are needed to curtail this inappropriate prescribing practice, avoiding side effects and drug interactions.
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[Evaluation of the incidence of upper gastrointestinal bleeding in Spain in relation to the taking of anti-ulcer agents]. Aten Primaria 2012; 44:478-84. [PMID: 22657738 DOI: 10.1016/j.aprim.2012.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 12/13/2011] [Accepted: 01/24/2012] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To analyse trends in the incidence of hospitalisation due to upper gastrointestinal bleeding (UGB) and the relationship with the prescribing of anti-ulcer agents. DESIGN Retrospective observational ecological study. SETTING Spanish National Health System (NHS) for the nine years between 1st January 2000 and 31st December 2008. PARTICIPANTS INCLUSION CRITERIA Patients aged 15 or over hospitalised due to UGB were divided into four age groups: 15-44, 45-64, 65-74 and ≥75 years old. Drugs, A02B subgroup, prescribed under the NHS. EXCLUSION CRITERIA Prescription of medicines in hospital or public-employee insurance companies. MEASUREMENTS Incidence (number of new cases of UGB occurring in one year), Incidence rate (incidence per 100,000 inhabitants), Dispersion rate (number of packets dispensed per year per 100,000 inhabitants), and Hazard ratio (HR, ratio between the rate of the last year over the first year. Annual rates were calculated by the standardised direct method). DATA SOURCE Ministry of Health. RESULTS We identified 110,150 hospital admissions due to UGB (61.17% male, 38.83% female). Values for 95% UGB: Total Mean Incidence Rate (MIR)=34.45 [32.70, 36.20], HR=0.83. Males: MIR=43.07 [40.41, 45.72], HR=0.80 and females: MIR=25.20 [25.18, 27.23], HR=0.88. HR HDA by age group in males: 15-44 years=0.64; 45-64 years=0.74, 65-74 years=0.74 and >74 years=0.85. Females: 15-44 years=0.82, 45-64 years=0.71, 65-74 years=0.3 and >74 years=0.89. Drug dispensing (2000-2008): HR proton pump inhibitors=4.43; HR all anti-ulcer agents=3.01. CONCLUSIONS Over nine years the dispensing of anti-ulcer agents by the Spanish National Health System has multiplied without having regard to the evolutionary trend of hospitalisation due to UGB.
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Sanjosé-Rodríguez AI, Velarde-Mayol C, Gómez De Caso-Canto JA. [Clinical practice variations: quality of prescription of proton pump inhibitors]. REVISTA DE CALIDAD ASISTENCIAL : ORGANO DE LA SOCIEDAD ESPANOLA DE CALIDAD ASISTENCIAL 2012; 27:182-183. [PMID: 22463848 DOI: 10.1016/j.cali.2012.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Accepted: 01/29/2012] [Indexed: 05/31/2023]
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Rosich I, Allepuz A, Alba G, Benages N, Arranz T. [The efficiency of drug prescription: impact of a therapeutic exchange program]. GACETA SANITARIA 2011; 26:58-64. [PMID: 21993073 DOI: 10.1016/j.gaceta.2011.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 06/08/2011] [Accepted: 06/15/2011] [Indexed: 10/16/2022]
Abstract
OBJECTIVE To assess the impact of substituting proton pump inhibitors (PPI) for omeprazole. METHOD We performed a community trial of the impact of a therapeutic exchange program in the primary care teams of a region compared with non-implementation in a control region. The study included patients prescribed a PPI between May 2008 and June 2009. The intervention consisted of providing educational sessions to physicians (n=68), as well as a list of patients receiving a PPI who were suitable for therapeutic exchange. Information was gathered from medical records (PPI prescribed, primary care team) and the pharmacy database (cost of defined daily doses of the PPI). The percentage of therapeutic exchange in each region before and after the intervention was compared through relative risk (RR). The percentage of omeprazole at the end of each study period and changes in PPI costs were also calculated. RESULTS Therapeutic exchange was higher in the intervention group (RR: 4.2; 95%CI: 3.1-5.8) than in the control group (RR: 1.8; 95%CI: 1.2-2.6). The percentage of patients prescribed omeprazole increased from 86.2% to 89.3% in the intervention region and from 84.3% to 84.7% in the control region. The total cost of the PPI group decreased by 7.6% in the intervention region and increased by 2.0% in the control group. CONCLUSIONS This study demonstrates the effectiveness of the therapeutic exchange program. This is a simple intervention that is able to modify prescription and reduce its costs.
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Affiliation(s)
- Isabel Rosich
- Servicio de Atención Primaria Alt Penedès-Garraf, Insituto Catalán de la Salud, Vilanova i la Geltrú, Barcelona, España.
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Association between proton pump inhibitors and respiratory infections: a systematic review and meta-analysis of clinical trials. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2009; 22:761-6. [PMID: 18818790 DOI: 10.1155/2008/821385] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Proton pump inhibitors (PPIs) have become the mainstay of treatment for and prevention of many serious gastrointestinal diseases. Laboratory and clinical evidence suggests that the increase in gastric pH caused by PPIs may be linked to increased bacterial colonization of the stomach and may predispose patients to an increased risk for respiratory infections. OBJECTIVE To examine the association between PPI treatment and respiratory infections. METHODS A literature search was conducted using PubMed, MEDLINE and Cochrane databases of randomized, placebo-controlled trials evaluating the efficacy of PPIs. Studies that listed and quantified the specific adverse events of 'respiratory infection' or 'upper respiratory infection' (or equivalent), and compared their rates between PPIs and placebo were included. The chi(2) analysis was used to calculate the significance of association in individual studies and a meta-analysis of the selected studies was performed. RESULTS Of 7457 studies initially identified and 70 relevant randomized, controlled trials (RCTs) selected, seven studies met the inclusion criteria. A total of 16 comparisons for chi(2) analysis were possible given the multiple dosage arms used in several studies. PPIs included in the studies were esomeprazole, rabeprazole, pantoprazole and omeprazole. More than one-half of the studies showed a trend toward an association between PPI use and respiratory infections, although the majority of the studies failed to show a significant correlation. A single study using high-dose esomeprazole (40 mg) showed a significant association -4.3% rate of respiratory infections in the active group compared with 0% in the placebo group (P<0.05). Meta-analysis showed a trend toward an association between PPIs and respiratory infections, although it failed to reach significance (OR 1.42, 95% CI 0.86 to 2.35; P=0.17). CONCLUSION Although a trend was evident in both a chi(2) analysis of individual studies and a meta-analysis, the present review and meta-analysis failed to show a conclusive association between PPIs and respiratory infections. Very few RCTs actively sought out respiratory infections, which excluded the majority of RCTs identified. A well-structured, placebo-controlled prospective study would be needed to determine whether a true association between PPIs and respiratory infections exists.
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