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Shanika LGT, Reynolds A, Pattison S, Braund R. Proton pump inhibitor use: systematic review of global trends and practices. Eur J Clin Pharmacol 2023; 79:1159-1172. [PMID: 37420019 PMCID: PMC10427555 DOI: 10.1007/s00228-023-03534-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 06/27/2023] [Indexed: 07/09/2023]
Abstract
PURPOSE Proton pump inhibitors (PPIs) reduce acid secretion in the stomach and rank as one of the most widely used acid-suppressing medicines globally. While PPIs are safe in the short-term, emerging evidence shows risks associated with long-term use. Current evidence on global PPI use is scarce. This systematic review aims to evaluate global PPI use in the general population. METHODS Ovid MEDLINE, Embase, and International Pharmaceutical Abstracts were systematically searched from inception to 31 March 2023 to identify observational studies on oral PPI use among individuals aged ≥ 18 years. PPI use was classified by demographics and medication factors (dose, duration, and PPI types). The absolute numbers of PPI users for each subcategory were summed and expressed as a percentage. RESULTS The search identified data from 28 million PPI users in 23 countries from 65 articles. This review indicated that nearly one-quarter of adults use a PPI. Of those using PPIs, 63% were less than 65 years. 56% of PPI users were female, and "White" ethnicities accounted for 75% of users. Nearly two-thirds of users were on high doses (≥ defined daily dose (DDD)), 25% of users continued PPIs for > 1 year, and 28% of these continued for > 3 years. CONCLUSION Given the widespread use PPIs and increasing concern regarding long-term use, this review provides a catalyst to support more rational use, particularly with unnecessary prolonged continuation. Clinicians should review PPI prescriptions regularly and deprescribe when there is no appropriate ongoing indication or evidence of benefit to reduce health harm and treatment cost.
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Affiliation(s)
- Lelwala Guruge Thushani Shanika
- New Zealand Pharmacovigilance Centre, University of Otago, 913, Dunedin, 9054, New Zealand
- Department of Pharmacy and Pharmaceutical Science, University of Sri Jayewardenepura, Gangodawila, Sri Lanka
| | - Andrew Reynolds
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Sharon Pattison
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Rhiannon Braund
- New Zealand Pharmacovigilance Centre, University of Otago, 913, Dunedin, 9054, New Zealand.
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Janani TSJ, Risla R, Shanika LGT, Samaranayake NR. The extent of community pharmacists' involvement in detecting and resolving Drug Related Problems (DRPs) in prescriptions – A real time study from Sri Lanka. Exploratory Research in Clinical and Social Pharmacy 2021; 3:100061. [PMID: 35480615 PMCID: PMC9031679 DOI: 10.1016/j.rcsop.2021.100061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 08/01/2021] [Accepted: 08/08/2021] [Indexed: 11/28/2022] Open
Abstract
Background Appropriate medication use is necessary to ensure patient safety. Drug Related Problems (DRPs) could result in patient harm. Purpose To assess the prevalence and types of DRPs in prescriptions, and the proportion of DRPs detected and resolved by community pharmacists during dispensation of prescriptions in a selected community pharmacy. Methods A prospective, cross-sectional study was conducted in a selected community pharmacy in Colombo, Sri Lanka, where one researcher reviewed for DRPs in systematically selected prescriptions (N = 400), and another directly observed the frequency of DRPs identified by community pharmacists in the same set of prescriptions. Actions taken by pharmacists on resolving DRPs were also documented. DRPs were classified according to a slightly modified version of Pharmaceutical Care Network Euro pe classification V8.01. Descriptive and comparative data analysis were performed using SPSS database V.21. P < 0.05 was considered as significant. Results Among 1986 medications, a total of 1211 DRPs were identified by researchers, of which only 441 DRPs were detected by community pharmacists who participated in the study (N = 24). DRPs identified by the researcher were related to medication selection (N = 15), medication form (N = 1), dose selection (N = 817), duration of treatment (N = 128), incomplete prescriptions (N = 128), and other (outdated prescriptions, missing unit of measurements, and ambiguous names of medications that could not be read by both community pharmacists and researcher) (N = 122) of which only one, one, 394, 13, five, and 27 were identified by pharmacists, respectively. Among 441 DRPs identified by pharmacists, 406 were resolved by them. Most DRPs were self-resolved by pharmacists themselves (367/406), while patients were also sent back to the prescriber (13/406), and some dispensation of medications to patients were refused (9/406). Conclusion Among the DRPs frequently observed in the sample of community prescriptions, the community pharmacists identified significantly fewer DRPs in relation to each type identified by the researcher, and pharmacists missed some, including incomplete prescriptions, that had potential to harm. Systematic and sustainable training of pharmacists on performing a preliminary prescription review and continuous education programs must be implemented to improve community pharmacist dispensing practices in this community.
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Affiliation(s)
- Tharmalinga Sharma Jegath Janani
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Sri Soratha Mawatha, Nugegoda, Sri Lanka
- Ministry of Health, Nutrition & Indigenous Medicine, Baddegama Wimalawansa Thero Mawatha, Colombo, Sri Lanka
| | - Rafaideen Risla
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Sri Soratha Mawatha, Nugegoda, Sri Lanka
| | - Lelwala Guruge Thushani Shanika
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Sri Soratha Mawatha, Nugegoda, Sri Lanka
| | - Nithushi Rajitha Samaranayake
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Sri Soratha Mawatha, Nugegoda, Sri Lanka
- Corresponding author at: Department of Pharmacy and Pharmaceutical Sciences, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Sri Soratha Mawatha, Nugegoda 10250, Sri Lanka.
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Samaranayake NR, Balasuriya A, Fernando GH, Samaraweera D, Shanika LGT, Wanigasuriya JKP, Wijekoon CN, Wanigatunge CA. 'Modified STOPP-START criteria for Sri Lanka'; translating to a resource limited healthcare setting by Delphi consensus. BMC Geriatr 2019; 19:282. [PMID: 31640572 PMCID: PMC6805460 DOI: 10.1186/s12877-019-1293-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 09/24/2019] [Indexed: 01/18/2023] Open
Abstract
Background ‘Screening tool of older people’s prescriptions (STOPP) and screening tool to alert to right treatment (START)’ criteria is a useful tool to assess the appropriateness of medicines among older adults. However, the original STOPP/START criteria developed in the West, may not be directly applicable to resource limited healthcare settings like Sri Lanka. Hence, we aimed to modify STOPP/START criteria (Version 2) to suit Sri Lanka. Method Two investigators (a clinical pharmacologist and a pharmacist) reviewed and flagged criteria that were unfeasible to Sri Lanka based on their previous research experiences on using STOPP/START version 1. A Delphi consensus methodology was conducted among six experts, including geriatricians, clinical pharmacologists, physicians and a pharmacist, to review and assess each criterion (including the ones flagged by the researchers) for suitability to Sri Lanka. Results Two Delphi validation rounds were conducted. A final meeting was held with the participation of all experts to resolve disagreements and to establish 100% consensus. The expert panel agreed on a list of 105 criteria, including 70 STOPP and 35 START criteria, indicating an 8% reduction in criteria compared to the original version. Modifications included complete removal (n = 11), re-wording (n = 25), splitting (n = 1) of original criteria and adding a new criterion (n = 1). Main reasons for modifications were unavailability of some medicines in the country, unavailability or inaccessibility of specific clinical information required for assessment of criteria, and adherence to treatment guidelines commonly used in the country. Conclusion A list of ‘Modified STOPP/START criteria for Sri Lanka’ was developed. These criteria are currently being validated through a multi-centre study.
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Affiliation(s)
- N R Samaranayake
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka.
| | | | - G H Fernando
- Department of Pharmacology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - D Samaraweera
- Colombo South Teaching Hospital, Kalubowila, Sri Lanka
| | - L G T Shanika
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - J K P Wanigasuriya
- Department of Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - C N Wijekoon
- Department of Pharmacology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
| | - C A Wanigatunge
- Department of Pharmacology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
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Shanika LGT, Jayamanne S, Wijekoon CN, Coombes J, Perera D, Mohamed F, Coombes I, De Silva HA, Dawson AH. Ward-based clinical pharmacists and hospital readmission: a non-randomized controlled trial in Sri Lanka. Bull World Health Organ 2017. [PMID: 29531414 PMCID: PMC5840627 DOI: 10.2471/blt.17.198366] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective To assess if a ward-based clinical pharmacy service resolving drug-related problems improved medication appropriateness at discharge and prevented drug-related hospital readmissions. Method Between March and September 2013, we recruited patients with noncommunicable diseases in a Sri Lankan tertiary-care hospital, for a non-randomized controlled clinical trial. The intervention group received usual care and clinical pharmacy service. The intervention pharmacist made prospective medication reviews, identified drug-related problems and discussed recommendations with the health-care team and patients. At discharge, the patients received oral and written medication information. The control group received usual care. We used the medication appropriateness index to assess appropriateness of prescribing at discharge. During a six-month follow-up period, a pharmacist interviewed patients to identify drug-related hospital readmissions. Results Data from 361 patients in the intervention group and 354 patients in the control group were available for analysis. Resolutions of drug-related problems were higher in the intervention group than in the control group (57.6%; 592/1027, versus 13.2%; 161/1217; P < 0.001) and the medication was more appropriate in the intervention group. Mean score of medication appropriateness index per patient was 1.25 versus 4.3 in the control group (P < 0.001). Patients in the intervention group were less likely to be readmitted due to drug-related problems (44 patients of 311 versus 93 of 311 in the control group; P < 0.001). Conclusion A ward-based clinical pharmacy service improved appropriate prescribing, reduced drug-related problems and readmissions for patients with noncommunicable diseases. Implementation of such a service could improve health care in Sri Lanka and similar settings.
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Affiliation(s)
| | | | | | - Judith Coombes
- School of Pharmacy, University of Queensland, Brisbane, Australia
| | - Dhineli Perera
- Department of Pharmacy, Austin Health, Melbourne, Australia
| | - Fahim Mohamed
- Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Ian Coombes
- School of Pharmacy, University of Queensland, Brisbane, Australia
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Perera DMP, Coombes JA, Shanika LGT, Dawson A, Lynch C, Mohamed F, De Silva HA, Jayamanne SF, Peters NB, Myers B, Coombes ID. Opportunities for pharmacists to optimise quality use of medicines in a Sri Lankan hospital: an observational, prospective, cohort study. J Pharm Pract Res 2017. [DOI: 10.1002/jppr.1302] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - Judith Ann Coombes
- School of Pharmacy; University of Queensland; Brisbane Australia
- Department of Pharmacy; Princess Alexandra Hospital; Brisbane Australia
- Collaboration of Australian and Sri Lankans for Pharmacy Practice Education and Research (CASPPER); Brisbane Australia
| | - Lelwala Guruge Thushani Shanika
- Collaboration of Australian and Sri Lankans for Pharmacy Practice Education and Research (CASPPER); Brisbane Australia
- South Asian Clinical Toxicology Research Collaboration; University of Peradeniya; Peradeniya Sri Lanka
- University of Sri Jayewardenapura; Colombo Sri Lanka
| | - Andrew Dawson
- Collaboration of Australian and Sri Lankans for Pharmacy Practice Education and Research (CASPPER); Brisbane Australia
- South Asian Clinical Toxicology Research Collaboration; University of Peradeniya; Peradeniya Sri Lanka
- Central Clinical School; University of Sydney; Sydney Australia
| | - Catherine Lynch
- Collaboration of Australian and Sri Lankans for Pharmacy Practice Education and Research (CASPPER); Brisbane Australia
| | - Fahim Mohamed
- Collaboration of Australian and Sri Lankans for Pharmacy Practice Education and Research (CASPPER); Brisbane Australia
- South Asian Clinical Toxicology Research Collaboration; University of Peradeniya; Peradeniya Sri Lanka
- Department of Pharmacology; University of Sydney; Sydney Australia
| | - Hithanadura Asita De Silva
- Clinical Trials Unit; Department of Pharmacology; Faculty of Medicine; University of Kelaniya; Kelaniya Sri Lanka
| | | | - Nimali Buddhima Peters
- Department of Pharmacy; Princess Alexandra Hospital; Brisbane Australia
- Collaboration of Australian and Sri Lankans for Pharmacy Practice Education and Research (CASPPER); Brisbane Australia
| | - Brooke Myers
- Collaboration of Australian and Sri Lankans for Pharmacy Practice Education and Research (CASPPER); Brisbane Australia
- Department of Pharmacy; Gold Coast University Hospital and Health Service; Gold Coast Australia
| | - Ian David Coombes
- School of Pharmacy; University of Queensland; Brisbane Australia
- Collaboration of Australian and Sri Lankans for Pharmacy Practice Education and Research (CASPPER); Brisbane Australia
- Department of Pharmacy; Royal Brisbane and Women's Hospital; Brisbane Australia
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Shanika LGT, Wijekoon CN, Jayamanne S, Coombes J, Coombes I, Mamunuwa N, Dawson AH, De Silva HA. Acceptance and attitudes of healthcare staff towards the introduction of clinical pharmacy service: a descriptive cross-sectional study from a tertiary care hospital in Sri Lanka. BMC Health Serv Res 2017; 17:46. [PMID: 28100204 PMCID: PMC5241951 DOI: 10.1186/s12913-017-2001-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 01/11/2017] [Indexed: 12/01/2022] Open
Abstract
Background Multidisciplinary patient management including a clinical pharmacist shows an improvement in patient quality use of medicine. Implementation of a clinical pharmacy service represents a significant novel change in practice in Sri Lanka. Although attitudes of doctors and nurses are an important determinant of successful implementation, there is no Sri Lankan data about staff attitudes to such changes in clinical practice. This study determines the level of acceptance and attitudes of doctors and nurses towards the introduction of a ward-based clinical pharmacy service in Sri Lanka. Methods This is a descriptive cross-sectional sub-study which determines the acceptance and attitudes of healthcare staff about the introduction of a clinical pharmacy service to a tertiary care hospital in Sri Lanka. The level of acceptance of pharmacist’s recommendations regarding drug-related problems (DRPs) was measured. Data regarding attitudes were collected through a pre-tested self-administered questionnaires distributed to doctors (baseline, N =13, post-intervention period, N = 12) and nurses (12) worked in professorial medical unit at baseline and post-intervention period. Results A total of 274 (272 to doctors and 2 to nurses) recommendations regarding DRPs were made. Eighty three percent (225/272) and 100% (2/2) of the recommendations were accepted by doctors and nurses, respectively. The rate of implementation of pharmacist’s recommendations by doctors was 73.5% (200/272) (95% CI 67.9 – 78.7%; P < 0.001). The response rate of doctors was higher at the post-intervention period (92.3%; 12/13) compared to the baseline (66.7%; 8/12). At the post-intervention survey 91.6% of doctors were happy to work with competent clinical pharmacists and accepted the necessity of this service to improve standards of care. The nurses’ rate of response at baseline and post-intervention surveys were 80.0 and 0.0% respectively. Their perceptions on the role of clinical pharmacist were negative at baseline survey. Conclusions There was high acceptance and implementation of clinical pharmacist’s recommendations regarding DRPs by the healthcare team. The doctors’ views and attitudes were positive regarding the inclusion of a ward-based pharmacist to the healthcare team. However there is a need to improve liaison between clinical pharmacist and nursing staff. Trial registration Sri Lanka Clinical Trials Registry SLCTR/2013/029 Date: 13 September 2013; retrospectively registered. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2001-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lelwala Guruge Thushani Shanika
- Department of Allied Health Sciences, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Jayewardenepura Kotte, Sri Lanka. .,South Asian Clinical Toxicology Research Collaboration, Peradeniya, Sri Lanka.
| | - Chandrani Nirmala Wijekoon
- Department of Pharmacology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Jayewardenepura Kotte, Sri Lanka
| | - Shaluka Jayamanne
- South Asian Clinical Toxicology Research Collaboration, Peradeniya, Sri Lanka.,Department of Medicine, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Judith Coombes
- Princess Alexandra Hospital, Brisbane, Australia.,University of Queensland, Brisbane, Australia
| | - Ian Coombes
- University of Queensland, Brisbane, Australia.,Royal Brisbane Hospital, Brisbane, Australia
| | - Nilani Mamunuwa
- South Asian Clinical Toxicology Research Collaboration, Peradeniya, Sri Lanka
| | - Andrew Hamilton Dawson
- South Asian Clinical Toxicology Research Collaboration, Peradeniya, Sri Lanka.,Central Clinical School, Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Hithanadura Asita De Silva
- Clinical Trials Unit, Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
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