Deprescribing Strategies: A Prospective Study on Proton Pump Inhibitors

被引:1
|
作者
Calvini, Giulia [1 ,2 ]
Baiardi, Giammarco [1 ,2 ]
Mattioli, Francesca [1 ,2 ]
Milano, Giulia [3 ]
Calautti, Francesca [4 ]
Zunino, Alessia [4 ]
Fraguglia, Carla Elda [4 ]
Caccavale, Fabio [5 ]
Lantieri, Francesca [6 ]
Antonucci, Giancarlo [7 ]
机构
[1] EO Osped Galliera, Clin Pharmacol Unit, Mura Cappuccine 14, I-16128 Genoa, Italy
[2] Univ Genoa, Dept Internal Med, Clin Pharmacol & Toxicol Unit, Viale Benedetto XV 2, I-16132 Genoa, Italy
[3] IRCCS Osped Policlin San Martino, Dept Lab Med, I-16132 Genoa, Italy
[4] EO Osped Galliera, SC Farm Interna, Mura Cappuccine 14, I-16128 Genoa, Italy
[5] Chartered Accountancy & Advisory Firm, Piazza Remondini 3, I-16131 Genoa, Italy
[6] Univ Genoa, Hlth Sci Dept, Biostat Unit, Via Pastore 1, I-16132 Genoa, Italy
[7] EO Osped Galliera, Internal Med Unit, Mura Cappuccine 14, I-16128 Genoa, Italy
关键词
polypharmacy; prescriptive appropriateness; deprescribing; proton pump inhibitors; clinical pharmacology; SEASONAL-VARIATION;
D O I
10.3390/jcm12083029
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Proton pump inhibitors (PPIs) are among the most controversially prescribed drugs in polypharmacy. This observational prospective study assessed the PPI prescriptive trend during hospitalization before and after implementation of a prescribing/deprescribing algorithm in a real-life hospital setting and the related clinical-economic benefit at discharge. PPI prescriptive trends were compared between three quarters of 2019 (9 months) and the same period of 2018 by a chi-square test with a Yate's correction. The proportions of treated patients in the two years (1120 discharged patients in 2018 and 1107 in 2019) were compared by the Cochran-Armitage trend test. DDDs (defined daily doses) were compared between 2018 and 2019 by the non-parametric Mann-Whitney test and normalizing DDD/DOT (days of therapy) and DDD/100 bd (bed days) for each patient. Multivariate logistic regression was performed on PPI prescriptions at discharge. The distribution of patients with PPIs at discharge was significantly different in the two years (p = 0.0121). There was a downward trend in the number of PPI prescriptions (29.9%) in the third trimester of 2019 compared to the others of the same year (first trimester: 34.1%, second trimester: 36.0%) and by contrast with the same periods of 2018 (29.4, 36.0, and 34.7%) (p = 0.0124). DDDs/patient did not differ between 2018 and 2019 nor across the three trimesters. However, both DDD/DOT and DDD/100 bd showed a decrease in the third trimester of 2019, with a marked difference for DDD/DOT (p = 0.0107). The reduction in consumption detected in the last phase of 2019 in terms of DDD/DOT was 0.09 with a consequent containment of pharmaceutical spending. The development and implementation of multidisciplinary prescribing/deprescribing protocols in both hospital and community settings could lead to a reduction in the misuse of PPIs, with significant savings in healthcare resources.
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页数:13
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