Gupta Ruchi, Garg Praveen, Kottoor Ravi, Munoz Juan Carlos, Jamal M Mazen, Lambiase Louis R, Vega Kenneth J
Department of Medicine and Division of Gastroenterology, University of Florida College of Medicine Center/Jacksonville, Jacksonville, FL, USA.
South Med J. 2010 Mar;103(3):207-11. doi: 10.1097/SMJ.0b013e3181ce0e7a.
Acid suppression therapy (AST) is one of the most commonly prescribed classes of medications in hospitalized patients. Multiple studies have shown that AST is overused during inpatient admissions. However, minimal data is available regarding the frequency and patient characteristics of those discharged on unnecessary AST. The aims of the study were to examine administration of AST on admission, to characterize the patient population discharged on unnecessary AST and to determine predictive factors for inappropriate administration of AST in hospitalized patients.
A retrospective chart review of randomly selected patients admitted to the general medicine service at University of Florida Health Science Center/Jacksonville from August to October 2006 for appropriateness of AST was done. The admitting diagnosis, indications for starting AST, type of AST used, and discharge on these medications was recorded on a case by case basis.
Seventy percent of patients were started on AST on admission. Of these, 73% were unnecessary. Stress ulcers prophylaxis in low risk patients or the concomitant use of ulcerogenic drugs motivated initiation of therapy most frequently. Sixty nine percent of patients started on inappropriate AST were discharged on the same regimen. Admitting diagnosis, age of patient, length of stay, or concomitant use of ulcerogenic drugs did not predict continuation of unnecessary AST at discharge.
AST is overused in hospitalized patients. This primarily occurred in low risk patients and was compounded by continuation at discharge. This significantly increases cost to the health care system and the risk of drug interactions.
抑酸治疗（AST）是住院患者中最常用的处方药类别之一。多项研究表明，住院期间AST存在过度使用的情况。然而，关于因不必要的AST出院的患者的频率和特征的数据却很少。本研究的目的是检查入院时AST的使用情况，对因不必要的AST出院的患者群体进行特征描述，并确定住院患者AST使用不当的预测因素。
对2006年8月至10月在佛罗里达大学健康科学中心/杰克逊维尔分校普通内科住院的随机选择的患者进行回顾性病历审查，以评估AST的使用是否恰当。逐案记录入院诊断、开始使用AST的指征、所使用的AST类型以及这些药物的出院情况。
70%的患者入院时开始使用AST。其中，73%是不必要的。低风险患者的应激性溃疡预防或同时使用致溃疡药物是最常见的启动治疗原因。开始使用不恰当AST的患者中有69%以相同方案出院。入院诊断、患者年龄、住院时间或同时使用致溃疡药物并不能预测出院时不必要的AST是否会继续使用。
住院患者中AST存在过度使用的情况。这主要发生在低风险患者中，并且出院时仍继续使用，从而加剧了这种情况。这显著增加了医疗保健系统的成本以及药物相互作用的风险。
