Section of General Internal Medicine, Department of Medicine, School of Medicine, Boston University, Boston, Massachusetts 85004, USA.
J Am Geriatr Soc. 2011 Sep;59(9):1658-64. doi: 10.1111/j.1532-5415.2011.03545.x. Epub 2011 Aug 24.
To determine factors associated with proton pump inhibitor (PPI) discontinuation in long-term care.
Retrospective cohort analysis.
Veterans Affairs (VA) long-term care facilities.
Veterans admitted for nonhospice care in 2005 with a length of stay of 7 days or more who were prescribed a PPI within 7 days of admission (N = 10,371).
Prescribed medications and comorbidities were determined from VA pharmacy and administrative databases and functional status from Minimum Data Set records. Associations between participant characteristics and PPI discontinuation were determined using Cox proportional hazard ratios (HRs), censoring at death, discharge, or 180 days after admission.
Participants were predominantly male (97%) and had a median age of 73 (interquartile range 60-81). There were 2,749 (27%) PPI discontinuations; 43% of these occurred within 28 days of admission. Hospitalizations (HR = 1.22, 95% confidence interval (CI) = 1.01-1.46), preadmission PPI use (HR = 1.35, 95% CI = 1.16-1.56), and lowest functional status (HR = 1.22, 95% CI = 1.03-1.45) were associated with early PPI discontinuation in adjusted models. Participants with gastric acid-related disease (HR = 0.53, 95% CI 0.46-0.61), diabetes mellitus (HR = 0.82, 95% CI 0.72-0.94), and those who were prescribed six or more medications (6-7 medications, HR = 0.78, 95% CI = 0.66-0.92; 8-10 medications, HR = 0.64, 95% CI = 0.54-0.76; ≥ 11 medications 0.51, 95% CI = 0.42-0.62) were less likely to have early discontinuation. No PPI discontinuer had PPIs resumed during the study, and few (9%) had histamine-2 receptor antagonist substitutions.
Although there may be clinical uncertainty regarding PPI discontinuation, more than one-quarter of participants prescribed a PPI upon admission to long-term care had it discontinued within 180 days. Targeting individuals prescribed PPIs for medication appropriateness review may reduce prescribing of potentially nonindicated medications.
确定与质子泵抑制剂（PPI）在长期护理中停药相关的因素。
回顾性队列分析。
退伍军人事务部（VA）长期护理机构。
2005 年入住非临终关怀的退伍军人，住院时间超过 7 天，在入院后 7 天内开处了 PPI（N=10371）。
从 VA 药房和管理数据库确定处方药物和合并症，从最低数据组记录确定功能状态。使用 Cox 比例风险比（HR）确定参与者特征与 PPI 停药之间的关联，以死亡、出院或入院后 180 天为截止点。
参与者主要为男性（97%），中位年龄为 73 岁（四分位间距 60-81）。有 2749 例（27%）PPI 停药；其中 43%在入院后 28 天内发生。住院治疗（HR=1.22，95%置信区间[CI] = 1.01-1.46）、入院前使用 PPI（HR=1.35，95%CI=1.16-1.56）和最低功能状态（HR=1.22，95%CI=1.03-1.45）与调整后的模型中的早期 PPI 停药相关。患有胃酸相关疾病（HR=0.53，95%CI 0.46-0.61）、糖尿病（HR=0.82，95%CI 0.72-0.94）和服用 6 种或更多药物的参与者（6-7 种药物，HR=0.78，95%CI=0.66-0.92；8-10 种药物，HR=0.64，95%CI=0.54-0.76；≥11 种药物，HR=0.51，95%CI=0.42-0.62）不太可能早期停药。没有 PPI 停药者在研究期间重新开了 PPI，很少（9%）有组胺 2 受体拮抗剂替代。
尽管在 PPI 停药方面可能存在临床不确定性，但在长期护理机构入院时开处 PPI 的参与者中，超过四分之一在 180 天内停止了 PPI 治疗。针对开处 PPI 的患者进行药物适宜性审查，可能会减少潜在非适应证药物的开具。
