Akram Farooq, Huang Yufang, Lim Valencia, Huggan Paul J, Merchant Reshma A
University Medicine Cluster, National University Health System, Singapore ; Yong Loo Lin School of Medicine, National University of Singapore.
Yong Loo Lin School of Medicine, National University of Singapore.
Australas Med J. 2014 Nov 30;7(11):465-70. doi: 10.4066/AMJ.2014.2093. eCollection 2014.
Evidence from several Western studies has shown an alarmingly high and inappropriate rate of prescription of proton pump inhibitors (PPIs), which may be associated with increased healthcare costs and adverse outcomes. PPI prescribing patterns remain largely unknown in well-developed healthcare systems in Southeast Asia.
We aimed to determine the prevalence of inappropriate prescription of PPI among elderly patients without documentation of valid indications, in a tertiary teaching hospital in Singapore.
We carried out a retrospective clinical records review of 150 elderly patients aged ≥65 years that had been admitted to two internal medicine wards between 25 May 2011 and 28 June 2011 to determine the appropriateness of indications for PPIs prescribed at hospital discharge. PPI indications were categorised as "valid", "likely invalid", and "probable" based on current clinical literature. Pre-admission and discharge prescriptions were reviewed to determine continuation of pre-admission and new PPI prescriptions at discharge. Data on clinical characteristics and concurrent use of ulcerogenic medications were collected.
From a total of 150 patients, 80 (53 per cent) received prescriptions for PPIs. Of these, 65 (81.2 per cent) had no valid documented indications (i.e., the indication was classed as "likely invalid"); 10 (12.5 per cent) had valid indications; and in five cases (6.2 per cent) the indication was "probable". The most common "likely invalid" indication was primary gastrointestinal bleeding prophylaxis (GIP) among low-dose aspirin users in 28 patients (43 per cent) of invalid PPI prescriptions.
Inappropriate prescribing of PPIs without documented valid indications was prevalent among elderly patients at our tertiary teaching hospital in Singapore, providing evidence that shows a similar trend to PPI prescribing to data from Western countries.
多项西方研究的证据表明，质子泵抑制剂（PPI）的处方率高得惊人且不合理，这可能与医疗成本增加和不良后果有关。在东南亚发达的医疗体系中，PPI的处方模式仍 largely unknown。
我们旨在确定新加坡一家三级教学医院中，无有效适应症记录的老年患者中PPI不适当处方的 prevalence。
我们对2011年5月25日至2011年6月28日期间入住两个内科病房的150名年龄≥65岁的老年患者进行了回顾性临床记录 review，以确定出院时开具的PPI适应症的 appropriateness。根据当前临床文献，PPI适应症分为“有效”、“可能无效”和“可能”。审查入院前和出院处方，以确定出院时入院前和新的PPI处方的延续情况。收集了临床特征和致溃疡药物同时使用的数据。
在总共150名患者中，80名（53%）接受了PPI处方。其中，65名（81.2%）没有有效的记录适应症（即适应症被归类为“可能无效”）；10名（12.5%）有有效适应症；5例（6.2%）的适应症为“可能”。最常见的“可能无效”适应症是28名（43%）无效PPI处方的低剂量阿司匹林使用者的原发性胃肠道出血预防（GIP）。
在我们新加坡的三级教学医院中，无有效记录适应症的PPI不适当处方在老年患者中很普遍，这提供了证据表明与西方国家的数据相比，PPI处方存在类似趋势。
