Redfern Roberta E, Brown Megan, Karhoff Kathryn L, Middleton Jennifer L
From Ohio Health Riverside Methodist Hospital, Columbus, ProMedica Health System, ProMedica Research, Toledo, and Eastern Woods Family Practice, Findlay, Ohio.
South Med J. 2015 Dec;108(12):732-8. doi: 10.14423/SMJ.0000000000000383.
Acid-suppressive therapy (AST) is widely used for gastrointestinal prophylaxis in hospitalized patients, particularly to prevent stress-related mucosal bleeding in critically ill individuals. Previous reports suggest gross overutilization and continuation of unnecessary therapy, which have been linked to several adverse effects.
Retrospective chart review at a large tertiary care hospital, evaluating the use of AST for ulcer prophylaxis in accordance with American Society of Health-System Pharmacists' guidelines and the less commonly studied nonsteroidal anti-inflammatory drug-related ulcer prophylaxis guidelines.
A total of 119 (39.3%) patients who received AST met either American Society of Health-System Pharmacists guidelines or nonsteroidal anti-inflammatory drug-related prophylaxis guidelines. Subjects whose AST was appropriate were older, had a higher Charlson Comorbidity Index (P < 0.001), and were more often men (P = 0.005). The rate of discontinuation at discharge was 70.7%; subjects whose prescriptions were not discontinued were older, had a higher Charlson Comorbidity Index, and longer hospital and intensive care unit lengths of stay (P < 0.001). Family medicine physicians, hospitalists, and surgeons prescribed AST similarly; internal medicine physicians demonstrated higher adherence with guidelines than all others (P = 0.02). Adherence varied by etiology; cardiology patients were treated with the highest level of appropriateness (53.6%), whereas those admitted for gastrointestinal diagnoses demonstrated the lowest (17.6%, P = 0.03).
Inappropriate prescribing of AST for ulcer prophylaxis remains problematic. There may be differences in prescribing habits of physicians of different specialties. Age and comorbidity scores were associated with inappropriate prescribing and continuation of medication at discharge. Interventions to raise prescribers' awareness of ulcer risk factors in hospitalized patients, both in the intensive care unit and those who are noncritically ill, are needed.
抑酸疗法（AST）在住院患者中广泛用于胃肠道预防，尤其是预防重症患者的应激相关黏膜出血。既往报告提示存在严重的过度使用和不必要治疗的持续，这与多种不良反应相关。
在一家大型三级医疗中心进行回顾性病历审查，根据美国卫生系统药师协会的指南以及较少研究的非甾体抗炎药相关溃疡预防指南，评估AST用于溃疡预防的情况。
共有119名（39.3%）接受AST治疗的患者符合美国卫生系统药师协会指南或非甾体抗炎药相关预防指南。AST使用恰当的受试者年龄较大，查尔森合并症指数较高（P<0.001），男性更常见（P = 0.005）。出院时停药率为70.7%；处方未停用的受试者年龄较大，查尔森合并症指数较高，住院和重症监护病房住院时间较长（P<0.001）。家庭医学医生、住院医师和外科医生开具AST的情况相似；内科医生对指南的依从性高于其他所有医生（P = 0.02）。依从性因病因而异；心脏病患者的治疗恰当程度最高（53.6%），而因胃肠道诊断入院的患者最低（17.6%，P = 0.03）。
AST用于溃疡预防的不恰当处方仍然存在问题。不同专科医生的处方习惯可能存在差异。年龄和合并症评分与出院时不恰当处方和药物持续使用有关。需要采取干预措施，提高开处方者对住院患者（包括重症监护病房患者和非重症患者）溃疡危险因素的认识。
