Chan Adriel, Liang Libby, Tung Anthony C H, Kinkade Angus, Tejani Aaron M
, BSc(Pharm), is with the Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia.
, BSc(Pharm), ACPR, MBA, is with Lower Mainland Pharmacy Services, Surrey, British Columbia.
Can J Hosp Pharm. 2018 Sep-Oct;71(5):295-301. Epub 2018 Oct 31.
The use of proton pump inhibitors (PPIs) may cause significant harm to patients in the residential care setting, as these patients are often frail with multiple morbidities. The extent of non-evidence-based use of PPIs in residential care sites of the Fraser Health Authority in British Columbia is unknown.
To determine the proportion of non-evidence-based use of PPI therapy for residential care patients of the Fraser Health Authority.
This retrospective cross-sectional study was conducted in 6 Fraser Health residential care facilities in British Columbia between April 1, 2015, and March 31, 2016. Two definitions of "evidence-based indications" were used. The first definition encompassed evidence-based indications for PPI use, specifically gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), gastritis, esophagitis, Barrett esophagus, and gastrointestinal protection from concurrent oral steroids, oral nonsteroidal anti-inflammatory drugs, antiplatelet agents, and anticoagulants. The second definition involved evidence-based indications for PPI use, specifically GERD or PUD. Descriptive statistics were used to evaluate the primary outcome: the proportion of PPI orders without a documented broad or common evidence-based indication for PPI treatment.
A total of 331 residential care patients and 407 PPI orders were assessed. The proportion of PPI orders without a documented broad evidence-based indication was 16.2% (66/407). The proportion of PPI orders without a documented common evidence-based indication was 43.7% (178/407). The most frequently documented reason for a PPI order was GERD (214/407 or 52.6%). PPI orders for patients with GERD and gastrointestinal bleeding had the longest duration of therapy during residential care admission, averaging 205.1 and 218.1 days, respectively.
About 1 in 6 PPI orders for Fraser Health residential care patients did not have a documented broad evidence-based indication, and about 2 in 5 PPI orders did not have a documented common evidence-based indication. These results indicate a need to assess the appropriateness of therapy for every patient with an active PPI order in residential care facilities.
质子泵抑制剂（PPI）的使用可能会对入住机构护理机构的患者造成重大伤害，因为这些患者通常身体虚弱且患有多种疾病。不列颠哥伦比亚省弗雷泽卫生局机构护理场所中PPI的非循证使用程度尚不清楚。
确定弗雷泽卫生局机构护理患者中PPI治疗的非循证使用比例。
这项回顾性横断面研究于2015年4月1日至2016年3月31日在不列颠哥伦比亚省的6家弗雷泽卫生局机构护理设施中进行。使用了“循证指征”的两种定义。第一种定义包括PPI使用的循证指征，具体为胃食管反流病（GERD）、消化性溃疡病（PUD）、胃炎、食管炎、巴雷特食管以及预防同时使用口服类固醇、口服非甾体抗炎药、抗血小板药物和抗凝剂时的胃肠道损伤。第二种定义涉及PPI使用的循证指征，具体为GERD或PUD。采用描述性统计来评估主要结果：无记录的广泛或常见PPI治疗循证指征的PPI处方比例。
共评估了331名机构护理患者和407份PPI处方。无记录的广泛循证指征的PPI处方比例为16.2%（66/407）。无记录的常见循证指征的PPI处方比例为43.7%（178/407）。PPI处方最常记录的原因是GERD（214/407或52.6%）。GERD患者和胃肠道出血患者的PPI处方在机构护理住院期间的治疗持续时间最长，平均分别为205.1天和218.1天。
弗雷泽卫生局机构护理患者中，约六分之一的PPI处方没有记录的广泛循证指征，约五分之二的PPI处方没有记录的常见循证指征。这些结果表明，需要评估机构护理设施中每一位正在接受PPI治疗患者的治疗适宜性。
