Wan Andrea, Halpape Katelyn, Talkhi Shirin C, Dixon Claire, Dossa Hafeez, Tabamo Jenifer, Roberts Mark, Dahri Karen
, BSc(Pharm), ACPR, is with the Department of Pharmacy, St Paul's Hospital, Vancouver, British Columbia.
, BSc(Pharm), ACPR, PharmD, is with the Department of Pharmacy, Vancouver General Hospital, Vancouver, British Columbia.
Can J Hosp Pharm. 2018 Sep-Oct;71(5):308-315. Epub 2018 Oct 31.
Proton pump inhibitors (PPIs) have proven clinical efficacy for a variety of indications. However, there is emerging evidence of adverse events associated with their long-term use. The emergence of these adverse events has reinforced the need to regularly evaluate the appropriateness of continuing PPI therapy, and to use only the lowest effective dose for the minimally indicated duration.
To characterize the appropriateness of PPI orders continued or initiated in the internal medicine and family practice units of Vancouver General Hospital, to detect adverse events associated with PPI use, and to explore the impact of multidisciplinary teaching and provision of educational resources on health care practitioners' views about PPI use.
A chart review was conducted for patients admitted (for at least 24 hours) between January 1 and December 31, 2015, for whom a hospital formulary PPI was prescribed. An educational initiative, which included interprofessional in-service sessions, a PPI prescribing infographic, a PPI prescribing card, and a patient counselling sheet, was implemented. The impact of these interventions was assessed using a qualitative survey of health care practitioners.
Of the 258 patients whose charts were reviewed, 175 had a PPI prescription before hospital admission, and 83 were initiated on PPI therapy during their hospital stay. Overall, 94 (36%) of the patients were receiving PPIs without an appropriate indication. Community-acquired pneumonia and infections were the most common adverse events potentially associated with PPI use. In-service sessions and educational resources on PPI prescribing were reported to affect the clinical practice of 24 (52%) of the 46 survey respondents.
The results of this study emphasize the need for ongoing re-evaluation of long-term PPI therapy at the time of admission, during the hospital stay, and upon discharge. Implementing multidisciplinary teaching and providing educational resources may encourage more appropriate prescribing.
质子泵抑制剂（PPIs）已被证明在多种适应症上具有临床疗效。然而，越来越多的证据表明其长期使用会带来不良事件。这些不良事件的出现强化了定期评估继续使用PPI治疗的适宜性以及仅在最短指示疗程内使用最低有效剂量的必要性。
描述温哥华总医院内科和家庭医疗科室中继续或开始使用PPI医嘱的适宜性，检测与PPI使用相关的不良事件，并探讨多学科教学和提供教育资源对医护人员关于PPI使用观点的影响。
对2015年1月1日至12月31日期间入院（至少24小时）且开具了医院处方集PPI的患者进行病历审查。实施了一项教育倡议，包括跨专业在职培训课程、PPI处方信息图表、PPI处方卡和患者咨询单。通过对医护人员的定性调查评估这些干预措施的影响。
在审查的258例患者中，175例在入院前已有PPI处方，83例在住院期间开始接受PPI治疗。总体而言，94例（36%）患者在无适当适应症的情况下接受PPI治疗。社区获得性肺炎和感染是与PPI使用潜在相关的最常见不良事件。据报告，46名调查受访者中有24名（52%）的在职培训课程和PPI处方教育资源影响了他们的临床实践。
本研究结果强调在入院时、住院期间及出院时对长期PPI治疗进行持续重新评估的必要性。实施多学科教学并提供教育资源可能会促使更合理的处方开具。
