Gamelas Verónica, Salvado Vera, Dias Luís
aGastrenterologia, Centro Hospitalar Lisboa Central, Lisbon, Portugal.
bMedicina Interna, Centro Hospitalar Lisboa Central, Lisbon, Portugal.
GE Port J Gastroenterol. 2019 Mar;26(2):114-120. doi: 10.1159/000488506. Epub 2018 May 2.
Proton pump inhibitors (PPI) have reportedly been used in inappropriate clinical settings, often leading to an increased risk of adverse effects, drug interactions, and costs.
The aim of this study was to evaluate the adequacy of PPI prescription in an internal medicine ward.
The discharged home inpatients of a segment in the medicine department of a central hospital in the first trimester of 2017 were evaluated; those who died or were transferred to another unit were excluded. Data on gender, age, admission, and discharge therapy and diagnoses which could support PPI use were collected from clinical records. Statistical analysis was performed using Microsoft Excel 2013® and IBM SPSS Statistics 20®.
A total of 318 hospitalizations were included, corresponding to 301 patients; 171 (56.8%) were female and the average age was 75.4 ± 14.6 years. Among the 318 hospitalizations, 148 patients (46.5%) were on PPI at admission and 175 (55%) at discharge, the majority of them without indication ( = 91, 61.5% vs. = 109, 62.3%). The main inappropriate indication was anticoagulation alone ( = 33, 36.3% vs. = 43, 39.4%). There was indication for PPI therapy in 93 (29.2%) of the cases at admission and 111 (34.9%) at discharge, mostly for prophylaxis of gastrointestinal bleeding in high-risk patients ( = 82, 88.2% vs. = 96, 86.5%). Among those with indication, 57 (61.3%) were medicated at admission versus 66 (59%) at discharge. The association between PPI therapy and an indication for its prescription was lost by the time of discharge ( = 0.245).
PPI prescription is not in agreement with existing recommendations, which is why it should be revised at hospital discharge. The primary indication for PPI therapy is the prophylaxis of gastrointestinal bleeding in high-risk patients and the main inappropriate indication is prophylaxis in low-risk patients. A large proportion of the patients indicated for PPI use were discharged without prescription.
据报道，质子泵抑制剂（PPI）在不适当的临床环境中使用，常常导致不良反应、药物相互作用及成本增加的风险上升。
本研究旨在评估内科病房中PPI处方的合理性。
对一家中心医院内科某科室2017年第一季度出院的居家患者进行评估；排除死亡或转至其他科室的患者。从临床记录中收集患者的性别、年龄、入院及出院治疗情况以及支持使用PPI的诊断信息。使用Microsoft Excel 2013®和IBM SPSS Statistics 20®进行统计分析。
共纳入318例住院病例，对应301名患者；其中171例（56.8%）为女性，平均年龄为75.4±14.6岁。在318例住院病例中，148例患者（46.5%）入院时使用PPI，175例（55%）出院时使用PPI，其中大多数无用药指征（入院时91例，61.5%；出院时109例，62.3%）。主要的不适当指征是单独抗凝（入院时33例，36.3%；出院时43例，39.4%）。入院时93例（29.2%）病例及出院时111例（34.9%）病例有PPI治疗指征，主要用于高危患者预防胃肠道出血（入院时82例，88.2%；出院时96例，86.5%）。在有指征的患者中，57例（61.3%）入院时用药，66例（59%）出院时用药。出院时PPI治疗与其处方指征之间的关联消失（P=0.245）。
PPI处方与现有建议不一致，因此应在出院时进行修订。PPI治疗的主要指征是高危患者预防胃肠道出血，主要的不适当指征是低危患者预防用药。很大一部分有PPI使用指征的患者出院时未带处方。
