Carter Jillian H, Sketris Ingrid S, Tamim Hala, Levy Adrian R, Langley Joanne M
Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada.
Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada.
J Popul Ther Clin Pharmacol. 2019 Dec 27;26(4):e37-e53. doi: 10.15586/jptcp.v26i4.053.
Proton pump inhibitors (PPIs) are often prescribed potentially inappropriately. The screening tool of older person's potentially inappropriate prescriptions (STOPP) for therapeutic dose PPIs has been adapted to examine PPI discontinuation, dose reduction, or switching to Histamine-2 Receptor Antagonist (H2RA) after 60 days.
The objectives of the present study were to (1) describe the use of acid suppression therapy (PPIs and H2RAs) 60 and 90 days after a new PPI dispensing, (2) assess predictors of lack of adherence to adapted STOPP criteria for PPI use, and (3) assess PPI dispensing over time.
This was a retrospective cohort study of beneficiaries of the Nova Scotia Seniors Pharmacare (NSSP) aged 66 years or older who were newly dispensed a PPI between January 1, 1997 and March 31, 2011. The main outcome measure was adherence to the adapted STOPP criteria, which was analyzed using logistic regression.
A total of 14,453 participants were included: 89.8% beginning on standard dose and 10.2% beginning on high-dose PPI. Of those beginning on high-dose PPI, 26.4% were dispensed high-dose PPI at day 60 and 30.2% were dispensed high-dose PPI at day 90. Predictors of lack of adherence to our adapted STOPP criteria included age ≥86 years, rural residence, and hospitalization within 1 year prior to cohort entry.
Many PPI prescriptions dispensed for NSSP beneficiaries fail to adhere to the STOPP criteria. Predictors of lack of adherence to the adapted STOPP criteria were identified.
质子泵抑制剂（PPIs）的处方开具常常可能并不恰当。老年人潜在不恰当处方筛查工具（STOPP）已被调整，用于检查治疗剂量的PPIs在60天后是否停药、减量或换用组胺-2受体拮抗剂（H2RA）。
本研究的目的是：（1）描述新开具PPI后60天和90天的抑酸治疗（PPIs和H2RAs）使用情况；（2）评估未遵循调整后的PPI使用STOPP标准的预测因素；（3）评估随时间推移的PPI配药情况。
这是一项对1997年1月1日至2011年3月31日期间新开具PPI的66岁及以上新斯科舍省老年人药物护理计划（NSSP）受益人的回顾性队列研究。主要结局指标是遵循调整后的STOPP标准情况，采用逻辑回归进行分析。
共纳入14453名参与者：89.8%开始使用标准剂量PPI，10.2%开始使用高剂量PPI。开始使用高剂量PPI的参与者中，26.4%在第60天仍被配给高剂量PPI，30.2%在第90天仍被配给高剂量PPI。未遵循我们调整后的STOPP标准的预测因素包括年龄≥86岁、居住在农村以及队列入组前1年内住院治疗。
为NSSP受益人开具的许多PPI处方未遵循STOPP标准。已确定未遵循调整后的STOPP标准的预测因素。
