Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy.
Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy.
Dig Liver Dis. 2020 Aug;52(8):862-868. doi: 10.1016/j.dld.2020.05.005. Epub 2020 Jun 3.
High rates of inappropriate proton pump inhibitor (PPI) prescriptions have been reported in retrospective database analyses. Assessing the appropriateness of long-term PPIs in outpatients, with a proactive approach at drug optimisation may enhance treatment adequacy.
To describe the characteristics of outpatients who are on long-term PPIs, to assess the magnitude of inappropriate PPI prescriptions, and to evaluate the rate of drug optimisation following specialist recommendations.
Appropriateness of long-term (>8weeks) PPI prescription was prospectively assessed in 249 consecutive patients referred to a Gastroenterology outpatient clinic. We recorded reason for prescription, dose, modality, duration of therapy, and attempts at PPI optimisation.
PPIs were inappropriately prescribed in 96/249 patients (38.6%). Gastro-oesophageal reflux disease (50/143, 35.0%) and prophylaxis of anti-platelet/non-steroidal anti-inflammatory drugs (5/49, 10.2%) were the most common PPI indications and those with the lowest rate of inappropriateness, while the highest rates were observed for treatment of dyspepsia (10/12, 83.3%) and anti-coagulant therapy (21/21, 100%). PPI treatment was optimised in 112 patients (45.0%).
PPIs are inappropriately used in about 40% of outpatients, reflecting scant attention to guidelines. A proactive approach may improve therapeutic adequacy in approximately half of patients. Educational efforts to guide PPI prescription should be further pursued.
回顾性数据库分析报告质子泵抑制剂（PPI）的不合理处方率较高。主动优化药物可能会提高治疗的充分性，从而评估门诊患者长期使用 PPI 的适宜性。
描述长期使用 PPI 的门诊患者的特征，评估不合理 PPI 处方的程度，并评估根据专家建议进行药物优化的比例。
前瞻性评估 249 例连续就诊于消化科门诊的患者长期（>8 周）使用 PPI 的情况。我们记录了处方的原因、剂量、方式、治疗持续时间以及 PPI 优化的尝试。
96/249 例（38.6%）患者 PPI 处方不合理。胃食管反流病（50/143，35.0%）和预防抗血小板/非甾体抗炎药（5/49，10.2%）是最常见的 PPI 适应证，也是不合理程度最低的适应证，而治疗消化不良（10/12，83.3%）和抗凝治疗（21/21，100%）的不合理程度最高。112 例（45.0%）患者接受了 PPI 治疗优化。
约 40%的门诊患者不合理使用 PPI，反映出对指南的关注不足。主动的方法可能会改善约一半患者的治疗充分性。应进一步开展指导 PPI 处方的教育工作。
