Pharmacy, Nantes Université, CHU Nantes, 44000, Nantes, France.
Medical Department, French National Health Insurance, DRSM, Nantes, France.
BMC Prim Care. 2022 Dec 30;23(1):341. doi: 10.1186/s12875-022-01941-2.
Proton pump inhibitors (PPIs) are one of the most widely prescribed drug classes in the community and at hospital. The significant misuse of PPIs requires the implementation for a deprescribing strategy. Numerous studies aiming at evaluating the impact of deprescribing interventions have been set up, implying a precisely known evolution of consumption of PPIs in the population studied without intervention. The main objective of the study was to study overall changes in PPI prescribing and deprescribing in a regional population of chronic consumers without intervention, according to health insurance databases.
This historical cohort study was based on the French National Health Data System databases. All adult patients living in the Pays de la Loire area and covered by the French National Health Insurance and who had at least one reimbursement for a PPI dispensing between 01 October 2016 and 31 December 2020 were included. Only chronic consumer patients were included, defined as patients who has had PPI dispensed for 3 consecutive months with a temporal coverage of at least 80%. Patients under 18 years of age and patients who received parenteral PPIs only were excluded.
The percentage of chronic treatment discontinuation in 2017 was 12.5% and remained stable to reach 12.4% in 2020. The number of new chronic patients increased from year to year to reach 77,222 patients in 2020, with an increasing rate of 1.2 to 2% between 2017 and 2020. The prevalent patient population increased from year to year to reach 167 751 patients in 2020, with an increasing rate of 4.2 to 4.4% between 2017 and 2020. Regarding the initiation of PPI therapy, in 2020, 87.1% of treatment initiations were done by general practitioners. They renewed 2,402,263 prescriptions (89.3%) between 2017 and 2020.
This study shows a stagnation over the last 4 years in the deprescribing of chronic PPI treatments in a French region despite the information on their inappropriate use reported by national agencies and in the literature with increasing frequency. This reinforces the interest of setting up a deprescribing project.
质子泵抑制剂 (PPI) 是社区和医院最广泛使用的药物类别之一。PPIs 的大量滥用需要实施去处方策略。已经进行了许多旨在评估去处方干预措施影响的研究，这些研究都意味着在没有干预的情况下，研究人群中 PPI 的使用情况会发生确切的已知变化。本研究的主要目的是根据健康保险数据库，研究在没有干预的情况下，慢性消费者的 PPI 处方和去处方的总体变化。
这是一项基于法国国家健康数据系统数据库的历史性队列研究。所有居住在卢瓦尔河地区并参加法国国家健康保险且在 2016 年 10 月 1 日至 2020 年 12 月 31 日期间至少有一次 PPI 配药报销的成年人患者均纳入研究。仅纳入慢性消费患者，定义为连续 3 个月接受 PPI 治疗且时间覆盖率至少为 80%的患者。18 岁以下患者和仅接受肠外 PPI 的患者被排除在外。
2017 年慢性治疗停药率为 12.5%，并保持稳定，2020 年降至 12.4%。新的慢性患者人数逐年增加，2020 年达到 77222 人，2017 年至 2020 年增长率为 1.2%至 2%。患者人群数量逐年增加，2020 年达到 167751 人，2017 年至 2020 年增长率为 4.2%至 4.4%。在开始 PPI 治疗方面，2020 年，87.1%的治疗开始由全科医生进行。2017 年至 2020 年期间，他们共更新了 2402263 张处方（89.3%）。
尽管国家机构和文献中越来越频繁地报告了其不当使用情况，但在法国某一地区，尽管最近 4 年来 PPI 慢性治疗的去处方情况基本保持不变，但这突显了制定去处方计划的重要性。
