Department of Pharmacy, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200123, China.
BMC Health Serv Res. 2023 Sep 20;23(1):1014. doi: 10.1186/s12913-023-09931-5.
Proton pump inhibitor (PPI) abuse poses an overwhelming threat to the allocation of medical resources and places a heavy burden on global medical expenses. In this study, we put forward our prospective prescription review system and evaluated the effects of this system on clinical outcomes, rational medication use and costs related to PPIs.
A retrospective cohort study was conducted in which the included patients were divided into a preintervention group (2019.10-2020.09) and a postintervention group (2020.10-2021.09). To reduce the bias of patients' baseline characteristics, the propensity score matching (PSM) method was employed. The primary endpoints were the incidence of stress ulcers (SUs), the improvement and cure rates of gastrointestinal haemorrhage, the defined daily dose (DDD), the drug utilization index (DUI) and the DDD/100 patient-days. The secondary endpoints included the types of unreasonable medication orders for PPIs, the PPI utilization rate and PPI costs.
A total of 53,870 patients were included to evaluate the secondary endpoints, and 46,922 patients were paired by PSM and assessed to evaluate the primary endpoints. The number of PPIs used and PPI costs were significantly lower in the postintervention group than in the preintervention group (P < 0.001). The rationality evaluation results showed that the frequency of PPI use and the number of drug interactions were significantly higher in the preintervention group than in the postintervention group (P < 0.01). The proportion of patients taking oral PPIs was significantly increased in the postintervention group (29.30% vs. 34.56%, p < 0.01). For the utilization of PPIs both for prevention and treatment, the DUI and DDD/100 patient-days were substantially decreased in the postintervention group (P < 0.001 and P < 0.05, respectively). The incidence of SUs in the postintervention group was 44.95%, and that in the preintervention group was 51.93% (p < 0.05).
The implementation of the prospective prescription review system on rational PPI use correlated with reduced PPI costs, more rational PPI medication use and better clinical outcomes, and this system is worthy of long-term implementation for further improvement of rational drug use.
质子泵抑制剂（PPI）滥用对医疗资源的分配构成了压倒性威胁，给全球医疗费用带来了沉重负担。本研究提出了我们的前瞻性处方审核系统，并评估了该系统对临床结局、合理用药和与 PPI 相关成本的影响。
采用回顾性队列研究，将纳入的患者分为干预前组（2019 年 10 月至 2020 年 9 月）和干预后组（2020 年 10 月至 2021 年 9 月）。为了减少患者基线特征的偏倚，采用倾向评分匹配（PSM）法。主要终点为应激性溃疡（SU）的发生率、胃肠道出血的改善和治愈率、限定日剂量（DDD）、药物利用指数（DUI）和 DDD/100 患者日。次要终点包括 PPI 不合理医嘱的类型、PPI 使用率和 PPI 费用。
共纳入 53870 例患者评估次要终点，46922 例患者通过 PSM 配对并评估主要终点。干预后组的 PPI 使用数量和 PPI 费用明显低于干预前组（P<0.001）。合理性评估结果显示，干预前组 PPI 使用频率和药物相互作用数量明显高于干预后组（P<0.01）。干预后组口服 PPI 的患者比例明显增加（29.30%比 34.56%，P<0.01）。对于预防和治疗用 PPI 的使用，干预后组 DUI 和 DDD/100 患者日明显降低（P<0.001 和 P<0.05）。干预后组 SU 的发生率为 44.95%，干预前组为 51.93%（P<0.05）。
实施前瞻性处方审核系统规范 PPI 使用与降低 PPI 成本、更合理的 PPI 用药和更好的临床结局相关，该系统值得长期实施，以进一步改善合理用药。
