The use of proton pump inhibitors in an Italian hospital: focus on oncologic and critical non-ICU patients
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Background Proton pump inhibitors (PPIs) are among the most misused drugs both at the community and hospital level. Recently, possible risks have been underscored, suggesting the importance of limiting PPI use to proven indications. Objective To survey the appropriateness of PPI use in a University hospital in Italy. Setting Azienda Ospedaliera Universitaria Policlinico ‘P. Giaccone’, in Palermo, Italy. Method A one day-observational study, reviewing patients’ medical records to identify treatments with PPIs and the indications for their use. After discharge, a subgroup of the cohort was followed up to assess the continuation of therapy at home. Appropriateness was evaluated according to the indications stated in the official product information sheet and supported by the AIFA notes. Main outcome measure Prevalence and appropriateness of PPI use in the hospital and after discharge. Results In the index day 62.9 % of 343 evaluable patients received a PPI. In only 29.1 % of these, the treatment could be considered appropriate. The most frequent reasons for inappropriate treatment were stress ulcer prophylaxis in low risk patients and unwarranted gastro-protection in drug treated patients. 30.9 % of patients received PPIs for uncertain indications: of these, 25.7 % were “critical” patients admitted in non-ICU wards. Furthermore, as much as 88.2 % of anticancer drug treated patients received PPIs as gastroprotective agents. At discharge 48.6 % of patients received a prescription to continue PPI therapy at home and 75.9 % of the 83 followed up patients were found to be still taking these drugs after on average 3 months from discharge. Conclusion This study confirms a high proportion of inappropriate PPI therapy into the hospital that translates in a prolonged unnecessary administration in the community setting. Further studies are needed to assess the cost-effectiveness of PPI therapy in subgroups of patients at moderate risk for gastric complications to optimize current guidelines.
KeywordsDrug utilization Hospital Italy Proton pump inhibitors Therapeutic appropriateness
The authors thank the physicians of the Policlinico “P. Giaccone” of Palermo Doctors: Alessandra Adamo, Salvo Asciutto, Vincenza Alonge, Mario Belvedere, Sergio Calamia, Giuseppe Cannizzaro, Maria Cappello, Egle Corrado, Bianca Maria Cudia, Francesco D’Arpa, Domenico Di Raimondo, Luisa Falletta, Angelo Ferrante, Fabio Fulfaro, Girolamo Geraci, Vincenzo Geraci, Fabio Giacalone, Lydia Giannitrapani, Antonella Giugno, Maria Pia Imbergamo, Egle Incalcaterra, Nicola Lo Biundo, Francesco Lombardo, Filippo Longo, Carla Maione, Pasquale Mansueto, Antonietta Matina, Gaetano Morreale, Ida Muratori, Mario Napoli, Giuseppe Pistone, Giuseppe Profita, Simona Raso, Giovanni Ruvolo, Francesco Vaccaro, Giorgia Virzì, Giovanni Zabbia, Carmela Zarino for their support in reviewing and evaluating the clinical documentation of patients.
No funding was received for this study.
Conflicts of interest
The authors declare that they have no conflict of interest.
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