Inappropriate prescribing of proton pump inhibitors (PPI) in patients > 65 years at a level 2 Irish hospital
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LETTER TO THE EDITOR
Inappropriate prescribing of proton pump inhibitors (PPI) in patients > 65 years at a level 2 Irish hospital Paul Tansey 1
&
Paul Shiels 1
Received: 1 September 2020 / Accepted: 5 September 2020 # Royal Academy of Medicine in Ireland 2020
Keywords Adverse events . Gastrointestinal disorders . Inappropriate prescribing . Medicine for the elderly . Polypharmacy . Proton pump inhibitors (PPI)
Dear Editor, Proton pump inhibitors (PPIs) were first marketed in the 1980s, and since then have become the most commonly prescribed drug for upper gastrointestinal disorders [1]. Use of PPIs for longer than indicated in older people has become a concern, particularly in those at low risk of gastrointestinal disease. Adverse events such as Clostridium difficile infection, osteoporosis, and pneumonia have been documented. A particular source of concern, as illustrated in the updated Screening Tool for Older Person’s Prescriptions (STOPP), is that PPIs prescribed at therapeutic dose or higher for longer than 8 weeks as potentially inappropriate for people aged > 65 years [2]. It is estimated that the worldwide figure for inappropriate PPI use ranged from 40 to 80% [3]. This could translate to possible significant long-term adverse effects. Previous studies within Ireland, in both hospital and community settings, have shown PPI overuse is significant, and thus, continued prescribing education among NCHDs is paramount. [4, 5] We conducted a study at our institution to identify inappropriate prescribing of PPIs in patients over the age of 65 and raise awareness of the safety concerns around PPI usage and management in line with NICE guidelines in order to affect a change in future prescribing behaviour. Data was collected from the wards of Tullamore Regional hospital over a 3-week period from 9 to 27 September 2019. Patients over the age of 65 years were included and PPI prescription identified using the prescription Kardex. The indication for PPI prescription was investigated using the patients’
medical notes, and where possible, the duration of treatment was noted. A total number of 60 patients were included in the study. One-third of the patients had no clear indication for prescribing of a PPI, 30% of which had been prescribed high-dose PPI which could suggest inappropriate PPI prescribing. It is plausible that inappropriate PPI use without a clear documented indication is perhaps due to many physicians considering PPIs are safe, long-term medications. One quantitative study in Trinity College Dublin showed that PPIs were perceived as very safe by many physicians, but knowledge of recommended treatment durations, awareness of potential adverse effects and drug-drug interactions were low. Review of PPI prescriptions was infrequent. Documentation of indication for newly prescribed PPI on discharge was low, but documentation of duration was higher. Other studies have documented that physicians do not document PPI indications which then results in long-term continuations of the PPI [6]. In conclusion, it is
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