Use and prescription appropriateness of drugs for peptic ulcer and gastrooesophageal reflux disease in hospitalized older people
The aims of this study were to assess the prevalence of use and prescription appropriateness of drugs for peptic ulcer and gastrooesophageal reflux disease (GERD) at hospital admission and discharge.
Patients aged 65 years or more hospitalized from 2010 to 2016 in 101 Italian internal medicine and geriatric wards in the context of the REPOSI register were scrutinized to assess if they were prescribed with drugs for peptic ulcer and GERD at hospital admission and discharge. Appropriateness of prescription was assessed considering the presence of specific conditions (i.e., history of peptic ulcer or gastrointestinal hemorrhages, advanced age, Helicobacter Pylori) or gastro-toxic drug combinations, according to the criteria provided by the reimbursement rules of the Agenzia Italiana del Farmaco (NOTA 1 and 48).
Among 4715 enrolled patients, 3899 were discharged alive. At hospital discharge, 2412 (61.9%, 95%CI: 60.3–63.4%) patients were prescribed with drugs for peptic ulcer and GERD, a 12% of increase from hospital admission. Almost half of the patients (N = 1776, 45.6%, 95%CI: 44.0–47.1%) were inappropriately prescribed or not prescribed: among the drugs for peptic ulcer and GERD users, about 60% (1444/2412) were overprescribed, and among nonusers, 22% (332/1487) were underprescribed. Among patients newly prescribed at hospital discharge, 60% (392/668) were inappropriately prescribed. The appropriateness of drugs for peptic ulcer and GERD therapy decreased by 3% from hospital admission to discharge.
Hospitalization missed the opportunity to improve the quality of prescription of this class of drug.
KeywordsProton pump inhibitors Older people Hospital setting Appropriateness Drug prescription
We acknowledge all the investigators and co-authors of the REPOSI (REgistro POliterapie SIMI, Società Italiana di Medicina Interna) Study Group, listed in the Supplementary Appendix 1.
C.F. wrote the manuscript; C.F and I.A. designed the study research; C.F. and I.A. performed the research; I.A. analyzed the data; P.M.M. and A.N. critically revised the manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 3.http://www.agenziafarmaco.gov.it/sites/default/files/Rapporto_OsMed-2017.pdf. Accessed January , 2019
- 8.Franchi C, Marcucci M, Mannucci PM, Tettamanti M, Pasina L, Fortino I, Bortolotti A, Merlino L, Nobili A (2016) Changes in clinical outcomes for community-dwelling older people exposed to incident chronic polypharmacy: a comparison between 2001 and 2009. Pharmacoepidemiol Drug Saf 25(2):204–211CrossRefGoogle Scholar
- 9.Franchi C, Antoniazzi S, Proietti M, Nobili A, Mannucci PM, SIM-AF collaborators (2018) Appropriateness of oral anticoagulant therapy prescription and its associated factors in hospitalized older people with atrial fibrillation. Br J Clin Pharmacol 84(9):2010–2019. https://doi.org/10.1111/bcp.13631 CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Ardoino I, Rossio R, Di Blanca D, Nobili A, Pasina L, Mannucci PM, Peyvandi F (2017) Franchi C; REPOSI investigators. Appropriateness of antiplatelet therapy for primary and secondary cardio- and cerebrovascular prevention in acutely hospitalized older people. Br J Clin Pharmacol 83(11):2528–2540CrossRefGoogle Scholar
- 12.Miller MD, Towers A (1991) Manual of guidelines for scoring the cumulative illness rating scale for geriatrics (CIRS-G). University of Pittsburgh, PittsburgGoogle Scholar
- 13.http://www.agenziafarmaco.gov.it/content/note-aifa. Accessed January, 2019
- 16.Schepisi R, Fusco S, Sganga F, Falcone B, Vetrano DL, Abbatecola A, Corica F, Maggio M, Ruggiero C, Fabbietti P, Corsonello A, Onder G, Lattanzio F (2016) Inappropriate use of proton pump inhibitors in elderly patients discharged from acute care hospitals. J Nutr Health Aging 20(6):665–670CrossRefGoogle Scholar
- 17.Pasina L, Nobili A, Tettamanti M, Salerno F, Corrao S, Marengoni A, Iorio A, Marcucci M, Mannucci PM, REPOSI investigators (2011) Prevalence and appropriateness of drug prescriptions for peptic ulcer and gastro-esophageal reflux disease in a cohort of hospitalized elderly. Eur J Intern Med 22(2):205–210CrossRefGoogle Scholar
- 20.Scarpignato C, Gatta L, Zullo A, Blandizzi C, SIF-AIGO-FIMMG Group; Italian Society of Pharmacology, the Italian Association of Hospital Gastroenterologists, and the Italian Federation of General Practitioners (2016) Effective and safe proton pump inhibitor therapy in acid-related diseases - a position paper addressing benefits and potential harms of acid suppression. BMC Med 14(1):179 ReviewCrossRefGoogle Scholar
- 22.Franchi C, Ardoino I, Rossio R, Nobili A, Biganzoli EM, Marengoni A, Marcucci M, Pasina L, Tettamanti M, Corrao S, Mannucci PM, REPOSI investigators (2016) Prevalence and risk factors associated with use of QT-prolonging drugs in hospitalized older people. Drugs Aging 33(1):53–61. https://doi.org/10.1007/s40266-015-0337-y CrossRefPubMedGoogle Scholar
- 23.Franchi C, Tettamanti M, Djade CD, Pasina L, Mannucci PM, Onder G, Gussoni G, Manfellotto D, Bonassi S, Salerno F, Nobili A, ELICADHE investigators (2016) E-learning in order to improve drug prescription for hospitalized older patients: a cluster-randomized controlled study. Br J Clin Pharmacol 82(1):53–63CrossRefGoogle Scholar
- 24.Franchi C, Antoniazzi S, Ardoino I, Proietti M, Marcucci M, Santalucia P, Monzani V, Mannucci PM, Nobili A, SIM-AF collaborators (2019) Simulation-based education for physicians to increase oral anticoagulants in hospitalized elderly patients with atrial fibrillation. Am J Med 132(8):e634–e647. https://doi.org/10.1016/j.amjmed.2019.03.052 CrossRefPubMedGoogle Scholar
- 25.Antoniazzi S, Ardoino I, Proietti M, Monzani V, Mannucci PM, Nobili A, Franchi C, SIM-AF collaborators (2019) Appropriateness of prescription of oral anticoagulant therapy in acutely hospitalized older people with atrial fibrillation. Secondary analysis of the SIM-AF cluster randomized clinical trial. Br J Clin Pharmacol 85(9):2134–2142. https://doi.org/10.1111/bcp.14029 CrossRefPubMedGoogle Scholar