Background Proton pump inhibitors (PPIs) are widely prescribed, very often inappropriately. This over prescribing may be related to important healthcare costs, numerous adverse effects and drugs interactions.
Purpose To assess relevance of PPI prescriptions, to propose axes of improvement and to evaluate the impact of pharmacists’ interventions.
Material and methods This study was carried out in our geriatric hospital. An audit of PPI prescriptions was carried out over 6 weeks using an assessment grid. We gathered data from hospital charts. At the same time, a survey on knowledge of PPIs was handed to prescribers.
Results 114 patients were hospitalised during the period of the study and 66% (n = 75) were receiving PPIs. It was continuation of pre-admission treatment for 93% of them. 5 treatments were introduced during the hospitalisation; 3 were stopped after a pharmacist’s intervention.
For 79% (n = 59) of these patients, the prescription had no valid justification. An association of low dose non-steroidal anti-inflammatory drug (NSAID), anticoagulants or corticoids explained the prescription of PPIs for half of them.
For 40% (n = 30) of these patients, the prescription was started at least 1 year prior to hospitalisation, without any valid documented indications for most of them.
For 61% (n = 46) of these patients, a double dose was prescribed without any justification for 33 of them.
Thanks to the pharmacists’ interventions, 40% (n = 24) of the unjustified prescriptions were stopped and the administration schedule (switch from evening to morning) was modified for 25 patients (33%).
Most of the prescriptions were renewed without further evaluation of the treatment.
The survey showed a misunderstanding of recommendations.
Conclusion This study allowed a notable decrease in the number of unjustified prescriptions, and education of prescribers in the revaluation of PPI treatments. It also allowed measurement of the pharmacist’s impact on the management of the patient. To follow treatment modifications, a typical mail was prepared and was aimed at the general practitioner (revaluation and methods to stop PPIs). All of these actions fit into a therapeutic optimisation approach.
References and/or Acknowledgements
HAS guidelines. www.has-sante.fr/portail/jcms/c_812066
References and/or AcknowledgementsNo conflict of interest.
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