Highlights
- •Curbing proton pump inhibitors (PPI) over-prescription represents a challenge to health care providers.
- •A multifaceted-strategy aimed to optimize PPI prescriptions has been implemented in a hospital network.
- •A significant sustained reduction in new PPI prescriptions was obtained.
- •Further studies are needed to confirm the efficacy of the proposed strategy.
Abstract
Background
Proton pump inhibitors (PPIs) are indicated for a restricted number of clinical conditions,
and their misuse can lead to several adverse effects. Despite that, the proportion
of overuse is alarmingly high.
Objective
To test the efficacy of a multifaceted strategy in order to achieve a significant
reduction of new PPI prescriptions at discharge in hospitalized patients.
Design
Multicenter longitudinal quasi-experimental before-and-after study conducted from
July 1st, 2014 to June 30th, 2017.
Participants
44,973 admissions in a network of 5 public teaching hospitals of the Italian-speaking
region of Switzerland.
Intervention
Multifaceted strategy consisting in a continuous transparent monitoring-benchmarking
and in capillary educational interventions applied in the internal medicine departments.
To confirm the causality of the results we monitored the trend of new PPI prescriptions
in the, not exposed to the intervention, surgery departments of the same hospital
network.
Main measures
New PPI prescriptions at hospital discharge.
Key results
Over the 36 month study period 44,973 patient files were analyzed. At admission, comparing internal
medicine vs. surgery departments, 44.9% vs. 23.3% of patients were already being treated
with a PPI. The annual rate of new PPI prescriptions, for internal medicine showed
a decreasing trend: 19, 19, 18, 16% in years 2014, 2015, 2016, 2017, respectively
(p < 0.001, 2014 vs. 2017; p-for-trend <0.001), while an increasing rate was found in the surgery departments in the same
years: 30, 29, 36, 36%, respectively (p < 0.001, 2014 vs. 2017; p-for-trend <0.001). The case mix was significantly associated with the probability of new PPI
prescriptions in both departments (OR1.35, 95% CI 1.26–1.44 for internal medicine
and 1.24, 95% CI 1.19–1.30 for surgery).
Conclusions
The introduction of a multifaceted intervention significantly reduced the time trend
of PPI prescriptions at hospital discharge in internal medicine departments. Further
studies are needed to confirm whether the strategy proposed could contribute to optimize
the in-hospital drug prescription behavior in other healthcare settings as well.
Abbreviations:
PPIs (proton pump inhibitors), CM (case mix)Keywords
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Article info
Publication history
Published online: December 20, 2017
Accepted:
November 6,
2017
Received in revised form:
November 3,
2017
Received:
September 1,
2017
Identification
Copyright
© 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
