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Multifaceted intervention to curb in-hospital over-prescription of proton pump inhibitors: A longitudinal multicenter quasi-experimental before-and-after study

  • Author Footnotes
    1 Ente Ospedaliero Cantonale, (EOC), Switzerland.
    Rosaria Del Giorno
    Footnotes
    1 Ente Ospedaliero Cantonale, (EOC), Switzerland.
    Affiliations
    Department of Internal Medicine and Nephrology, Regional Hospital of Bellinzona and Valli, Bellinzona, Switzerland
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  • Author Footnotes
    1 Ente Ospedaliero Cantonale, (EOC), Switzerland.
    Alessandro Ceschi
    Footnotes
    1 Ente Ospedaliero Cantonale, (EOC), Switzerland.
    Affiliations
    Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland

    Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich, Switzerland
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  • Author Footnotes
    1 Ente Ospedaliero Cantonale, (EOC), Switzerland.
    Michela Pironi
    Footnotes
    1 Ente Ospedaliero Cantonale, (EOC), Switzerland.
    Affiliations
    Central Pharmacy Service, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
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  • Anna Zasa
    Affiliations
    Quality and Patient Safety Service, La Carità Hospital, Locarno, Switzerland
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  • Author Footnotes
    1 Ente Ospedaliero Cantonale, (EOC), Switzerland.
    Angela Greco
    Footnotes
    1 Ente Ospedaliero Cantonale, (EOC), Switzerland.
    Affiliations
    Quality and Patient Safety Service, La Carità Hospital, Locarno, Switzerland
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  • Author Footnotes
    1 Ente Ospedaliero Cantonale, (EOC), Switzerland.
    Luca Gabutti
    Correspondence
    Corresponding author at: Regional Hospital of Bellinzona and Valli, Ente Ospedaliero Cantonale (EOC), Department of Internal Medicine and Nephrology, 6500 Bellinzona, Switzerland.
    Footnotes
    1 Ente Ospedaliero Cantonale, (EOC), Switzerland.
    Affiliations
    Department of Internal Medicine and Nephrology, Regional Hospital of Bellinzona and Valli, Bellinzona, Switzerland

    Institute of Biomedicine, University of Southern Switzerland, Lugano, Switzerland
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  • Author Footnotes
    1 Ente Ospedaliero Cantonale, (EOC), Switzerland.
Published:December 20, 2017DOI:https://doi.org/10.1016/j.ejim.2017.11.002

      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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