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Deprescribing Strategies: A Prospective Study on Proton Pump Inhibitors

Proton pump inhibitors (PPIs) are among the most controversially prescribed drugs in polypharmacy. This observational prospective study assessed the PPI prescriptive trend during hospitalization before and after implementation of a prescribing/deprescribing algorithm in a real-life hospital setting...

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Autores principales: Calvini, Giulia, Baiardi, Giammarco, Mattioli, Francesca, Milano, Giulia, Calautti, Francesca, Zunino, Alessia, Fraguglia, Carla Elda, Caccavale, Fabio, Lantieri, Francesca, Antonucci, Giancarlo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10140867/
https://www.ncbi.nlm.nih.gov/pubmed/37109364
http://dx.doi.org/10.3390/jcm12083029
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author Calvini, Giulia
Baiardi, Giammarco
Mattioli, Francesca
Milano, Giulia
Calautti, Francesca
Zunino, Alessia
Fraguglia, Carla Elda
Caccavale, Fabio
Lantieri, Francesca
Antonucci, Giancarlo
author_facet Calvini, Giulia
Baiardi, Giammarco
Mattioli, Francesca
Milano, Giulia
Calautti, Francesca
Zunino, Alessia
Fraguglia, Carla Elda
Caccavale, Fabio
Lantieri, Francesca
Antonucci, Giancarlo
author_sort Calvini, Giulia
collection PubMed
description Proton pump inhibitors (PPIs) are among the most controversially prescribed drugs in polypharmacy. This observational prospective study assessed the PPI prescriptive trend during hospitalization before and after implementation of a prescribing/deprescribing algorithm in a real-life hospital setting and the related clinical–economic benefit at discharge. PPI prescriptive trends were compared between three quarters of 2019 (9 months) and the same period of 2018 by a chi-square test with a Yate’s correction. The proportions of treated patients in the two years (1120 discharged patients in 2018 and 1107 in 2019) were compared by the Cochran–Armitage trend test. DDDs (defined daily doses) were compared between 2018 and 2019 by the non-parametric Mann–Whitney test and normalizing DDD/DOT (days of therapy) and DDD/100 bd (bed days) for each patient. Multivariate logistic regression was performed on PPI prescriptions at discharge. The distribution of patients with PPIs at discharge was significantly different in the two years (p = 0.0121). There was a downward trend in the number of PPI prescriptions (29.9%) in the third trimester of 2019 compared to the others of the same year (first trimester: 34.1%, second trimester: 36.0%) and by contrast with the same periods of 2018 (29.4, 36.0, and 34.7%) (p = 0.0124). DDDs/patient did not differ between 2018 and 2019 nor across the three trimesters. However, both DDD/DOT and DDD/100 bd showed a decrease in the third trimester of 2019, with a marked difference for DDD/DOT (p = 0.0107). The reduction in consumption detected in the last phase of 2019 in terms of DDD/DOT was 0.09 with a consequent containment of pharmaceutical spending. The development and implementation of multidisciplinary prescribing/deprescribing protocols in both hospital and community settings could lead to a reduction in the misuse of PPIs, with significant savings in healthcare resources.
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spelling pubmed-101408672023-04-29 Deprescribing Strategies: A Prospective Study on Proton Pump Inhibitors Calvini, Giulia Baiardi, Giammarco Mattioli, Francesca Milano, Giulia Calautti, Francesca Zunino, Alessia Fraguglia, Carla Elda Caccavale, Fabio Lantieri, Francesca Antonucci, Giancarlo J Clin Med Article Proton pump inhibitors (PPIs) are among the most controversially prescribed drugs in polypharmacy. This observational prospective study assessed the PPI prescriptive trend during hospitalization before and after implementation of a prescribing/deprescribing algorithm in a real-life hospital setting and the related clinical–economic benefit at discharge. PPI prescriptive trends were compared between three quarters of 2019 (9 months) and the same period of 2018 by a chi-square test with a Yate’s correction. The proportions of treated patients in the two years (1120 discharged patients in 2018 and 1107 in 2019) were compared by the Cochran–Armitage trend test. DDDs (defined daily doses) were compared between 2018 and 2019 by the non-parametric Mann–Whitney test and normalizing DDD/DOT (days of therapy) and DDD/100 bd (bed days) for each patient. Multivariate logistic regression was performed on PPI prescriptions at discharge. The distribution of patients with PPIs at discharge was significantly different in the two years (p = 0.0121). There was a downward trend in the number of PPI prescriptions (29.9%) in the third trimester of 2019 compared to the others of the same year (first trimester: 34.1%, second trimester: 36.0%) and by contrast with the same periods of 2018 (29.4, 36.0, and 34.7%) (p = 0.0124). DDDs/patient did not differ between 2018 and 2019 nor across the three trimesters. However, both DDD/DOT and DDD/100 bd showed a decrease in the third trimester of 2019, with a marked difference for DDD/DOT (p = 0.0107). The reduction in consumption detected in the last phase of 2019 in terms of DDD/DOT was 0.09 with a consequent containment of pharmaceutical spending. The development and implementation of multidisciplinary prescribing/deprescribing protocols in both hospital and community settings could lead to a reduction in the misuse of PPIs, with significant savings in healthcare resources. MDPI 2023-04-21 /pmc/articles/PMC10140867/ /pubmed/37109364 http://dx.doi.org/10.3390/jcm12083029 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Calvini, Giulia
Baiardi, Giammarco
Mattioli, Francesca
Milano, Giulia
Calautti, Francesca
Zunino, Alessia
Fraguglia, Carla Elda
Caccavale, Fabio
Lantieri, Francesca
Antonucci, Giancarlo
Deprescribing Strategies: A Prospective Study on Proton Pump Inhibitors
title Deprescribing Strategies: A Prospective Study on Proton Pump Inhibitors
title_full Deprescribing Strategies: A Prospective Study on Proton Pump Inhibitors
title_fullStr Deprescribing Strategies: A Prospective Study on Proton Pump Inhibitors
title_full_unstemmed Deprescribing Strategies: A Prospective Study on Proton Pump Inhibitors
title_short Deprescribing Strategies: A Prospective Study on Proton Pump Inhibitors
title_sort deprescribing strategies: a prospective study on proton pump inhibitors
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10140867/
https://www.ncbi.nlm.nih.gov/pubmed/37109364
http://dx.doi.org/10.3390/jcm12083029
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