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Analysis of deprescription strategies of proton pump inhibitors in primary care: a narrative review

BACKGROUND: Since the introduction of omeprazole in 1989, proton pump inhibitors (PPIs) have become the mainstream of treatment for acid-related pathologies, but nowadays, it is estimated that between 20% and 80% of people worldwide who are using PPIs are doing so without an approved indication. Ove...

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Autores principales: Del-Pino, Miguel, Sanz, Emilio J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cambridge University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9971848/
https://www.ncbi.nlm.nih.gov/pubmed/36788753
http://dx.doi.org/10.1017/S1463423623000026
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author Del-Pino, Miguel
Sanz, Emilio J.
author_facet Del-Pino, Miguel
Sanz, Emilio J.
author_sort Del-Pino, Miguel
collection PubMed
description BACKGROUND: Since the introduction of omeprazole in 1989, proton pump inhibitors (PPIs) have become the mainstream of treatment for acid-related pathologies, but nowadays, it is estimated that between 20% and 80% of people worldwide who are using PPIs are doing so without an approved indication. Overusing PPIs is known to involve a tremendous cost in financial terms, and many western countries have reported high spending on these medicines. OBJECTIVE: We conducted a narrative review to evaluate PPI deprescription strategies carried out entirely or in collaboration with primary care and to identify factors that could influence the success of these strategies. METHOD: This review was conducted in November 2022, following PRISMA guidelines. Four databases were searched: PubMed, Web of Science, Scopus and CINAHL Complete, using the MeSH terms ‘proton pump inhibitors’ AND ‘deprescriptions’. RESULTS: The search with the established criteria found eight studies. The different success rates obtained by the various studies analysed in this review may be due to the different methodologies used when establishing the protocols, sample selection and monitoring of the results. CONCLUSION: We can conclude that the two factors related to the most successful strategies were a) the clarity and simplicity of the de-escalation protocols, in which patients were instructed on the measures to follow in the event of the reappearance of symptoms, and b) the training of the physicians responsible for deprescribing. Long-term conclusions cannot be drawn about the effectiveness of these protocols, given that the studies are limited in time. Other barriers to generalizing the results are the small sample size and the absence of control groups.
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spelling pubmed-99718482023-03-01 Analysis of deprescription strategies of proton pump inhibitors in primary care: a narrative review Del-Pino, Miguel Sanz, Emilio J. Prim Health Care Res Dev Review BACKGROUND: Since the introduction of omeprazole in 1989, proton pump inhibitors (PPIs) have become the mainstream of treatment for acid-related pathologies, but nowadays, it is estimated that between 20% and 80% of people worldwide who are using PPIs are doing so without an approved indication. Overusing PPIs is known to involve a tremendous cost in financial terms, and many western countries have reported high spending on these medicines. OBJECTIVE: We conducted a narrative review to evaluate PPI deprescription strategies carried out entirely or in collaboration with primary care and to identify factors that could influence the success of these strategies. METHOD: This review was conducted in November 2022, following PRISMA guidelines. Four databases were searched: PubMed, Web of Science, Scopus and CINAHL Complete, using the MeSH terms ‘proton pump inhibitors’ AND ‘deprescriptions’. RESULTS: The search with the established criteria found eight studies. The different success rates obtained by the various studies analysed in this review may be due to the different methodologies used when establishing the protocols, sample selection and monitoring of the results. CONCLUSION: We can conclude that the two factors related to the most successful strategies were a) the clarity and simplicity of the de-escalation protocols, in which patients were instructed on the measures to follow in the event of the reappearance of symptoms, and b) the training of the physicians responsible for deprescribing. Long-term conclusions cannot be drawn about the effectiveness of these protocols, given that the studies are limited in time. Other barriers to generalizing the results are the small sample size and the absence of control groups. Cambridge University Press 2023-02-15 /pmc/articles/PMC9971848/ /pubmed/36788753 http://dx.doi.org/10.1017/S1463423623000026 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.
spellingShingle Review
Del-Pino, Miguel
Sanz, Emilio J.
Analysis of deprescription strategies of proton pump inhibitors in primary care: a narrative review
title Analysis of deprescription strategies of proton pump inhibitors in primary care: a narrative review
title_full Analysis of deprescription strategies of proton pump inhibitors in primary care: a narrative review
title_fullStr Analysis of deprescription strategies of proton pump inhibitors in primary care: a narrative review
title_full_unstemmed Analysis of deprescription strategies of proton pump inhibitors in primary care: a narrative review
title_short Analysis of deprescription strategies of proton pump inhibitors in primary care: a narrative review
title_sort analysis of deprescription strategies of proton pump inhibitors in primary care: a narrative review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9971848/
https://www.ncbi.nlm.nih.gov/pubmed/36788753
http://dx.doi.org/10.1017/S1463423623000026
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