Abstract

RIBEIRO, Suzane et al. Inappropriate use of Proton Pump Inhibitors in an internal medicine service. J Port Gastrenterol. [online]. 2014, vol.21, n.1, pp.9-14. ISSN 0872-8178.  https://doi.org/10.1016/j.jpg.2012.12.008.

Introduction: Proton pump inhibitors are the most effective medication for reducing gastric acid secretion, and are commonly utilized for the prophylaxis of ulcerative disease. Objective: This study aims to evaluate the prescription of Proton Pump Inhibitors in an internal medicine department, to determine whether its use in prophylaxis is appropriate and what is the financial impact associated. Similarly, in the case of justified use, to assess whether the administration route adopted was appropriate. Define subsequently institutional guidelines for the use of these drugs. Methods: A cross-sectional, prospective and observational study was conducted in an internal medicine department of a District Hospital in a two-month period in 2011. We performed na analysis of all patients, aged 18 years and older, who started this medication in the first 72 hours of admission. We identified the subgroup in which this agent was prescribed for prophylactic reasons and its use was evaluated. The appropriate indications were defined based on international guidelines of the American College of Gastroenterology and the American Journal of Health-System Pharmacy. Simultaneously, the Charlson’s Comorbidity Index was applied in all patients. Results: Of 343 patient admissions during this two-month period, 186 patients received this medication prophylactically, and from this group, 74 (39.8%) did not met the criteria for its use, while from the remaining 112, twenty-five received intravenous form inappropriately. Most patients who initiate this agent without indication aged more than 70 years (p < .001) and the application of Charlson’s Comorbidity Index showed that these patients did not have a greater number of comorbidities (mean índex = 1.68). The cost of inappropriate use in this internal medicine department was D 483.28 in this 2-month period, and the estimated cost of unjustified use of Proton Pump Inhibitors in 2011 was approximately D 3000, which represents around 9% of the total cost of the Hospital with this medication. Conclusion: This study demonstrates that the use of Proton Pump Inhibitors in non-critical patients is often unnecessary and results in significant financial impact. Development of clinical guidelines is essential for the rational use of medicines.

Keywords : Proton pump inhibitors; Inappropriate use; Prophylaxis; Financial impact.

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