Inappropriate use of proton pump inhibitors in elderly patients discharged from acute care hospitals

R. Schepisi, Sergio Fusco, F. Sganga, B. Falcone, D. L. Vetrano, A. Abbatecola, F. Corica, M. Maggio, C. Ruggiero, P. Fabbietti, A. Corsonello, G. Onder, F. Lattanzio

Research output: Contribution to journalArticle

Abstract

Background: Proton-pump inhibitors (PPI) are extensively prescribed in older patients. However, little information is available on factors associated to PPI prescribing patterns among older patients discharged from hospital. Objective: To evaluate the appropriateness and clinical correlates of PPI prescription at discharge in a population of 1081 older patients discharged from acute care Italian hospitals. Design: We used data from the CRiteria to Assess Appropriate Medication Use among Elderly Complex Patients (CRIME) study, a multicenter observational study. The appropriateness of PPI prescriptions was defined according to the Italian Medicines Agency (AIFA) rules. Correlates of overprescribing (i.e prescribing without recognized AIFA indications) and underprescribing (i.e. not prescribing despite the presence of recognized AIFA indications) were investigated by logistic regression analysis. Results: Overprescribing was observed in 30% of patients receiving PPIs at discharge. Underprescribing was observed in 11% of patients not receiving PPIs at discharge. Overprescribing of PPIs at discharge was negatively associated with age (OR=0.88, 95%CI=0.85-0.91), depression (OR=0.58, 95%CI=0.35-0.96), use of aspirin (OR=0.03, 95%CI=0.02-0.06) and systemic corticosteroids (OR=0.02, 95%CI=0.01-0.04). The negative association with number of medications (OR=0.95, 95%CI=0.88-1.03) and overall comorbidities (OR=0.92, 95%CI=0.83-1.02) was nearly significant. Conversely, older age (OR=1.09, 95%CI=1.04-1.14), use of aspirin (OR=24.0, 95%CI=11.5-49.8) and systemic corticosteroids (OR=19.3, 95%CI=11.5-49.8) and overall comorbidities (OR=1.22, 95%CI=1.04-1.42) were independent correlates of underprescribing. Conclusion: Overprescribing of PPIs is more frequent in younger patients with lower burden of depression, whilst underprescribing is characterized by older age and greater burden of comorbidity and polypharmacy. Hospitalization should be considered as a clue to identify inappropriate use of PPIs and improve appropriateness of prescribing.

Original languageEnglish
Pages (from-to)1-6
Number of pages6
JournalJournal of Nutrition, Health and Aging
DOIs
Publication statusAccepted/In press - Dec 18 2015

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Proton Pump Inhibitors
Comorbidity
Aspirin
Prescriptions
Adrenal Cortex Hormones
Polypharmacy
Multicenter Studies
Observational Studies
Hospitalization
Logistic Models
Regression Analysis
Population

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics
  • Geriatrics and Gerontology

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Inappropriate use of proton pump inhibitors in elderly patients discharged from acute care hospitals. / Schepisi, R.; Fusco, Sergio; Sganga, F.; Falcone, B.; Vetrano, D. L.; Abbatecola, A.; Corica, F.; Maggio, M.; Ruggiero, C.; Fabbietti, P.; Corsonello, A.; Onder, G.; Lattanzio, F.

In: Journal of Nutrition, Health and Aging, 18.12.2015, p. 1-6.

Research output: Contribution to journalArticle

Schepisi, R. ; Fusco, Sergio ; Sganga, F. ; Falcone, B. ; Vetrano, D. L. ; Abbatecola, A. ; Corica, F. ; Maggio, M. ; Ruggiero, C. ; Fabbietti, P. ; Corsonello, A. ; Onder, G. ; Lattanzio, F. / Inappropriate use of proton pump inhibitors in elderly patients discharged from acute care hospitals. In: Journal of Nutrition, Health and Aging. 2015 ; pp. 1-6.
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abstract = "Background: Proton-pump inhibitors (PPI) are extensively prescribed in older patients. However, little information is available on factors associated to PPI prescribing patterns among older patients discharged from hospital. Objective: To evaluate the appropriateness and clinical correlates of PPI prescription at discharge in a population of 1081 older patients discharged from acute care Italian hospitals. Design: We used data from the CRiteria to Assess Appropriate Medication Use among Elderly Complex Patients (CRIME) study, a multicenter observational study. The appropriateness of PPI prescriptions was defined according to the Italian Medicines Agency (AIFA) rules. Correlates of overprescribing (i.e prescribing without recognized AIFA indications) and underprescribing (i.e. not prescribing despite the presence of recognized AIFA indications) were investigated by logistic regression analysis. Results: Overprescribing was observed in 30{\%} of patients receiving PPIs at discharge. Underprescribing was observed in 11{\%} of patients not receiving PPIs at discharge. Overprescribing of PPIs at discharge was negatively associated with age (OR=0.88, 95{\%}CI=0.85-0.91), depression (OR=0.58, 95{\%}CI=0.35-0.96), use of aspirin (OR=0.03, 95{\%}CI=0.02-0.06) and systemic corticosteroids (OR=0.02, 95{\%}CI=0.01-0.04). The negative association with number of medications (OR=0.95, 95{\%}CI=0.88-1.03) and overall comorbidities (OR=0.92, 95{\%}CI=0.83-1.02) was nearly significant. Conversely, older age (OR=1.09, 95{\%}CI=1.04-1.14), use of aspirin (OR=24.0, 95{\%}CI=11.5-49.8) and systemic corticosteroids (OR=19.3, 95{\%}CI=11.5-49.8) and overall comorbidities (OR=1.22, 95{\%}CI=1.04-1.42) were independent correlates of underprescribing. Conclusion: Overprescribing of PPIs is more frequent in younger patients with lower burden of depression, whilst underprescribing is characterized by older age and greater burden of comorbidity and polypharmacy. Hospitalization should be considered as a clue to identify inappropriate use of PPIs and improve appropriateness of prescribing.",
author = "R. Schepisi and Sergio Fusco and F. Sganga and B. Falcone and Vetrano, {D. L.} and A. Abbatecola and F. Corica and M. Maggio and C. Ruggiero and P. Fabbietti and A. Corsonello and G. Onder and F. Lattanzio",
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T1 - Inappropriate use of proton pump inhibitors in elderly patients discharged from acute care hospitals

AU - Schepisi, R.

AU - Fusco, Sergio

AU - Sganga, F.

AU - Falcone, B.

AU - Vetrano, D. L.

AU - Abbatecola, A.

AU - Corica, F.

AU - Maggio, M.

AU - Ruggiero, C.

AU - Fabbietti, P.

AU - Corsonello, A.

AU - Onder, G.

AU - Lattanzio, F.

PY - 2015/12/18

Y1 - 2015/12/18

N2 - Background: Proton-pump inhibitors (PPI) are extensively prescribed in older patients. However, little information is available on factors associated to PPI prescribing patterns among older patients discharged from hospital. Objective: To evaluate the appropriateness and clinical correlates of PPI prescription at discharge in a population of 1081 older patients discharged from acute care Italian hospitals. Design: We used data from the CRiteria to Assess Appropriate Medication Use among Elderly Complex Patients (CRIME) study, a multicenter observational study. The appropriateness of PPI prescriptions was defined according to the Italian Medicines Agency (AIFA) rules. Correlates of overprescribing (i.e prescribing without recognized AIFA indications) and underprescribing (i.e. not prescribing despite the presence of recognized AIFA indications) were investigated by logistic regression analysis. Results: Overprescribing was observed in 30% of patients receiving PPIs at discharge. Underprescribing was observed in 11% of patients not receiving PPIs at discharge. Overprescribing of PPIs at discharge was negatively associated with age (OR=0.88, 95%CI=0.85-0.91), depression (OR=0.58, 95%CI=0.35-0.96), use of aspirin (OR=0.03, 95%CI=0.02-0.06) and systemic corticosteroids (OR=0.02, 95%CI=0.01-0.04). The negative association with number of medications (OR=0.95, 95%CI=0.88-1.03) and overall comorbidities (OR=0.92, 95%CI=0.83-1.02) was nearly significant. Conversely, older age (OR=1.09, 95%CI=1.04-1.14), use of aspirin (OR=24.0, 95%CI=11.5-49.8) and systemic corticosteroids (OR=19.3, 95%CI=11.5-49.8) and overall comorbidities (OR=1.22, 95%CI=1.04-1.42) were independent correlates of underprescribing. Conclusion: Overprescribing of PPIs is more frequent in younger patients with lower burden of depression, whilst underprescribing is characterized by older age and greater burden of comorbidity and polypharmacy. Hospitalization should be considered as a clue to identify inappropriate use of PPIs and improve appropriateness of prescribing.

AB - Background: Proton-pump inhibitors (PPI) are extensively prescribed in older patients. However, little information is available on factors associated to PPI prescribing patterns among older patients discharged from hospital. Objective: To evaluate the appropriateness and clinical correlates of PPI prescription at discharge in a population of 1081 older patients discharged from acute care Italian hospitals. Design: We used data from the CRiteria to Assess Appropriate Medication Use among Elderly Complex Patients (CRIME) study, a multicenter observational study. The appropriateness of PPI prescriptions was defined according to the Italian Medicines Agency (AIFA) rules. Correlates of overprescribing (i.e prescribing without recognized AIFA indications) and underprescribing (i.e. not prescribing despite the presence of recognized AIFA indications) were investigated by logistic regression analysis. Results: Overprescribing was observed in 30% of patients receiving PPIs at discharge. Underprescribing was observed in 11% of patients not receiving PPIs at discharge. Overprescribing of PPIs at discharge was negatively associated with age (OR=0.88, 95%CI=0.85-0.91), depression (OR=0.58, 95%CI=0.35-0.96), use of aspirin (OR=0.03, 95%CI=0.02-0.06) and systemic corticosteroids (OR=0.02, 95%CI=0.01-0.04). The negative association with number of medications (OR=0.95, 95%CI=0.88-1.03) and overall comorbidities (OR=0.92, 95%CI=0.83-1.02) was nearly significant. Conversely, older age (OR=1.09, 95%CI=1.04-1.14), use of aspirin (OR=24.0, 95%CI=11.5-49.8) and systemic corticosteroids (OR=19.3, 95%CI=11.5-49.8) and overall comorbidities (OR=1.22, 95%CI=1.04-1.42) were independent correlates of underprescribing. Conclusion: Overprescribing of PPIs is more frequent in younger patients with lower burden of depression, whilst underprescribing is characterized by older age and greater burden of comorbidity and polypharmacy. Hospitalization should be considered as a clue to identify inappropriate use of PPIs and improve appropriateness of prescribing.

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