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van Gestel LC, Adriaanse MA, Kanis SL, Mensink-Bout SM, Schoones JW, Numans ME, Kiefte-de Jong JC, van den Brink G. Determinants of and interventions for Proton Pump Inhibitor prescription behavior: A systematic scoping review. BMC PRIMARY CARE 2024; 25:208. [PMID: 38862886 PMCID: PMC11165893 DOI: 10.1186/s12875-024-02459-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/03/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Proton Pump Inhibitors (PPI) are frequently prescribed. Long-term use is associated with side-effects and patients often lack a valid indication. Inappropriate PPI prescribing thus needs to be addressed. This review aims to scope 1) what determinants are studied as reasons for PPI prescribing, 2) what strategies are used for changing PPI (de)prescribing, and 3) whether important determinants are addressed in these interventions. METHODS We searched eight databases for papers on determinants of physician PPI prescribing. Studies were included if they were conducted in a Western country and focused on oral PPIs for an adult population. By following the Behaviour Change Wheel, we extracted information regarding PPI prescribing behavior, behavioral determinants and intervention strategies. FINDINGS We included 74 papers. Most focused on the determinants knowledge and beliefs about consequences. The latter was consistently related to PPI prescribing. Results for knowledge were mixed. Most interventions used education or enablement (e.g., algorithms, quality check improvements, involvement of pharmacists) as strategies. Enablement consistently improved PPI prescribing, while results for education were mixed. INTERPRETATION There is an overemphasis on reflective processes in studies on PPI prescribing. Future research should comprehensively identify behavioral determinants, focusing on reflective and impulsive processes, such that interventions can address the most important determinants.
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Affiliation(s)
- L C van Gestel
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands.
| | - M A Adriaanse
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - S L Kanis
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - S M Mensink-Bout
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - J W Schoones
- Directorate of Research Policy, Leiden University Medical Center, Leiden, The Netherlands
| | - M E Numans
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - J C Kiefte-de Jong
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - G van den Brink
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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Gutiérrez-Igual S, Lucas-Domínguez R, Martí Rodrigo A, Romero Crespo I, Montesinos Mezquita MC. [New tools for medication review: DRP in patients treatment with proton pump inhibitors]. Aten Primaria 2024; 56:102836. [PMID: 38150850 PMCID: PMC11058877 DOI: 10.1016/j.aprim.2023.102836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 12/29/2023] Open
Abstract
OBJECTIVE To analyze, using the medication review program, Revisem®, the prevalence of drug-related problems (DRP) in patients in the province of Valencia who were on active treatment with proton pump inhibitors (PPI) in 2022. DESIGN Descriptive and retrospective observational study. MATERIAL AND METHODS The pharmacotherapeutic history of 295 patients was analyzed following the criteria proposed by the Pharmaceutical Care Network Europe, using the Revisem® digital platform of the Muy Ilustre Colegio Oficial de Farmacéuticos (MICOF). RESULTS The mean age of the patients was 81.8 ± 11.1 years and 66.4% were women. At least one DRP was detected in 97.3% of patients. 46.9% of the DRP analyzed were interactions, of which 29.7% involved a PPI, with omeprazole being the most frequent. DRPs with PPI are significantly related to certain patient conditions and pharmacological groups, such as female sex, age over 54 years and polypharmacy. CONCLUSIONS The application of the Revisem® digital platform allows the detection of a high prevalence of DRP at the provincial level. The application of new technological tools to detect the prevalence of DRP is essential to optimize patient treatments.
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Affiliation(s)
- Salvador Gutiérrez-Igual
- Servicios Asistenciales Farmacéuticos y Formación, Muy Ilustre Colegio Oficial de Farmacéuticos de Valencia (MICOF), Valencia, España; Departamento de Farmacología, Universidad de Valencia (UV), Burjassot, España.
| | - Rut Lucas-Domínguez
- UISYS, Departamento de Historia de la Ciencia y Documentación, Facultad de Medicina y Odontología, Universidad de Valencia (UV), Valencia, España; Unidad asociada al Instituto Interuniversitario de Investigación Avanzada sobre Evaluación de la Ciencia y la Universidad (INAECU), UC3M-UAM3, Madrid, España; CIBERONC, Valencia, España.
| | - Alberto Martí Rodrigo
- Servicios Asistenciales Farmacéuticos y Formación, Muy Ilustre Colegio Oficial de Farmacéuticos de Valencia (MICOF), Valencia, España
| | - Isabel Romero Crespo
- Servicios Asistenciales Farmacéuticos y Formación, Muy Ilustre Colegio Oficial de Farmacéuticos de Valencia (MICOF), Valencia, España
| | - M Carmen Montesinos Mezquita
- Departamento de Farmacología, Universidad de Valencia (UV), Burjassot, España; Equipo Estudios de Bioactividad, Instituto Interuniversitario de Reconocimiento Molecular y Desarrollo Tecnológico (IDM). Universidad Politécnica de Valencia (UPV). Universidad de Valencia (UV), Valencia, España
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3
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Su Y, Chen Y, Zheng J, Yao C. Association between proton pump inhibitors and risk of hepatic encephalopathy in patients undergoing transjugular intrahepatic portosystemic shunt: a protocol for a systematic review and meta-analysis. BMJ Open 2024; 14:e078412. [PMID: 38569689 PMCID: PMC10989172 DOI: 10.1136/bmjopen-2023-078412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 03/20/2024] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Hepatic encephalopathy (HE) is a major complication of acute liver failure, cirrhosis and transjugular intrahepatic portosystemic shunt (TIPS) placement. Its clinical manifestations range from mild cognitive deficits to coma. Furthermore, HE is a financial burden to a patient's family and significantly affects the patient's quality of life. In clinical practice, proton pump inhibitors (PPIs) are widely used for the treatment of HE. The use of PPIs is associated with an increased risk of post-TIPS HE; however, findings on the risk relationship between PPIs and post-TIPS HE are inconsistent. Therefore, a systematic evaluation of the relationship is needed to further provide valid evidence for the rational use of PPIs in patients who undergo TIPS. METHODS AND ANALYSIS PubMed, Web of Science, Cochrane Library and Embase will be searched extensively for relevant information. Information from 1 July 2023 to 31 July 2023 in these databases will be included. Primary outcomes will be the use of PPIs and incidence of HE after TIPS; secondary outcomes will be survival, dose dependence and adverse events. This meta-analysis will be reported in accordance with the 50 Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. The risk of bias, heterogeneity and quality of evidence of the included studies will be evaluated prior to the data analysis. All data will be analysed using Review Manager (V.5.4.1) and Stata (V.17.0) statistical software. ETHICS AND DISSEMINATION Ethical approval will not be necessary for this review and meta-analysis. The results of the study will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42022359208.
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Affiliation(s)
- Yun Su
- Post Graduate Institute, GuangXi University of Chinese Medicine, Nanning, Guangxi, China
| | - Yueqiao Chen
- Department of Liver Disease, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Jinghui Zheng
- Department of Geriatrics, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning, Guangxi, China
| | - Chun Yao
- University President, GuangXi University of Chinese Medicine, Nanning, Guangxi, China
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Kahrilas P, Anastasiou F, Bredenoord AJ, El Serag HB, Labenz J, Mendive J, Savarino EV, Sifrim D, Udrescu M, Yadlapati R, Hungin AP. Proton Pump Inhibitors: Rational Use and Use-Reduction - The Windsor Workshop. Dig Dis 2024; 42:211-220. [PMID: 38513623 DOI: 10.1159/000538399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Despite deprescribing initiatives to curb overutilization of proton pump inhibitors (PPIs), achieving meaningful reductions in PPI use is proving a challenge. SUMMARY An international group of primary care doctors and gastroenterologists examined the literature surrounding PPI use and use-reduction to clarify: (i) what constitutes rational PPI prescribing; (ii) when and in whom PPI use-reduction should be attempted; and (iii) what strategies to use when attempting PPI use-reduction. KEY MESSAGES Before starting a PPI for reflux-like symptoms, patients should be educated on potential causes and alternative approaches including dietary and lifestyle modification, weight loss, and relaxation strategies. When commencing a PPI, patients should understand the reason for treatment, planned duration, and review date. PPI use at hospital discharge should not be continued without a recognized indication for long-term treatment. Long-term PPI therapy should be reviewed at least annually. PPI use-reduction should be based on the lack of a rational indication for long-term PPI use, not concern for PPI-associated adverse events. PPI use-reduction strategies involving switching to on-demand PPI or dose tapering, with rescue therapy for rebound symptoms, are more likely to succeed than abrupt cessation.
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Affiliation(s)
- Peter Kahrilas
- Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Foteini Anastasiou
- 4th Local Primary Care Team, Municipality Practice and Academic Practice of Heraklion, Crete, Greece
| | - Albert J Bredenoord
- Department of Gastroenterology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Hashem B El Serag
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Joachim Labenz
- Department of Internal Medicine, Jung-Stilling-Hospital, Siegen, Germany
| | - Juan Mendive
- La Mina Primary Care Academic Centre, Catalan Health Institute, University of Barcelona, Barcelona, Spain
| | - Edoardo V Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Daniel Sifrim
- Wingate Institute of Neurogastroenterology, Queen Mary University of London, London, UK
| | | | - Rena Yadlapati
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | - A Pali Hungin
- Faculty of Medical Sciences, Professor Emeritus, Primary Care and General Practice, Newcastle University, Newcastle upon Tyne, UK
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Plehhova K, Häring M, Wray J, Coyle C, Kostev K. Proton Pump Inhibitors in Germany: Status Quo of a Growing Market. Health Serv Res Manag Epidemiol 2024; 11:23333928241241220. [PMID: 38562150 PMCID: PMC10983788 DOI: 10.1177/23333928241241220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 02/12/2024] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction The volume of prescriptions for proton pump inhibitors (PPIs) remains high, although the literature increasingly points to excessive prescribing in relation to guideline recommendations. No very recent data is available on the specific situation in Germany, particularly on the proportion of PPI consumption from over-the-counter (OTC) sales and self-selection, following PPI down-scheduling. The aim of this study was to determine the actual amount of prescribed and OTC PPIs in Germany. Methods For this retrospective study, several IQVIA databases were used, representing all prescriptions billed to statutory and private health insurers in Germany, as well as OTC sales. Analyses were performed for the period November 2020 to October 2021 or partially November 2018 to October 2021 and were descriptive in nature. Mainly, data were collected from IQVIATM PharmaScope National® as well as IQVIA TM DPM® databases. Results A total of 2.87 billion PPI tablets were shown to have been sold between November 2020 and October 2021, with most drugs prescribed in the largest packages and strengths. In addition, the OTC PPI market increased by an average of 14% per year over a 3-year period. Conclusions The results of this study suggest the substantial size of the PPI market in Germany is based on prescriptions, a consistent increase in OTC PPI purchases and a recent increase in prescriptions.
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