Overuse of proton pump inhibitors in nursing homes: An Italian multicenter observational study

Luca Pasina, Alessio Novella, Chiara Elli, Alessandro Nobili, Aladar Ianes
Pharmacoepidemiology and Drug Safety 2020 January 27

PURPOSE: To examine the prevalence of residents receiving proton pump inhibitors (PPIs) for evidence-based indications in a large sample of Italian nursing homes (NHs) and to assess the predictors of potentially inappropriate prescriptions.

METHODS: This study was conducted in a sample of Italian long-term care NHs. Information on drug prescription, diseases, and socio-demographic characteristics of NH residents was collected three times during 2018. Appropriate use of PPI was defined in accordance with the strongest evidence-based indications and the Italian criteria for PPI prescription.

RESULTS: Among the 2579 patients recruited from 27 long-term care NHs, 1177 (45.6%) were receiving PPIs; 597 (50.7%) were taking them for evidence-based indications. Corticosteroids, anticoagulants, and mean number of drugs were the most important predictors of inappropriate PPIs prescriptions. NH residents receiving ≥13 drugs had about 10 times the risk of receiving a PPI than those taking 0 to 4 drugs. Similarly, residents with more comorbidity had about 2.5 times the risk of receiving a PPI than those in better health. The prevalence of residents inappropriately treated with PPI in individual NHs varied widely, ranging from 22% to 63%.

CONCLUSIONS: Number of drugs, comorbidity, corticosteroids, and anticoagulants are the most important predictors of the inappropriate use of PPI in NHs. The wide variability between NHs in the appropriate use of PPIs suggests the need for thorough drug review in this fragile and vulnerable population. Prescribing patterns linked to evidence-based guidelines and national recommendations are essential for rational, cost-effective use of PPIs.

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