Besides those with the lowest risk of contracting pneumonia and C. The unique design of the study also has powerful implications on how future risk-benefit balancing studies can be conducted. Simulations using observational data could reduce the need for large prospective clinical trials. Additional inappropriate indications were surgical stress ulcer prophylaxis for surgeries without bleeding risks Of discharge reports assessed, in Conclusion: In hospitalized patients there is a high prevalence of prescription of proton-pump-inhibitors unnecessarily.
The superfluous use is often associated with the prescription of treatment protocols. Those treatments started in the hospital generally did not contribute to over-use existing primary care, most of them were removed at discharge. Key words: Proton pump inhibitor. The release of the proton pump inhibitors PPIs in the early 80s represented a breakthrough in the treatment of digestive diseases related to gastric acid secretion.
Currently, gastroesophageal reflux disease accounts for most of the approved indications for PPIs for long-term use, followed by prophylaxis against nonsteroidal anti-inflammatory drugs NSAIDs 1. The high prevalence of gastroesophageal reflux disease, its chronic nature and the concomitant presence of other risk factors such as the aging of the population, which is often associated with increased morbidity or treatments that increase the risk of bleeding such as anticoagulants or antiplatelets, contribute to a very high prescription of PPIs 2,3.
Due to the high prevalence of diseases that leads to PPI prescriptions, in recent years PPIs have become one of the most commonly used medicines in the developed world 4. However, Spain has a higher rate of prescription of PPIs than other neighbouring countries, which does not seem justified by our clinical needs 5. PPIs have side effects that can have serious consequences for patients. Long-term use has been associated with hypergastrinemia and an increased risk of community-acquired pneumonia or vitamin B12 deficiency in the elderly and in patients with Zollinger-Ellison syndrome 6.
Several epidemiological studies have shown associations between bone fractures and PPI use, mainly in long-term treatments at high doses 7,8. However, despite these adverse effects, their prevalence is not high and PPIs are considered safe drugs.
On the other hand, studies conducted on the use of PPIs in recent years have consistently found over-prescription. Clinicians often have a mistaken idea of the need for PPI prescriptions as gastric protectors for patients treated with polypharmacy, regardless of gastrolesive properties of the concomitant drugs, which generates a large number of unnecessary prescriptions for PPIs. The elderly, who generally have more comorbidity, are often treated with numerous drugs, thus they are particularly susceptible to inappropriate prescription of PPIs Over-prescription is even greater in healthcare transitions.
Many PPI treatments are initiated in hospital, sometimes without justification, and often the prescription remains after discharge from primary care, thus exposing patients to potential adverse effects and generating avoidable costs to the healthcare system. We developed the following study, whose hypothesis was that there is an unnecessary prescription of PPIs in hospitals, which in turn induces unnecessary PPI prescriptions after discharge.
The main objective of the study was to evaluate the proportion of patients starting treatment with a PPI during hospitalisation and whether the prescription was appropriate or inappropriate. Additional objectives were to evaluate the clinical and pharmacological risk factors and whether PPI initiation in hospital induced the prescription of PPIs in ambulatory care. The PPIs used, medical specialties involved and the demographic data of hospitalised patients on PPIs were also assessed.
This was a descriptive, observational, cross-sectional study in a tertiary hospital of 1, beds. The study was carried out on the first Tuesday in February of On this day, using this program, pharmacists screened all admitted patients who were being treated with a PPI.
In those cases in which a PPI was prescribed at admission, pharmacists assessed the indication via the electronic prescription program, medical history record or by contacting the attending clinician.
Patients who were on a PPI that was available in the hospital omeprazole, pantoprazole or esomeprazole the day the study was carried out; patients admitted to the following adult wards: Oncology, Internal Medicine, Pulmonology, Neurology, Cardiology, and General Surgery, Maxillofacial Surgery, Urology, Vascular Surgery, Neurosurgery and Traumatology; patients admitted to critical care units, Gastroenterology, the children's hospital and the maternity hospital were excluded.
The primary outcome variable measured was the number of patients who began treatment with a PPI at admission and whether this prescription was appropriate or not.
The rest were considered inappropriate and unnecessary prescriptions. Secondary outcomes measured were clinical and pharmacological risk factors : History of a previously complicated ulcer, older than age 65, serious co-morbidity cardiovascular, diabetes, renal or hepatic , smoker, history of gastrointestinal disease and concomitant use of drugs that increase risk of bleeding, demographic variables, available PPIs prescribed omeprazole, pantoprazole, esomeprazole and whether the PPI was prescribed at discharge and for how long.
The study was approved by the Clinical Research Ethics Committee of hospital. A database was designed to reflect the Case Report Form's content, in which a data entry matrix with possible ranges or values was established, along with the various consistency rules between variables. The quality of information received through exploratory analysis aimed at detecting discrepancies in the values, out-of-range values or missing values.
Exploratory analysis also provided information on the distribution of the main variables to be studied and provided guidance on possible transformations. For categorical data, the frequency distributions absolute and relative were presented. The statistical analysis was carried out using SAS 9. The sample size was calculated based on a pilot study in which a prevalence of PPI prescriptions was detected during the admission of According to data available from the Pharmacy Department, each patient admitted to the units studied receives approximately 10 medications daily.
A total of patients admitted were analysed. Some of them were prescribed a PPI The characteristics of the patients receiving PPIs varied depending on the time from initiation of the prescription, whether it occurred at admission or was previously prescribed in primary care Table II.
According to the prescribers, They prevent a condition called heterotopic ossification, or unexpected bone formation, which once was commonly seen after hip replacement surgery. Typically we use these medications for three weeks after surgery. Somac pantoprazole Somac belongs to a group of medications known as proton pump inhibitors.
It decreases the amount of acid produced by the stomach. In joint replacement surgery it is prescribed to prevent ulcers associated with the use of non-steroidal anti-inflammatories and aspirin.
Somac can assist with nausea and reflux. Movicol Constipation and its sequel is our most common complication of surgery. Movicol is a type of laxative. It assists in keeps the bowels moving. Pantoprazole slide 8 of 21, Pantoprazole,. Pantoprazole slide 9 of 21, Pantoprazole,. Pantoprazole slide 10 of 21, Pantoprazole,. Pantoprazole slide 11 of 21, Pantoprazole,. Pantoprazole slide 12 of 21, Pantoprazole,. Pantoprazole slide 13 of 21, Pantoprazole,. Pantoprazole slide 14 of 21, Pantoprazole,.
Pantoprazole slide 15 of 21, Pantoprazole,. Pantoprazole slide 16 of 21, Pantoprazole,. Pantoprazole slide 17 of 21, Pantoprazole,. Pantoprazole slide 18 of 21, Pantoprazole,. Pantoprazole slide 19 of 21, Pantoprazole,.
Protonix slide 20 of 21, Protonix,. Protonix slide 21 of 21, Protonix,. What is the most important information I should know about pantoprazole? What is pantoprazole?
Pantoprazole is not for immediate relief of heartburn. Pantoprazole may also be used for purposes not listed in this medication guide. What should I discuss with my healthcare provider before using pantoprazole? You should not use this medicine if:. Pantoprazole is not approved for use by anyone younger than 5 years old. How should I use pantoprazole? Do not crush, chew, or break the tablet. Swallow it whole. Store this medicine at room temperature away from moisture, heat, and light. What happens if I miss a dose?
0コメント