Determining proton pump inhibitor prescription dispensing patterns and adherence to STOPP criteria for Nova Scotia Seniors Pharmacare Program beneficiaries
Main Article Content
Keywords
proton pump inhibitor, screening tool of older people’s potentially inappropriate prescriptions (STOPP)
Abstract
Background
Proton pump inhibitors (PPIs) are often prescribed potentially inappropriately. The screening tool of older person’s potentially inappropriate prescriptions (STOPP) for therapeutic dose PPIs has been adapted to examine PPI discontinuation, dose reduction, or switching to Histamine-2 Receptor Antagonist (H2RA) after 60 days.
Objectives
The objectives of the present study were to (1) describe the use of acid suppression therapy (PPIs and H2RAs) 60 and 90 days after a new PPI dispensing, (2) assess predictors of lack of adherence to adapted STOPP criteria for PPI use, and (3) assess PPI dispensing over time.
Methods
This was a retrospective cohort study of beneficiaries of the Nova Scotia Seniors Pharmacare (NSSP) aged 66 years or older who were newly dispensed a PPI between January 1, 1997 and March 31, 2011. The main outcome measure was adherence to the adapted STOPP criteria, which was analyzed using logistic regression.
Results
A total of 14,453 participants were included: 89.8% beginning on standard dose and 10.2% beginning on high dose PPI. Of those beginning on high-dose PPI, 26.4% were dispensed high-dose PPI at day 60 and 30.2% were dispensed high-dose PPI at day 90. Predictors of lack of adherence to our adapted STOPP criteria included age ?86 years, rural residence, and hospitalization within 1 year prior to cohort entry.
Conclusions
Many PPI prescriptions dispensed for NSSP beneficiaries fail to adhere to the STOPP criteria. Predictors of lack of adherence to the adapted STOPP criteria were identified.
Proton pump inhibitors (PPIs) are often prescribed potentially inappropriately. The screening tool of older person’s potentially inappropriate prescriptions (STOPP) for therapeutic dose PPIs has been adapted to examine PPI discontinuation, dose reduction, or switching to Histamine-2 Receptor Antagonist (H2RA) after 60 days.
Objectives
The objectives of the present study were to (1) describe the use of acid suppression therapy (PPIs and H2RAs) 60 and 90 days after a new PPI dispensing, (2) assess predictors of lack of adherence to adapted STOPP criteria for PPI use, and (3) assess PPI dispensing over time.
Methods
This was a retrospective cohort study of beneficiaries of the Nova Scotia Seniors Pharmacare (NSSP) aged 66 years or older who were newly dispensed a PPI between January 1, 1997 and March 31, 2011. The main outcome measure was adherence to the adapted STOPP criteria, which was analyzed using logistic regression.
Results
A total of 14,453 participants were included: 89.8% beginning on standard dose and 10.2% beginning on high dose PPI. Of those beginning on high-dose PPI, 26.4% were dispensed high-dose PPI at day 60 and 30.2% were dispensed high-dose PPI at day 90. Predictors of lack of adherence to our adapted STOPP criteria included age ?86 years, rural residence, and hospitalization within 1 year prior to cohort entry.
Conclusions
Many PPI prescriptions dispensed for NSSP beneficiaries fail to adhere to the STOPP criteria. Predictors of lack of adherence to the adapted STOPP criteria were identified.
References
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8. Gibson S. Regulating direct-to-consumer advertising of prescription drugs in the digital age. Laws. 2014;3(3):410–38. doi: 10.3390/laws3030410
9. Aronson JK. Inhibiting the proton pump: Mechanisms, benefits, harms, and questions. BMC Med. 2016;14(1):172. doi: 10.1186/ s12916-016-0724-1
10. Eusebi LH, Rabitti S, Artesiani ML, et al. Proton pump inhibitors: Risks of long-term use. J Gastroenterol Hepatol. 2017;32(7):1295–302. doi: 10.1111/jgh.13737
11. Schnoll-Sussman F, Katz PO. Clinical implications of emerging data on the safety of proton pump inhibitors. Curr Treat Options Gastroenterol. 2017;15(1):1–9. doi: 10.1007/s11938-017-0115-5
12. Freedberg DE, Lebwohl B, Abrams JA. The impact of proton pump inhibitors on the human gastrointestinal microbiome. Clin Lab Med. 2014;34(4):771–85. doi: 10.1016/j.cll.2014.08.008
13. Hollingworth S, Duncan EL, Martin JH. Marked increase in proton pump inhibitors use in Australia. Pharmacoepidemiol Drug Saf. 2010;19(10):1019–24. doi: 10.1002/pds.1969
14. Haastrup PF, Rasmussen S, Hansen JM, Christensen RD, Sondergaard J, Jarbol DE. General practice variation when initiating long-term prescribing of proton pump inhibitors: A nationwide cohort study. BMC Fam Pract. 2016;17:57. doi: 10.1186/s12875-016-0460-9
15. Moriarty F, Bennett K, Cahir C, Fahey T. Characterizing potentially inappropriate prescribing of proton pump inhibitors in older people in primary care in Ireland from 1997 to 2012. J Am Geriatr Soc. 2016;64(12):e291–6. doi: 10.1111/jgs.14528
16. Tsuda A, Suda W, Morita H, et al. Influence of proton-pump inhibitors on the luminal microbiota in the gastrointestinal tract. Clin Transl Gastroenterol. 2015;6:e89. doi: 10.1038/ ctg.2015.20
17. Laine L, Nagar A. Long-term PPI use: Balancing potential harms and documented benefits. Am J Gastroenterol. 2016;111(7):913–5. doi: 10.1038/ ajg.2016.156
18. Heidelbaugh JJ, Metz DC, Yang Y-X. Proton pump inhibitors: Are they overutilised in clinical practice and do they pose significant risk? Int J Clin Pract. 2012;66(6):582–91. doi: 10.1111/ j.1742-1241.2012.02921.x
19. Naunton M, Peterson GM, Bleasel MD. Overuse of proton pump inhibitors. J Clin Pharm Ther. 2000;25(5):333–40. doi: 10.1046/j.1365-2710.2000. 00312.x
20. Malfertheiner P, Kandulski A, Venerito M. Proton-pump inhibitors: Understanding the complications and risks. Nat Rev Gastroenterol Hepatol. 2017;14(12):697–710. doi: 10.1038/ nrgastro.2017.117
21. Fisher L, Fisher A. Acid-suppressive therapy and risk of infections: Pros and cons. Clin Drug Investig. 2017;37(7):587–624. doi: 10.1007/ s40261-017-0519-y
22. Mahieu LM, De Muynck AO, Ieven MM, De Dooy JJ, Goossens HJ, Van Reempts PJ. Risk factors for central vascular catheter-associated bloodstream infections among patients in a neonatal intensive care unit. J Hosp Infect. 2001;48(2):108–16. doi: 10.1053/ jhin.2001.0984
23. Gallagher P, Ryan C, Byrne S, Kennedy J, O’Mahony D. STOPP (screening tool of older person’s prescriptions) and START (screening tool to alert doctors to right treatment). Consensus validation. Int J Clin Pharmacol Ther. 2008;46(2): 72–83. doi: 10.5414/cpp46072
24. Goldstein FC, Steenland K, Zhao L, Wharton W, Levey AI, Hajjar I. Proton pump inhibitors and risk of mild cognitive impairment and dementia. J Am Geriatr Soc. June 2017;65(9):1969–74. doi: 10.1111/jgs.14956
25. Gomm W, von Holt K, Thome F, et al. Association of proton pump inhibitors with risk of dementia: A pharmacoepidemiological claims data analysis. JAMA Neurol. 2016;73(4):410–6. doi: 10.1001/ jamaneurol.2015.4791
26. Lam JR, Schneider JL, Quesenberry CP, Corley DA. Proton pump inhibitor and histamine-2 receptor antagonist use and iron deficiency. Gastroenterology. 2017;152(4):821–9.e1. doi: 10.1053/j.gastro.2016.11.023
27. Lue A, Lanas A. Protons pump inhibitor treatment and lower gastrointestinal bleeding: Balancing risks and benefits. World J Gastroenterol. 2016;22(48): 10477–81. doi: 10.3748/wjg.v22.i48.10477
28. Mossner J. The indications, applications, and risks of proton pump inhibitors. Dtsch Arztebl Int. 2016;113(27–28):477–83. doi: 10.3238/arztebl. 2016.0477
29. Pinto-Sanchez MI, Yuan Y, Bercik P, Moayyedi P. Proton pump inhibitors for functional dyspepsia. Cochrane Database Syst Rev. 2017;3: CD011194. doi: 10.1002/14651858.
30. Scarpignato C, Gatta L, Zullo A, Blandizzi C.
Effective and safe proton pump inhibitor therapy in acid-related diseases—A position paper addressing benefits and potential harms of acid suppression. BMC Med. 2016;14(1):179. doi: 10.1186/s12916-016-0718-z
31. Moriarty F, Cahir C, Bennett K, Fahey T. Economic impact of potentially inappropriate prescribing and related adverse events in older people: A cost-utility analysis using Markov models. BMJ Open. 2019;9(1):e021832. doi: 10.1136/ bmjopen-2018-021832
32. Molloy D, Molloy A, O’Loughlin C, Falconer M, Hennessy M. Inappropriate use of proton pump inhibitors. Ir J Med Sci. 2010;179(1):73–5. doi: 10.1007/s11845-009-0426-1
33. Dries AM, Richardson P, Cavazos J, Abraham NS. Therapeutic intent of proton pump inhibitor prescription among elderly nonsteroidal anti-inflammatory drug users. Aliment Pharmacol Ther. 2009;30(6):652–61. doi: 10.1111/j.1365-2036.2009.04085.x
34. Forgacs I, Loganayagam A. Overprescribing proton pump inhibitors. Br Med J. 2008;336(7634): 2–3. doi: 10.1136/bmj.39406.449456.BE
35. Bashford JN, Norwood J, Chapman SR. Why are patients prescribed proton pump inhibitors? Retrospective analysis of link between morbidity and prescribing in the General Practice Research Database. BMJ. 1998;317(7156):452–6. doi: 10.1136/bmj.317.7156.452
36. Mat Saad AZ, Collins N, Lobo MM, O’Connor HJ. Proton pump inhibitors: A survey of prescribing in an Irish general hospital. Int J Clin Pract. 2005;59(1):31–4. doi: 10.1111/j.1742-1241.2004. 00298.x
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Dec 27, 2019
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H. Carter, J., S. Sketris, I., Tamim, H., Levy, A. R., & Langley, J. M. (2019). Determining proton pump inhibitor prescription dispensing patterns and adherence to STOPP criteria for Nova Scotia Seniors Pharmacare Program beneficiaries. Journal of Population Therapeutics and Clinical Pharmacology, 26(4), e37-e51. https://doi.org/10.15586/jptcp.v26i4.053
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