Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Aug 6, 2017; 8(3): 180-185
Published online Aug 6, 2017. doi: 10.4292/wjgpt.v8.i3.180
Use of proton pump inhibitors in general practice
Cesare Tosetti, Ilaria Nanni
Cesare Tosetti, Ilaria Nanni, Health Agency of Bologna, 40046 Alto Reno Terme, Italy
Author contributions: Tosetti C and Nanni I contributed equally in the study design, literature reviewing and data evaluation; Tosetti C wrote the paper with the critical contribution of Nanni I.
Conflict-of-interest statement: No financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Cesare Tosetti, MD, General Practitioner, Health Agency of Bologna, Via Rosselli 21, Porretta Terme, 40046 Alto Reno Terme, Italy. tosetti@libero.it
Telephone: +39-338-3902526 Fax: +39-534-21493
Received: December 28, 2016
Peer-review started: December 29, 2016
First decision: March 13, 2017
Revised: April 18, 2017
Accepted: July 14, 2017
Article in press: July 17, 2017
Published online: August 6, 2017
Abstract
AIM

To evaluate the characteristics of the prescription of the proton pump inhibitor drugs (PPI) and the adherence to the indications of the guidelines regulating the reimbursement limitations set forth by the Italian Drug Agency.

METHODS

Thirty general practitioners (GP) participated in the study, providing data on more than 40000 patients in total. The population was divided into non occasional users of PPI drugs (PPI users) and non-users (PPI non-users) based on evidence of a prescription of at least 3 packs of PPIs in the last 90 d before analysis. The data provided allowed an assessment of compliance with the requirements of eligibility for PPI reimbursement according to the Italian Drug Agency rules, in order to obtain subpopulations which complied or not with the rules.

RESULTS

Six thousand three hundred and twenty-two patients were found to be PPI users, accounting for 14.9% of the patient population. PPI users were more frequently female, older and more frequently diagnosed with gastroesophageal reflux disease, gastric or duodenal ulcers, arthropathy, heart disease and cancer than the rest of the population. PPI users had more frequently received prescriptions for non-steroidal ant-inflammatory drugs (NSAIDS), acetylsalicylic acid (ASA), oral anticoagulant therapy (OAT) and systemic steroids. PPI reimbursement resulted applicable to 69.3% of the PPI users, but a potential for reimbursement of PPI prescriptions was identified in the non PPI users for the treatment of peptic or reflux disease (8.5%) and for the protection of gastric damage caused by NSAIDS (6.1%). Patients who are potentially eligible for reimbursement are older, diagnosed with arthropathy and heart disease more frequently and most commonly receive NSAID and ASA prescriptions compared with PPI users who do not satisfy eligibility requirements. Patients in whom it was not possible to identify conditions related to prescription suitability were more frequently associated with use of OAT.

CONCLUSION

A substantial number of patients who apparently do not meet prescription suitability conditions can be identified, but among non PPI users on the contrary, it is possible to identify an equal number of patients for whom prescription would be suitable. Poor suitability can be identified in the population receiving OAT. Thus, there is scope for decreasing inappropriate use of PPI drugs by adhering to certain criteria and by involving all interested parties.

Keywords: Proton pump inhibitors, Appropriateness, General practice, Gastroprotection, Peptic disease

Core tip: This study was carried out in a large unselected population to evaluate the characteristics of proton pump inhibitor (PPI) prescription and the adherence to the guidelines regulating the reimbursement limitations set forth by the Italian Drug Agency. A substantial number of patients who apparently do not meet prescription suitability conditions can be identified, but among non-PPI users on the contrary, it is possible to identify an equal number of patients for whom prescription would be suitable. According to our data the greatest problems in clinical decision originate in patients in antithrombotic therapy.