Medication-related factors associated with proton pump inhibitor prescription beyond official guidelines in older adults

• Published in: European geriatric medicine Vol. 11; no. 6; pp. 1051 - 1061
• Main Authors: Puchon, Erik, Goboova, Maria, Vano, Ivan, Fazekas, Tomas, Javorova-Rihova, Zuzana, Kuzelova, Magdalena
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.12.2020
• Subjects: Geriatrics/Gerontology; Internal Medicine; Medicine; Medicine & Public Health; Research Paper; Older patients; Proton pump inhibitors; Medications; Slovak Republic; Guidelines
• ISSN: 1878-7657; 1878-7657
• DOI: 10.1007/s41999-020-00380-5

Key summary points Aim To identify the medication-related factors responsible for proton pump inhibitors (PPIs) prescriptions being given not following guidelines at hospital admission and discharge among hospitalised adults aged 65 years or older. Findings In older adults, the number of medications prescribed, potentially inappropriate medications (PIMs) prescribed according to the European EU(7)-PIM list and the Beers criteria, and the use of direct oral anticoagulants, warfarin and corticosteroids are all medication-related factors associated with more frequent PPI prescription not according to guidelines. Message Determination of need for long-term therapy with PPIs in older patients is crucial for reducing the frequency of PPI prescriptions not according to guidelines. Purpose To investigate the relationship between medications with a known risk of gastrointestinal bleeding and proton pump inhibitor (PPI) prescription not according to guidelines. Methods An analysis of the records of 592 hospitalised patients aged 65 years or older was undertaken. The number of all medicines, potentially inappropriate medicines according to the EU(7)-PIM list and the Beers Criteria 2019 and medicines with a known risk of gastrointestinal bleeding, was compared in patients with PPI prescription not given based on guidelines and in patients with no PPI prescription. Results Patients prescribed PPI not based on guidelines used more medications on average (9.6 vs. 6.4, p  < 0.001), more PIMs according to the EU(7)-PIM list (2.4 vs. 1.1, p  < 0.001) and the Beers criteria (2.0 vs. 0.6, p  < 0.001) at hospital admission and at discharge (8.9 vs. 7.5, p  < 0.001, mean number of medications), (2.0 vs. 1.2, p  < 0.001, EU(7)-PIM list), (1.9 vs. 0.8, p  < 0.001, Beers criteria) than patients with no PPI prescription. Patients prescribed PPI not according to guidelines were more frequently using direct oral anticoagulants (28% vs. 12.8%, p  < 0.001), corticosteroids (5.3% vs. 0.7%, p  = 0.025) at hospital admission and at discharge (25.9% vs. 16.5%, p  = 0.018, oral anticoagulants), (6.6% vs. 1%, p  = 0.006, corticosteroids), (13.3% vs. 5.4%, p  = 0.004, warfarin) than patients with no PPI prescription. Conclusion The number of medications, potentially inappropriate medications according to the EU(7)-PIM list and Beers criteria, and the use of direct oral anticoagulants, warfarin and corticosteroid prescriptions were the medication-related factors associated with PPI prescription not according to guidelines in elderly patients.