Peer Reviewed

1

Document Type

Article

Publication Date

12-2016

Keywords

Proton Pump Inhibitors, Potentially Inappropriate Prescribing, Older Persons, Primary Care, Gastrointestinal Bleeding

Funder/Sponsor

This work was supported by the Health Research Board of Ireland (HRB) through the HRB PhD Scholars Programme in Health Services Research (grant no. PHD/2007/16) and the HRB Centre for Primary Care Research (grant no. HRC/2007/1).

Comments

This is the peer reviewed version of the following article: Moriarty, F., Bennett, K., Cahir, C., and 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-e296, which has been published in final form at http://onlinelibrary.wiley.com/doi/10.1111/jgs.14528/abstract. This article may be used for noncommercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.

Abstract

OBJECTIVES: To characterize prescribing of proton pump inhibitors (PPIs) and medicines that increase gastrointestinal bleeding risk (ulcerogenic) in older people from 1997 to 2012 and assess factors associated with maximal-dose prescribing in long-term PPI users.

DESIGN: Repeated cross-sectional study of pharmacy claims data.

SETTING: Eastern Health Board region of Ireland.

PARTICIPANTS: Individuals aged 65 and older from a means-tested health plan in 1997, 2002, 2007, and 2012 (range 78,489-133,884 individuals).

MEASUREMENTS: PPI prescribing prevalence was determined per study year, categorized according to duration (≤8 or >8 weeks), dosage (maximal or maintenance), and co-prescribed drugs. Logistic regression in long-term PPI users was used to determine whether age, sex, polypharmacy, and ulcerogenic medicine use were associated with being prescribed a maximal dose rather than a maintenance dose. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) are presented.

RESULTS: Half of this older population received a PPI in 2007 and 2012. Long-term use (>8 weeks) of maximal doses rose from 0.8% of individuals in 1997 to 23.6% in 2012. Although some ulcerogenic medicines and polypharmacy were significantly associated with maximal PPI doses, any nonsteroidal anti-inflammatory drug use was significantly associated with lower odds of maximal PPI dose (adjusted OR = 0.87, 95% CI = 0.85-0.89), as were aspirin use and older age. Adjusting for medication and demographic factors, odds of being prescribed a maximal PPI dose were significantly higher in 2012 than in 1997 (adjusted OR = 6.30, 95% CI = 5.76-6.88).

CONCLUSIONS: Long-term maximal-dose PPI prescribing is highly prevalent in older adults and is not consistently associated with gastrointestinal bleeding risk factors. Interventions involving prescribers and patients may promote appropriate PPI use, reducing costs and adverse effects of PPI overprescribing.

Disciplines

Family Medicine | Health Services Research | Medicine and Health Sciences

Citation

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. Journal of the American Geriatrics Society. 2016;64(12): e291-e296.

PubMed ID

27996115

DOI Link

doi:10.1111/jgs.14528

Creative Commons License

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Available for download on Friday, December 01, 2017

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