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The incidence and prevalence of proton pump inhibitor usage among internal medicine patients after hospital admission: A retrospective cohort study

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Abstract

Background

The use of proton pump inhibitors (PPIs) has increased over the past decades. One potential gateway into new PPI use is following a hospital admission. The study aimed to examine the incidence of new PPI usage following admission to internal medicine services and the ratio of new persistent users.

Methods

A retrospective descriptive study was conducted among all adults who had been admitted to internal medicine wards at the National University Hospital of Iceland from 2010–2020. Data was obtained from the Icelandic Internal Medicine Database. The proportion of patients who started treatment with PPI within 3 months of discharge (new users) and the proportion of patients who continued to use it after 3 months (persistent users) were examined.

Results

Among 85.942 admissions during the study period, 7238 (15.6%) became new users, and of those 4942 (68%) were new persistent users. The incidence of new PPI use was highest for patients discharged from gastroenterology (32.2%), hematology (31.8%), and oncology (29.2%). Patients with new PPI use more commonly had a history of malignancy (19.5%) and liver disease (22.7%) and more commonly were admitted to the ICU during their hospitalization. The highest ratio of persistent usage was among patients discharged from geriatric medicine (84%).

Conclusion

One in every six patients admitted to internal medicine wards filled out a prescription for PPI within 3 months from discharge, and a large proportion of them became persistent users. The high rate of new PPI users from oncology and hematology is noteworthy and requires further research.

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Availability of data and materials

Due to ethical concerns, supporting data cannot be made available.

References

  1. Torres-Bondia F, de Batlle J, Galván L, Buti M, Barbé F, Piñol-Ripoll G (2022) Evolution of the consumption trend of proton pump inhibitors in the Lleida Health Region between 2002 and 2015. BMC Public Health 22(1):818

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  2. Robinson M, Horn J (2003) Clinical pharmacology of proton pump inhibitors: what the practising physician needs to know. Drugs 63(24):2739–2754

    Article  PubMed  CAS  Google Scholar 

  3. Batuwitage BT, Kingham JGC, Morgan NE, Bartlett RL (2007) Inappropriate prescribing of proton pump inhibitors in primary care. 83(975):66–68

    Google Scholar 

  4. Daniels B, Pearson SA, Buckley NA, Bruno C, Zoega H (2020) Long-term use of proton-pump inhibitors: whole-of-population patterns in Australia 2013–2016. Ther Adv Gastroenterol 13:1756284820913743

    Article  CAS  Google Scholar 

  5. Excellence NIfHa C (2014) Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management

  6. Katz PO, Gerson LB, Vela MF (2013) Guidelines for the diagnosis and management of gastroesophageal reflux disease 108(3):308–328

    Google Scholar 

  7. Waldum HL, Qvigstad G, Fossmark R, Kleveland PM, Sandvik AK (2010) Rebound acid hypersecretion from a physiological, pathophysiological and clinical viewpoint. Scand J Gastroenterol 45(4):389–394

    Article  PubMed  Google Scholar 

  8. Helgadottir H, Bjornsson ES (2019) Problems associated with deprescribing of proton pump inhibitors. Int J Mol Sci 20(21)

  9. Jaynes M, Kumar AB (2019) The risks of long-term use of proton pump inhibitors: a critical review. Therapeutic advances in drug safety 10:2042098618809927

    Article  Google Scholar 

  10. Lanas A (2016) We are using too many PPIs, and we need to stop: a European perspective. Am J Gastroenterol 111(8):1085–1086

    Article  PubMed  ADS  Google Scholar 

  11. Sattayalertyanyong O, Thitilertdecha P, Auesomwang C (2020) The inappropriate use of proton pump inhibitors during admission and after discharge: a prospective cross-sectional study. Int J Clin Pharm 42(1):174–183

    Article  PubMed  Google Scholar 

  12. Laine L, Nagar A (2016) Long-term PPI use: balancing potential harms and documented benefits. Am J Gastroenterol 111(7):913–915

    Article  PubMed  ADS  CAS  Google Scholar 

  13. Wahking RA, Steele RL, Hanners RE, Lockwood SM, Davis KWJHP (2018) Outcomes from a pharmacist - led proton pump inhibitor stewardship program at a single institution 53:59–67

    Google Scholar 

  14. Scarpignato C, Gatta L, Zullo A, Blandizzi C (2016) Effective and safe proton pump inhibitor therapy in acid-related diseases - a position paper addressing benefits and potential harms of acid suppression. BMC Med 14(1):179

    Article  PubMed  PubMed Central  Google Scholar 

  15. Gawron AJ, Feinglass J, Pandolfino JE, Tan BK, Bove MJ, Shintani-Smith S (2015) Brand name and generic proton pump inhibitor prescriptions in the United States: insights from the national ambulatory medical care survey (2006–2010). Gastroenterology research and practice 2015:689531

    Article  PubMed  PubMed Central  Google Scholar 

  16. Johnson DA, Katz PO, Armstrong D, Cohen H, Delaney BC, Howden CW et al (2017) The safety of appropriate use of over-the-counter proton pump inhibitors: an evidence-based review and delphi consensus. Drugs 77(5):547–561

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  17. Hálfdánarson Ó, Pottegård A, Björnsson ES, Lund SH, Ogmundsdottir MH, Steingrímsson E et al (2018) Proton-pump inhibitors among adults: a nationwide drug-utilization study. Ther Adv Gastroenterol 11:1756284818777943

    Article  Google Scholar 

  18. Landlæknis E. Lyfjatölfræði - gangvirk birting Available from: https://island.is/tolfraedi-um-lyfjanotkun

  19. Kristjánsdóttir TR (2021) Faraldsfræði skamm- og langtímanotkunar prótónupumpuhemla í kjölfar skurðaðgerða. In: Íslands H, editor. Háskóli Íslands p. 7

  20. DA Peura BR, Gonzalez J, Brunetti L (2011) The value of branded proton pump inhibitors. P T 36(7):434–445

    PubMed  PubMed Central  Google Scholar 

  21. Roffman CE, Buchanan J, Allison GT (2016) Charlson comorbidities index. J Physiother 62(3):171

    PubMed  Google Scholar 

  22. Ng TP, Feng L, Nyunt MSZ, Larbi A, Yap KB (2014) Frailty in older persons: multisystem risk factors and the frailty risk index (FRI). J Am Med Dir Assoc 15(9):635–642

    Article  Google Scholar 

  23. Pottegård A, Broe A, Hallas J, de Muckadell OB, Lassen AT, Lødrup AB (2016) Use of proton-pump inhibitors among adults: a Danish nationwide drug utilization study. Ther Adv Gastroenterol 9(5):671–678

    Article  Google Scholar 

  24. Song J, Chang RW, Manheim LM, Dunlop DD (2006) Gender differences across race/ethnicity in use of health care among Medicare-aged Americans. J Women's Health 15(10):1205–13

  25. Cameron KA, Song J, Manheim LM, Dunlop DD (2010) Gender disparities in health and healthcare use among older adults. J Women's Health 19(9):1643–50

  26. Simmonds SJ, Syddall HE, Walsh B, Evandrou M, Dennison EM, Cooper C et al (2014) Understanding NHS hospital admissions in England: linkage of hospital episode statistics to the Hertfordshire Cohort Study. Age Ageing 43(5):653–660

    Article  Google Scholar 

  27. Balzano A, Carle F, Tamburini C, Monica F, Milazzo G, Spolaore P et al (2019) Hospital admission for digestive diseases: gastroenterology units offer a more effective and efficient care. Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver. 51(1):43–46

  28. Ramirez E, Lei SH, Borobia AM, Piñana E, Fudio S, Muñoz R et al (2010) Overuse of PPIs in patients at admission, during treatment, and at discharge in a tertiary Spanish hospital. Curr Clin Pharmacol 5(4):288–297

    Article  CAS  Google Scholar 

  29. Numico G, Fusco V, Franco P, Roila F (2017) Proton pump inhibitors in cancer patients: how useful they are? A review of the most common indications for their use. Crit Rev Oncol Hematol 111:144–151

    Article  PubMed  Google Scholar 

  30. McCaleb RV, Gandhi AS, Clark SM, Clemmons AB (2016) Clinical outcomes of acid suppressive therapy use in hematology/oncology patients at an academic medical center. 50(7):541–547

    CAS  Google Scholar 

  31. Weisz G, Smilowitz NR, Kirtane AJ, Rinaldi MJ, Parvataneni R, Xu K et al (2015) Proton pump inhibitors, platelet reactivity, and cardiovascular outcomes after drug-eluting stents in clopidogrel-treated patients. 8(10):e001952

    CAS  Google Scholar 

  32. Collet J-P, Thiele H, Barbato E, Barthélémy O, Bauersachs J, Bhatt DL et al (2020) 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the Task Force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 42(14):1289–1367

    Article  Google Scholar 

  33. Fukuba N, Nishida M, Hayashi M, Furukawa N, Ishitobi H, Nagaoka M et al (2020) The relationship between polypharmacy and hospital-stay duration: a retrospective study. Cureus 12(3):e7267

    PubMed  PubMed Central  Google Scholar 

  34. Liu Y, Zhu X, Li R, Zhang J, Zhang F (2020) Proton pump inhibitor utilisation and potentially inappropriate prescribing analysis: insights from a single-centred retrospective study. BMJ Open 10(11):e040473

    Article  PubMed  PubMed Central  Google Scholar 

  35. Lodato F, Poluzzi E, Raschi E, Piccinni C, Koci A, Olivelli V et al (2016) Appropriateness of proton pump inhibitor (PPI) prescription in patients admitted to hospital: attitudes of general practitioners and hospital physicians in Italy. Eur J Intern Med 30:31–36

    Article  PubMed  Google Scholar 

  36. NICE NIfHaCE (2014) Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management

  37. Elínardóttir S, Eiríksdóttir V, Einarsson Ó (2020) Lyfjagagnagrunnur Landlæknis Embætti landlæknis. Available from: https://www.landlaeknir.is/servlet/file/store93/item43082/Lyfjagagnagrunnur_grein_2020_med_logo.pdf

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Funding

This work was supported by the Foundation of Icelandic Centre for Research of Iceland to Freyja Jónsdóttir.

Author information

Authors and Affiliations

  1. Clinical Pharmacy Services, Landspitali—The National University Hospital of Iceland, Reykjavik, Iceland

    Helga Rut Steinsdóttir & Freyja Jónsdóttir

  2. Faculty of Medicine, University of Iceland, Reykjavik, Iceland

    Martin I. Sigurðsson & Einar Stefán Björnsson

  3. Division of Anesthesia and Intensive Care Medicine, Landspitali—The National University Hospital of Iceland, Reykjavik, Iceland

    Martin I. Sigurðsson

  4. Department of Internal Medicine, Division of Gastroenterology, Landspitali—The National University Hospital of Iceland, Reykjavik, Iceland

    Einar Stefán Björnsson

  5. Pharmaceutical Sciences, University of Iceland, Reykjavik, Iceland

    Freyja Jónsdóttir

Authors
  1. Helga Rut Steinsdóttir
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  2. Martin I. Sigurðsson
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  3. Einar Stefán Björnsson
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  4. Freyja Jónsdóttir
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Helga Rut Steinsdóttir, Freyja Jonsdóttir, Einar Stefán Björnsson, and Martin Ingi Sigurðsson. The first draft of the manuscript was written by Helga Rut Steinsdóttir, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Helga Rut Steinsdóttir.

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Ethical approval

Ethical approval for the study was obtained from the National bioethics committee of Iceland (license number VSN-21-179) and the Data Protection Authority of Iceland. All the data for establishing the database was de-identified before statistical analysis.

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The authors have no conflicts to declare.

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Steinsdóttir, H.R., Sigurðsson, M.I., Björnsson, E.S. et al. The incidence and prevalence of proton pump inhibitor usage among internal medicine patients after hospital admission: A retrospective cohort study. Eur J Clin Pharmacol 80, 273–281 (2024). https://doi.org/10.1007/s00228-023-03607-z

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  • DOI: https://doi.org/10.1007/s00228-023-03607-z

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