Appropriateness of Acid Suppression Therapy

作者：De Rijdt Thomas^*; Spriet Isabel; Willems Ludo; Blanckaert Marianne; Hiele Martin; Wilmer Alexander; Simoens Steven

来源：Annals of Pharmacotherapy, 2017, 51(2): 125-134.

DOI：10.1177/1060028016670414

• AST
• acid suppression
• start-up
• initiation
• hospital
• appropriate therapy
• PPI
• H2A
• long-term
• economic
• cost saving

Background: The inappropriate startup of long-term acid suppressive therapy (AST) can have clinical and pharmacoeconomic impacts on ambulatory care. Objective: To assess the proportion of patients with appropriate initiation of long-term AST in non-critically ill patients. To describe possible risk factors for nonappropriate AST. To calculate the potential savings when eliminating the nonappropriate startup of AST. Method: This observational, retrospective study evaluated the appropriateness of startup of long-term AST in medical records using a broad variety of international criteria and guidelines and using a validated screening instrument. Results: A sample of 597 patients was included in the analysis. In 57% of them, AST was appropriately initiated. No specific risk profile could be defined. There was some indication that the availability of a clinical pharmacist and the use of standing orders were correlated to the outcome. Extrapolation to the total population (ie, 2836 patients) led to a total cost of Euro8880 during hospital stay plus an extra Euro40391 per month after discharge. Avoiding inappropriate initiation of AST could lead to a saving of Euro3805 plus Euro17441 per month. Conclusion: In all, 43% of initiation of long-term AST in the hospital was inappropriate. The potential savings from avoiding this could be substantial from a health care payer perspective. No patient characteristics that could predict for inappropriate initiation of AST were identified. A correlation between inappropriate initiation and medical disciplines using standing orders that include AST was seen.

• 出版日期2017-2