Abstract
Objectives: Proton pump inhibitors (PPIs) are used to manage excess stomach acid production and provide gastroprotection from bleeding risk-increasing drugs (BRIDs). We aimed to determine the prevalence of potentially inappropriate PPI use in nursing homes and associated factors.
Design: Longitudinal cohort study using 8 years of electronic data.
Setting and Participants: The study included 6439 permanent residents aged ≥65 years from 34 homes managed by 2 aged care providers in New South Wales.
Method: Continuous PPI use (>12 weeks) in the absence of long-term BRID (>30 days) use was deemed inappropriate overuse whereas long-term BRID use without concomitant PPI for gastroprotection was classified as inappropriate underuse. Binary logistic regression was used to determine factors associated with PPI overuse.
Results: Fifty-four percent of residents (n = 3478) received a PPI, with a median duration of 46 weeks, whereas 58.5% (n = 3770) were long-term BRID users. Four of 5 PPI users (83.6%, n = 2906) used PPIs for >12 weeks, and after accounting for BRID use, the prevalence of inappropriate PPI overuse was 27.1% (n = 944). PPI overuse was 4 times more likely in residents in provider A compared with residents in provider B [odds ratio (OR) 4.08, 95% CI 2.73-6.09]. The prevalence of PPI underuse was 38.5% (n = 1452).
Conclusions and Implications: One in 4 PPI users exceeded the clinically recommended duration, whereas 2 in 5 long-term BRID users did not receive a PPI for gastroprotection. There is a pressing need for tailored interventions, such as medication reviews and deprescribing initiatives, to improve PPI prescribing.
Original language | English |
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Article number | 105393 |
Pages (from-to) | 1-9 |
Number of pages | 9 |
Journal | Journal of the American Medical Directors Association |
Volume | 26 |
Issue number | 2 |
Early online date | 3 Dec 2024 |
DOIs | |
Publication status | Published - Feb 2025 |
Bibliographical note
Copyright the Author(s) 2024. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.Keywords
- potentially inappropriate medicine
- Proton pump inhibitors
- nursing homes
- residential aged care