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4CPS-004 Relevance of proton pump inhibitor (ppi) treatments in 2017 in two geriatric departments: impact of a first study in 2014 on prescribing practices

Background Because of their good efficiency and tolerance, PPIs are increasingly over-prescribed. This over-use is alarming particularly among the elderly, with 50% of inappropriate prescriptions. Numerous studies have shown that PPIs are involved in osteoporosis, pulmonary and gastrointestinal infections. The elderly appear to be a prime target of these adverse effects. In 2014, a first observation of PPI prescriptions was conducted in order to re-evaluate prescriptions. Purpose After the 2014 study’s results, a communication campaign was conducted with prescribers and the local medicine committee. The aim of the 2017 study was to evaluate the impact of this action undertaken in 2014, on PPIs prescriptions in 2017. Material and methods This was a one-day study performed in two geriatric departments. Patients undergoing PPI in 2017 were included in this study. Age, sex, dosage, indication and duration of treatment were recorded. Inappropriate prescriptions were reviewed in collaboration with prescribers. Results In our study, 61 patients were included (49.2% of hospitalised patients), versus 75 (60.5%) in 2014. Forty-seven (62.7%) of them were also included in the 2014 study. Thirty-five (57.4%) prescriptions were inappropriate in 2017, versus 41 (54.7%) in 2014. No indication was found for nine (14.8%) patients (versus 17 (22.7%) in 2014) (p=0. 017). Almost all patients were treated for more than 2 months (100% in 2017 versus 97.3% in 2014). In 2017, nine patients (14.7%) were treated for more than 4 years (versus 19 (25.3%) in 2014). In collaboration with the geriatricians, 11 (25%) of PPIs were stopped (versus 25 (43.1%) in 2014), nine (20.5%) decreased in dosage (versus 12 (20.7%) in 2014) and 26 (59.1%) maintained (versus 23 (39.7%) in 2014). Conclusion This study showed that PPI prescriptions decreased between 2014 and 2017. Duration of treatment and dosage also tended to decrease. However, the inappropriate prescription rate is stable between the two studies and it remains difficult to stop definitively their use, especially for fragile patients. Our study reassessed PPIs and assessed the sensitivity of geriatricians on their good use. References and/or Acknowledgements HAS – Fiche BUM – Les inhibiteurs de la pompe à proton chez l’adulte – June 2009, updated inDecember 2009. No conflict of interest