UEGJournal Abstracts 2021 - 899

Health economics / Digitalisation in GI / Education In GI / Gender and diversity
P1104
INAPPROPRIATE PRESCRIPTION OF PROTON PUMP INHIBITORS
IN AN INTERNAL MEDICINE SERVICE - A RETROSPECTIVE STUDY
P. Campelo1
A. Lopes2
1
, C. Candeias2
, F. Emidio2
, A. Fortuna2, C. Cabrita2
,
Centro Hospitalar Universitário do Algarve, Gastroenterology,
Faro, Portugal, 2Centro Hospitalar Universitário do Algarve,
Internal Medicine, Faro, Portugal
Contact E-Mail Address: pedroncampelo@gmail.com
Introduction: Proton pump inhibitors (PPIs) reduce gastric acid secretion
and are widely used in the treatment of gastrointestinal disorders and prophylaxis
of peptic ulcer disease.
However, these medications are frequently prescribed inappropriately
during hospitalization and after discharge from acute care hospitals. Inappropriate
use of PPIs can lead to adverse effects and unnecessary costs.
Aims & Methods: Our main purpose was to evaluate clinical and demographic
factors related to PPIs prescription at a Medicine ward and analyze
the appropriateness of its prescription during hospitalization and at
hospital discharge.
We performed a retrospective study including patients admitted to an
Internal Medicine ward from July to December 2018. In that sample, we
analyzed the factors significantly associated with PPIs prescription. In the
subgroup of patients prescribed with PPIs, we evaluated the factors significantly
associated with inappropriate prescription during hospitalization
and after discharge.
Additionally, the costs associated with inappropriate prescription of PPIs
in hospitalized patients were estimated. PPI indications were based on
current clinical literature.
Results: Five hundred and seventy-seven patients were included, with a
mean age of 79±14.6 years-old, 41.6% were male. Two hundred and nineteen
patients (38%) received PPIs during hospitalization and 133 (31%)
were prescribed with PPIs at discharge.
Factors associated with PPIs prescription in hospitalized patients were
PPIs prescription previous to admission (p<0.001), medical history of
more than three comorbidities (p<0.001) and polymedication with five or
more drugs (p=0.002). Of the 219 patients who received PPIs during hospitalization,
126 (57%) were inappropriate prescriptions.
The factors associated with inadequate prescription of PPIs during hospitalization
were therapy with acetylsalicylic acid (ASA) (p<0.001) or anticoagulants
(p=0.043) prior to admission and an age older than 65 years
(p=0.022). Of the 113 patients who were prescribed PPIs at discharge, 69
(52%) were inappropriate prescriptions. Therapy with ASA was the only
factor associated with inadequate prescription at discharge (p<0.001).
On multivariate analysis, PPIs prescription previous to admission (Odds
Ratio (OR) = 4.6; 95% Confidence Interval (95%CI): 3.1-6.9; p<0.001) and
medical history of more than three comorbidities (OR = 1.6; 95%CI: 1.12.4;
p=0.019) were independent risk factors for PPIs prescription during
hospitalization. Therapy with ASA was an independent risk factor for
inadequate PPIs prescription during hospitalization (OR = 11.5; 95%CI:
5.4-24.5; p<0.001) and at hospital discharge (OR = 10.3; 95%CI: 4.1-26.1;
p<0.001).
The estimated costs directly related to inappropriate prescription of PPIs
during hospitalization was 432€ during the period of the study.
Conclusion: This study shows that PPIs are frequently prescribed drugs
during hospitalization and at hospital discharge. In most cases, that prescription
revealed unnecessary, with repercussion on hospital costs, and
in most cases derived from the presence of risk factors for peptic ulcer disease
that do not translate in valid indications for PPIs.
Consequently, indications for the appropriate prescription of PPIs should
be widely spread to optimize their use in hospital and ambulatory settings.
Vol. 9 | October 2021
References:
Savarino V, Dulbecco P, de Bortoli N, Ottonello A, Savarino E. The appropriate
use of proton pump inhibitors (PPIs): Need for a reappraisal. Eur J
Intern Med. 2017;37:19-24
R Schepisi, S Fusco, F Sganga, B Falcone, D L Vetrano. Inappropriate Use
of Proton Pump Inhibitors in Elderly Patients Discharged from Acute Care
Hospitals; J Nutr Health Aging; 2016;20(6):665-70
Antonio Mendoza Ladd, Georgia Panagopoulos, Joshua Cohen, Nataliya
Mar, Robert Graham; Potential costs of inappropriate use of proton pump
inhibitors; Am J Med Sci;2014 Jun;347(6):446-51
Disclosure: Nothing to disclose.
P1105
CAN ARTIFICIAL INTELLIGENCE INCREASE THE EFFICIENCY IN
REFERRALS FROM PRIMARY TO SPECIALIZED CARE?
M. Tejedor1
, M. Delgado1
, D. Alcalde1
, R. Barranco1
, S.M. Monsalve Alonso1
,
R. Rodriguez Rodriguez1, P. Solis-Muñoz1
1
A. Calvache1, L.A. Castillo1, I. Chico1, M. López-Martín1
R. Marruffo Ramos1
, R. Briz1
,
, M. de Lucas1
Hospital Universitario Infanta Elena, Gastroenterology and
Hepatology, Valdemoro, Spain
Contact E-Mail Address: marta_tejedor@hotmail.com
Introduction: The overload of the current healthcare model makes the
search for strategies to improve process efficiency essential.
Aims & Methods: The aim was to evaluate the efficiency of an artificial
intelligence (AI) program in terms of discharges, need for additional tests
and the number of follow-up visits required (number of follow-up visits/
number of first visits in a given time period, FU/F index).
Methods: An artificial intelligence (AI) program was used to analyse the
referrals from primary care to Gastroenterology in the health area corresponding
to our hospital in order to identify the most frequent reasons
for consultation and to assign them a protocol for the performance of
complementary tests before being seen for the first time in specialized
care. We compared all referrals received in the first half of 2018, prior to
the implementation of the AI pathway July 2018, with those received in
the first half of 2019.
Results: In 2018, 1799 referrals were received, 1309 within our health area
and 490 from outside the area. In 2019, 2261 referrals were received, 1392
from our area and 869 out-of-area;The AI pathway was applied to 31.4% of
the area-referred patientsOverall, in 2019, the number of blood tests and
CT scans requested at the first visit decreased (55.3 vs 61.4% and 4.4 vs
7.4% respectively, p<0.05 for both comparisons). The FU/F index in 2019
was 1.9 ± 0.04 vs 2.26 ± 0.07 in 2018 (p<0.05).
When analysing patients fromour health area, a higher number of discharges
at the first consultation was observed among those referred using
both the AI and the normal pathway compared to 2018 (11.4%; 10.8% and
8.2% respectively).
The differences between each of the 2019 groups compared to 2018are
statistically significant, but not between the two groups in 2019. The number
of requested blood tests, CT scans and endoscopies amongpatients referred
using the AI pathway was reduced compared to 2018 (49.4 vs 62.1%,
4.1 vs 8.2% and 46.7 vs 54.5%, respectively, p<0.05 for all comparisons).
Only the number of endoscopies was reduced compared to standard referrals
in 2019 (46.7 vs 52.5%, p<0.05).
The FU/F index in patients referred using the AI pathway was 1.72 (± 0.08)
vs 2.25 (± 0.08) in 2018 (p<0.05) and 1.93 (± 0.07)inthose referred through
the standard pathway in 2019 (p=0.07). Among patients referred from outside
our health area, the number of endoscopies requested in 2019 was
higher compared to 2018 (68.8 vs 62.9%, p<0.05), and there was no sig899
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