drug utillization assesment of proton pump inhibitor in secondary healthcare hospital, review of ppi drug

1. drug utilization assessment of proton pump inhibitor

2. INTRODUCTION
Proton-pump inhibitor (PPI) is a class of medication that significantly reduces
stomach acid output. These are among the most widely sold medications in the
world.
 They represent the first choice in the treatment of acid-related diseases and are
currently the most prescribed drugs in the world. Over the past 10 years, there
has been a significant increase in their use throughout the world.
 Utilization of proton pump inhibitors (PPI) increasing continuously, in
Australia 18500 prescriptions were dispensed in 1990 after that it increased to
around 1.7 million prescriptions in 1996, while till 2006 it became the third
most frequently prescribed drug in the same country.

3.  In United States only United States of America, UK and New Zealand have also
reported similar high utilization of PPI. In India there are various drug utilization
studies of non-steroidal anti-inflammatory drugs (NSAIDs), antimicrobial agents,
in tertiary care hospital in emergency unit, on Out Patient Department (OPD) basis
patients and of In- Patient Department (IPD) patients are done but very less studies
of specifically of drug utilization of PPI.
 Various percentage of drug utilization of PPI are observed along with NSAIDs with
antibiotics. Utilization of PPI alone is less, and some newer adverse drugs reactions
are being reported.
 In this study, we review about proton pump inhibitor (PPI) medication therapy in
Secondary Health Care Hospital in Dharmapuri, Tamilnadu.

4. LITRATURE REVIEW
 Chandrashekar Valupadas et al., (2021) conducted a Drug Utilization Evaluation of Pantoprazole
in Inpatients of Tertiary Care Hospital in Warangal, Telangana, INDIA. The study is prospective and
observational conducted in inpatients of a tertiary care teaching hospital [MGM hospital]. A total of
1012 cases were enrolled according to our plan of work i.e., inpatients who were under pantoprazole
therapy were enrolled in two phases, phase-I (before intervention) and phase-II (after intervention) as
we assessed inappropriate use of drug, intervention was developed and implemented and therefore
pertinent use of drug is increased.
 Rona Sudhakar et al., (2019) conducted Drud use evalution of proton pump inhibitors in a tertiary
care hospital in Erode. In the study, out of 40 patients on PPI, 60% were females and the rest were
males. Most of the patients belonged to the age group of 51 - 60 years (12). PPIs were most
commonly prescribed for patients with a diagnosis of Respiratory tract infections (42.5%), followed
by infectious diseases and gastrointestinal diseases. Pantoprazole was the most commonly prescribed
PPI. They were commonly prescribed in the oral route (70%) and on a once-daily basis (62.5%).
Antibiotics (50%) and NSAIDs (7.5%) were the most common drugs used along with PPIs.

5.  Liu Y, Zhu X, Li R, et al., (2020) conducted Proton pump inhibitor utilization and potentially
inappropriate prescribing analysis: insights from a single-centred retrospective study. This study
aimed to characterise the prescribing patterns and evaluate the appropriateness of the prescribed
proton pump inhibitors (PPIs) in adult patients via a review of electronic medical records in a single-
centred hospital. Among 18 435 identified PPI users in 2018, 14 219 patients (aged 18 years or
above) who had at least one dispensing PPIs were new users (77%), and among them, men accounted
for 47%. The mean treatment duration was 23 days. Omeprazole was the most commonly prescribed
drug. PPIs are inappropriately prescribed in 50% (13 589/25 850) of prescriptions. among them, the
proportion of gastritis diagnosis was 34%. A majority of PPI users (73%) reported high-dose PPI
prescription.
 Lama Madi et al., (2019) conducted Prescribing Pattern of Proton Pump Inhibitors in Qatar
Rehabilitation Institute: A Retrospective Study. An observational, retrospective, patients’ chart-based
study included all patients who received a PPI in QRI between April 1, 2017, and October 1, 2017. A
standardized tool was prepared and reviewed by the involved clinical pharmacists to collect
appropriate data for the evaluation. Statistical analysis was performed using the 25th Version of the
Statistical Package of the Social Sciences (SPSS).

6.  Anton Pottegard et al., (2018) conducted a Proton-pump inhibitors among adults: a nationwide
drug-utilization study in Clinical Pharmacology and Pharmacy, University of Southern Denmark,
Odense, Denmark. This was a nationwide population-based drug-utilization study. We observed
1,372,790 prescription fills over the entire study period, of which 95% were for higher-dose
PPIs. Annual incidence remained stable across time (3.3–4.1 per 100 persons per year), while the
annual prevalence increased from 8.5 per 100 persons to 15.5 per 100 persons. In this nationwide
study, a considerable increase in overall outpatient use of PPIs over a 13-year period was
observed, particularly among older adults. Patients were increasingly treated for longer durations
than recommended by clinical guidelines and mainly with higher doses.

7. AIMAND OBJECTIVES
AIM:
The aim of this study is to review the Drug Utilization Assessment of Proton
Pump Inhibitor in Secondary Health Care Hospital.
OBJECTIVES:
 Creating criteria for appropriate drug utilization.
 Evaluating the effectiveness of medication therapy.
 To optimize drug use by developing criteria and standards.
 To analyse prescription pattern of proton pump inhibitors.
 To assess the rationality of prescribing proton pump inhibitors.

8. PLANOF WORK
The entire work was carried out in a period of 6 month from June 2022 to November
2022.The purposed study was designed in three different phases to achieve the objective.
PHASE I
Literature survey
Pilot study for one
month to determine the
scope of the study and its
feasibility
Preparation of study
protocol
PHASE II
Selection of patients based
on inclusion criteria
Designing data entry form
Obtaining consent from the
Institutional Ethical
Committee.
Collection of data from
case sheets
PHASE III
Data analysis
Evaluation of data
Discussion and results
Summary and
conclusion.

9. METHODOLOGY
STUDY SITE
The study is carried out in Drug Utilization assessment of Proton Pump Inhibitor in Secondary
Health Care Hospital, Dharmapuri District.
STUDY DESIGN
Retrospective study
DURATION OF STUDY
The duration of study is 6 months (June- November 2022)
SOURCE OF DATA
1)Patient’s medication profile
2)Physicians prescribing records
3)Nursing charts
SAMPLE SIZE
200 Patients
CONSENT FORM FROM HOSPITALAUTHORITY
It is customary that every project work carried out is to be informed to all the physicians,
surgeons, and other healthcare professionals of the hospital for the approval.

10. PATIENT SELECTION
 PATIENT INCLUSION CRITERIA:
 Inpatient at the gastroenterologist department during study period.
 Patients with other indication.
 Patients in 18 years and above.
 PATIENT EXCLUSION CRITERIA:
 Patients in other department of the hospital.
 Pregnant and lactating women.
 Patients below 18 years.
 Surgery patients.
STUDY PROCEDURE
The study was conducted by,
1) Collection of prescriptions
2) Recording the details from the prescription to the PROFORMA
3) Analyzing the prescriptions

11. DATA COLLECTION
The prescriptions were collected from the General Medicine, Pediatrics, Intensive care unit
Department in hospitals, for a period of 6 months from JUNE 2022 to NOVEMBER 2022. Data
collection was done by random method.
DATAANALYSIS
Collected data from the prescription were entered into the corresponding tables and the
data were analyzed.
ETHICAL COMMITTEE
The entire study was done under the approval of Institutional Ethical Committee.
STATISTICALANALYSIS
The data were be statistically analyzed by using SPSS.

12. RESULTSANDDISCUSSION
1) Gender
Patient demographic Out of 200 patients with peptic ulcer disease were collected in this present study.
In the study, 126 patients were Male (63%) and 74 patients were female (37%). The majority of the
patients were Male in this study. The data were presented [Table: 1 and Figure: 1].
Table 1: Gender wise Distribution (n=200) Figure 1: Gender

13. 2) AGE
The age group study included 200 patients. Out of them, 98 patients were observed from the age group
between 41-60 years old (49%), then 30 patients were above 60 years old (15%) and 72 patients of age
between 18-40 years (36%). Most of the patients were seen under the age category between 41-60 years. The
data were presented [Table: 2 and Figure: 2].
Table 2: Age wise distribution (n=200) Figure 2: Age

14. 3) Proton pump inhibitors used
Proton pump inhibitor distributed among 200 patients in the study, Pan was administered in 126 patients (63%)
followed by Rablet in 24 patients (12%), Esomac in 34 patients (17%), Omez in 10 patients (5%) and Rabicip
in 6 patient (3%). The data were presented [table: 3 and figure: 3]. It states that Pantoprazole was the most
prescribed PPI in their study. Patients who received multiple drug therapy with antibiotics in this study
received Pantoprazole as well more frequently for the eradication of H.Pylori induced Peptic ulcer disease and
as prophylactic agent for NSAID induced PUD.
Table 3: Proton pump inhibitors used
wise distribution (n=200)
Figure 3: Proton pump inhibitors used

15. 4) Indication
Out of 200 patients, Indication for giving PPI in 78 Patients were received PPIs for Co-morbidities (39%)
which was majority followed by Analgesic in 46 patients (23%), Gastritis in 26 patients (13%), Peptic ulcer in
18 patients (9%), UGI bleeding in 10 patients (5%). PPIs were administered in the remaining 22 patients (11)
for without indications. The data were presented [table: 4 and figure: 4].
Table 4: Indication wise distribution (n=200)

16. In this study, PPIs were administered in most of the patients because of co-morbidity. The indication for
administering PPIs depends upon the diagnosis and possible issues to be occurred.
Figure 4: Indication

17. 5) Duration
In duration study out of 200 patients, most of the patients received PPI for a duration of 4 days in 21 patients
(10.5%) followed by duration of 5 days in 39 patients (9.5%), duration of 3 days in 19 patients (9.5%),
duration of 6 days in 26 patients (13%), duration of 7 days in 25 patients (4.5%), duration of 2 days in 13
patients (6.5%), duration of 8 days in 11 patients (5.5%), duration of 9 days in 13 patients (6.5%) and
duration of 1 day in 5 patients (2.5%). Remaining 24 Patients (12%) received PPI for 10 days and above up to
21 days. The data were presented [table: 5 and figure: 5]. The duration therapy depends on the condition and
cure rate of the patient received. However, long term administration of PPIs may result in serious.
Figure 5: duration

18. Table-5: Duration wise distribution (n=200)

19. CONCLUSION
This retrospective observational study confirms that the majority of PPI
prescription within the secondary healthcare hospital in Dharmapuri comprise of
Pantoprazole. In our study about 126 patients (63%) were prescribed with PPIs without
any valid indication. which increase the patient therapeutic burden. The prescribing
pattern can lead us towards the rational use of drugs and can help us in improving
patient’s complexity of life. The study is used to reduce the irrelevant use of PPIs to
decrease drug interactions, health care.

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22. Thank
You