Prescriptive Appropriateness: Inhospital Adherence to Proton Pump Inhibitors Deprescription Flow Chart.

The prescriptive appropriateness of Proton Pump Inhibitors (PPIs) in polypharmacy is controversial. PPIs are often overprescribed and the risk of prescribing errors and adverse drug reactions increases for each additional drug added to therapy. Hence, guided deprescription should be considered and easily implementable in ward practice. This observational prospective study evaluated the implementation of a validated PPIs deprescription flow chart to real-life internal ward activity through the presence of a clinical pharmacologist as an enhancing additional factor by assessment of inhospital prescriber's adherence to the proposed flow chart. Patients' demographics and prescribing trends of PPIs prescriptions were analyzed by descriptive statistics. The final analysis of data included ninety-eight patients (forty-nine male and forty-nine female), aging 75.6 ± 10.6 years; 55.1% of patients had home-PPIs prescriptions, while 44.9% received inhospital-PPIs prescriptions. Evaluation of prescriber's adherence to the flow chart revealed that the percentage of patients with a prescriptive/deprescriptive pathway conforming to that of the flow chart was 70.4%, with low symptomatologic recurrences. The clinical pharmacologists' presence and influence in ward activity may have contributed to this finding, since continuous training of the prescribing physicians is deemed a success-related factor in the deprescribing strategy. Multidisciplinary management of PPIs deprescription protocols shows high adherence by prescribers in real-life hospital settings and low recurrence events.

Deprescribing Strategies: A Prospective Study on Proton Pump Inhibitors.

Proton pump inhibitors (PPIs) are among the most controversially prescribed drugs in polypharmacy. This observational prospective study assessed the PPI prescriptive trend during hospitalization before and after implementation of a prescribing/deprescribing algorithm in a real-life hospital setting and the related clinical-economic benefit at discharge. PPI prescriptive trends were compared between three quarters of 2019 (9 months) and the same period of 2018 by a chi-square test with a Yate's correction. The proportions of treated patients in the two years (1120 discharged patients in 2018 and 1107 in 2019) were compared by the Cochran-Armitage trend test. DDDs (defined daily doses) were compared between 2018 and 2019 by the non-parametric Mann-Whitney test and normalizing DDD/DOT (days of therapy) and DDD/100 bd (bed days) for each patient. Multivariate logistic regression was performed on PPI prescriptions at discharge. The distribution of patients with PPIs at discharge was significantly different in the two years (p = 0.0121). There was a downward trend in the number of PPI prescriptions (29.9%) in the third trimester of 2019 compared to the others of the same year (first trimester: 34.1%, second trimester: 36.0%) and by contrast with the same periods of 2018 (29.4, 36.0, and 34.7%) (p = 0.0124). DDDs/patient did not differ between 2018 and 2019 nor across the three trimesters. However, both DDD/DOT and DDD/100 bd showed a decrease in the third trimester of 2019, with a marked difference for DDD/DOT (p = 0.0107). The reduction in consumption detected in the last phase of 2019 in terms of DDD/DOT was 0.09 with a consequent containment of pharmaceutical spending. The development and implementation of multidisciplinary prescribing/deprescribing protocols in both hospital and community settings could lead to a reduction in the misuse of PPIs, with significant savings in healthcare resources.

[Clinical care pathway appropriateness of the intoxicated paediatric patient: a retrospective evaluation with Poisoning Severity Score]. / Appropriatezza del percorso clinico-assistenziale nel paziente pediatrico intossicato: una valutazione restrospettiva mediante Poisoning Severity Score.

OBJECTIVES: to assess the clinical care impact resulting from the lack of a regional reference Centre for Paediatric Poisoning in Liguria Region (Northern Italy) and to describe the demographic and clinical characteristics of paediatric patients who accessed the Emergency Department of the 'Gaslini' Paediatric Hospital (Genoa, Liguria Region) for intoxication. DESIGN: retrospective cohort study. SETTING AND PARTICIPANTS: patients' cases of both sexes, <18 years old, who accessed the Emergency Department of the 'Gaslini' Paediatric Hospital between January 2017 and December 2019 for intoxication. MAIN OUTCOME MEASURES: the Poisoning Severity Score (PSS), a simple and reliable scoring system to describe poisonings and define their severity, was used. The primary objective was pursued by investigating the percentage of cases of intoxication which followed, in the study period, a clinical care pathway inconsistent with the degree of severity ascertained through the retrospective application of the PSS. Clinical-demographic data, triage tag color-coding, and causes of intoxication of cases were also collected. Descriptive statistics were used to summarize results. RESULTS: a total of 172 cases were identified over the study period; 28 did not meet the inclusion criteria. The final analysis involved 144 cases of intoxication, 70 were from females and 74 from males, with a median age of 3 years-old; 60% of study cases followed a clinical care pathway consistent with the intoxication severity ascertained trough the PSS, in 40% of study cases the clinical care pathway was inconsistent with PSS. The triage tag colour-code assigned was green in 16% of accesses, yellow in 82%, and red in only 2%. Out of the total of accesses, 40% of cases were attributed to drug intoxication in which the agents most involved were analgesics and sedative-hypnotic drugs, 30% to carbon monoxide and fumes poisoning, 23% to food/other substance intoxication, and 7% to alcohol intoxication. CONCLUSIONS: implementing a referral Centre for Paediatric Poisoning could potentially affect 40% of access to the Emergency Department. Further analysis should be carried out to clarify whether an integrated Telemedicine Service could guide the correct management of intoxicated paediatric patients by referring them, through the Poisoning Severity Score system, for home monitoring or immediate hospitalization, if necessary.

Active pharmacovigilance program in patients affected by psoriasis and inflammatory bowel diseases
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OBJECTIVE: To help identify adverse events (AEs) in new biologic therapies and to spread the culture of pharmaceutical surveillance among patients affected by psoriasis or inflammatory bowel disease (IBD). MATERIALS AND METHODS: This active pharmacovigilance program provided all patients with telephone follow-ups (FU), carried out by a clinical pharmacologist for a total duration of 1 year. Collected AEs were classified according to the MedDRA dictionary. RESULTS: 21 patients with psoriasis and 10 patients with IBD were enrolled. In our sample, the AEs reported were frequent but mild, underlining the crucial role of active pharmacovigilance in detecting minor AEs rarely spontaneously reported by the patients. CONCLUSION: According to our experience, a multidisciplinary team is recommended to manage complex therapies improving AE reporting and promoting greater therapeutic adherence.