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Master Thesis

Évaluation de la pertinence de la prescription chronique des inhibiteurs de la pompe à protons chez les sujets de plus de 65 ans admis au court séjour gériatrique en provenance de la ville

Abstract : Introduction: 25% of the general population in France got an ambulatory prescription of proton pump inhibitors (PPI) in 2015. Among them, 46% of patients aged more than 65 years got prescribed PPI, and up to 90% by general practitioners. However, PPI are always more used out of the guidelines and up-to-date publications are reporting serious side effects in the event of chronic use, particularly on elderly subject. The main objective of this study is to analyze the relevance of long-term PPI’s advice applied for patients aged more than 65 years, in ambulatory pre-hospital prescriptions. Our secondary aim is to outline the potential drugs interactions, the potential side effects and to identify predictors factors of misuse local PPI’s prescription. Patients and methods: descriptive, retrospective, monocentric analysis of the relevance of ambulatory PPI prescriptions towards patients aged more than 65 years admitted from ambulatory in a geriatric acute-care unit at the Centre Gérontologique Départemental of Marseille. The relevance was assessed in comparison to the French Health Authority’s (HAS) recommendation, regarding medical indication, compliance with molecule and dosage. Realization of a descriptive statistical analysis and then predictive of the population using data collected in a standardized table. Results: During a 25 months period between 2017 and 2019, 214 pre-hospital prescriptions have been analysed. Only 33 prescriptions (15.4%) were following HAS 2009 recommendations. The most represented indication found was the treatment of an identified peptic ulcer (38 patients, 17,8% of prescriptions). Eighty-one percent of prescriptions did not comply with recommendations, mostly represented by the preventive treatment of gastro-duodenal lesions in the event of co-prescription with drugs potentially gastro-toxic without risk factors identified. In multivariate analysis, hypoalbuminemia (OR=1,156 ; IC95 1,023-1,306 ; p=0,02) and a morning administration of PPI (OR =0,130 ; IC95 0,03-0,53 ; p= 0,005) were significantly associated with a proper PPI chronic prescription. On the contrary, late-stage dementia (OR 2,6 ; IC95 1,8-5,8, p=0,017), polypharmacy (OR 2,1 ; IC95 0,7-6,7 ; p= 0,169) or co-prescription with Fluindione (OR 4,1 ; IC95 0,5-31,7 ; p = 0,178) were combined with inappropriate prescriptions. Osteoporotic fractures (33.6%), community or nosocomial-acquired infectious pneumonia (16.4%), B12 vitamin deficiency (18,5%), and hyponatremia (18.5%), were the most represented clinical and biological adverse effects. Conclusion: Respect of PPI proper use enable to prevent adverse effects combined with a chronic use, particularly towards elderly patients undergoing multiple pathologies and polypharmacy. Realization of an assessment of ambulatory professional practices prospectively would make possible to widely clarify our results. Medicinal conciliation and diffusion of an IPP proper use’s document could enable to raise awareness among prescribers. Reporting adverse events to pharmacovigilance will enable to expand our knowledge on long-term medication. Normalization of PPI’s use by patients could be blocked with widespread information about risks bound to this self-medication, to iatrogenia, and to the potential occurrence of adverse effects with chronic use. Therapeutic education of patients should be widespreadly carried out in daily practices.
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Romain Hamel. Évaluation de la pertinence de la prescription chronique des inhibiteurs de la pompe à protons chez les sujets de plus de 65 ans admis au court séjour gériatrique en provenance de la ville. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02429590⟩

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