PS-025 Prescription of proton pump inhibitors in the elderly: do physicians have a proper risk perception?

Background Many recent publications highlight the risk of side effects with long term prescriptions of proton pump inhibitors (PPIs). Purpose We wished to know physicians’ perceptions of this risk in our rehabilitation, recuperative and long term care establishment. This study was carried out within our evaluation of professional practices in the elderly. Material and methods We analysed on a given day all the prescriptions for patients hospitalised over 65 years of age and treated with oral PPIs. For each prescription, a survey was completed during a meeting between the pharmacist auditor and the physician (time of taking, associated treatments, indications, revaluation, duration of prescription, etc). Physicians then completed a questionnaire on their risk perception of such therapeutic class (deprescribing strategy, rebound, short and long term side effects). Results 58 patients out of 130 over 65 years were treated with PPIs (45%). Only 28% were prescribed the morning (marketing authorisation (MA)) recommendations. 33% of prescriptions were in the MA indications whereas physicians believed they had prescribed in the context of the MA in 56% of patients. The off-label indications were post surgical stress (28%) and antiplatelet prescriptions without an NSAID association (24%). In 17% of cases PPIs indications were unknown by physicians. 29% of prescriptions were initiated in our establishment, 72% were not revaluated during the stay and the end of treatment was scheduled in only 29% of cases. Among the 32 physicians interviewed, 94% perceived PPIs as a treatment of low or moderate risk. Only 25% had a deprescribing strategy and 55% believed that rebound did not exist. Physicians correctly discerned the short term side effects but few perceived the long term effects: only 44% quoted the risk of vitamin B12 deficiency, 47% hypomagnesaemia, 33% osteoporosis/bone fractures and 41% infections. Conclusion According to the literature, PPIs in post surgical stress have a beneficial effect in intensive care. Recommendations for this off-label indication were missing. 75% of prescriptions were reconducted and were not revaluated during the hospital stay because of poor perception of the long term side effects. Our results confirm the necessity to highlight to physicians the need for revaluation and PPIs risks. Such information can be relayed by hospital pharmacists. References and/or acknowledgements Acknowledgments to the 5 pharmacist auditors. No conflict of interest