Is There a Reason for the Proton Pump Inhibitor? An Assessment of Prescribing for Residential Care Patients in British Columbia
Bibliographic record
Abstract
ABSTRACTBackground: The use of proton pump inhibitors (PPis) may cause significant harm to patients in the residential care setting, as these patients are often frail with multiple morbidities. The extent of non-evidence based use of PPis in residential care sites of the Fraser Health Authority in British Columbia is unknown.Objectives:: To determine the proportion of non-evidence-based use of PPI therapy for residential care patients of the Fraser Health Authority.Methods: This retrospective cross-sectional study was conducted in 6 Fraser Health residential care facilities in British Columbia between April 1, 2015, and March 31, 2016. Two definitions of "evidence-based indications" were used. The first definition encompassed broad evidence based indications for PPI use, specifically gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), gastritis, esophagitis, Barrett esophagus, and gastrointestinal protection from concurrent oral steroids, oral nonsteroidal anti-inflammatory drugs, antiplatelet agents, and anticoagulants. The second definition involved common evidence-based indications for PPI use, specifically GERD or PUD. Descriptive statistics were used to evaluate the primary outcome: the proportion of PPI orders without a documented broad or common evidence-based indication for PPI treatment.Results: A total of 331 residential care patients and 407 PPI orders were assessed. The proportion of PPI orders without a documented broad evidence-based indication was 16.2% (66/407). The proportion of PPI orders without a documented common evidence-based indication was 43.7% (178/407). The most frequently documented reason for a PPI order was GERD (214/407 or 52.6%). PPI orders for patients with GERD and gastrointestinal bleeding had the longest duration of therapy during residential care admission, averaging 205.1 and 218.1 days, respectively.Conclusion: About 1 in 6 PPI orders for Fraser Health residential care patients did not have a documented broad evidence-based indication, and about 2 in 5 PPI orders did not have a documented common evidence based indication. These results indicate a need to assess the appropriateness of therapy for every patient with an active PPI order in residential care facilities.ResumeContexte : L'emploi d'inhibiteurs de la pompe a protons (IPP) peut causer des torts importants aux patients qui resident en centre d'hebergement et desoins de longue duree, car souvent ces personnes sont fragiles et souffient de multiples maladies. On ignore quelle est la proportion d'utilisation d'IPP ne reposant pas sur des donnees probantes clans !es centres d'hebergement et de soins de longue duree de la Fraser Health Authority en Colombie-Britannique.Objectif: Determiner la proportion d'utilisation de traitement par IPP ne reposant pas sur des donnees probantes chez Jes patients en centre d'hebergement et de soins de longue duree de la Fraser Health Authority.Methodes : Cette etude retrospective transversale a ete menee clans six centres d'hebergement et de soins de longue duree de la Fraser Health en Colombie-Britannique, entre le l" avril 2015 et le 31 mars 2016. Deux definitions du terme « indications fondees sur des donnees probantes » Ont ete utilisees. La premiere definition englobait des indications larges fondees sur des donnees probantes appuyant !'utilisation d'IPP, plus particulierement : pour traiter le reflux gastro-resophagien, l'ulcere gastroduodenal, la gastrite, !' resophagite et !'resophage de Barrett ainsi que pour fournir une protection gastrique contre !es effets indesirables de la prise de medicaments anti-inflammatoires oraux steroidiens ou non steroidiens, d'antiplaquettaires et d'anticoagulants. La seconde definition comprenait !es indications usuelles fondees sur des donnees probantes pour appuyer !'utilisation d'IPP, plus precisement: le reflux gastro-resophagien ou l'ulcere gastroduodenal. Des statistiques descriptives ont ete employees pour analyser le principal parametre d'evaluation : la proportion d'ordonnances d'IPP pour lesquelles aucune indication, large ou usuelle, fondee sur des donnees probantes n'a ete consignee.Resultats : Au total,!es dossiers de 331 residents de centres d'hebergement et de soins de longue duree et 407 ordonnances d'IPP Ont ete evalues. La proportion d'ordonnances d'IPP pour lesquelles aucune indication large fondee sur des donnees probantes n'a ete consignee etait de 16,2 % (66/407). La proportion d'ordonnances d'IPP pour lesquelles aucune indication usuelle fondee sur des donnees probantes n'a ete consignee etait de 43,7 % (178/407). La raison la plus souvent consignee pour!'emission d'une ordonnance d'IPP etait le reflux gastro-resophagien (214/407 ou 52,6 %). Les ordonnances d'IPP destinees aux patients souffrant de reflux gastro-resophagien ou d'hemorragie gastro-intestinale etaient celles pour lesquelles la duree du traitement etait la plus longue au cours du sejour en centre d'hebergement et de soins de longue duree, soit respectivement de 205,1 et 218,1 jours en moyenne.Conclusion : Environ 1 ordonnance d'IPP sur 6 pour !es patients de centres d'hebergement et de soins de longue duree de la Fraser Health ne reposait pas sur une indication large consignee et fondee sur des donnees probantes et environ 2 ordonnances d'IPP sur 5 ne s'appuyaient pas sur une indication usuelle consignee et fondee sur des donnees probantes. Les resultats revelent la necessite d' evaluer la pertinence des traitements par IPP pour chaque patient ayant une ordonnance active d'IPP clans !es centres d'hebergement et de soins de longue duree.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.005 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".