Appropriateness of proton pump inhibitor therapy in an ambulatory geriatrics clinic: A retrospective cross-sectional analysis
Bibliographic record
Abstract
Background: Proton pump inhibitors are considered potentially inappropriate medications in the geriatric population. The use of proton pump inhibitors by older adults has increased over the past several decades; however, existing literature suggests that only one-third of patients prescribed these medications have a valid indication for use. The aim of this study was to assess the appropriateness of proton pump inhibitor therapy in a population of ambulatory geriatric patients and to determine the impact of an interdisciplinary clinic on their use. Methods: This was a retrospective, cross-sectional study of patients referred to an ambulatory geriatrics clinic between October 2017 and March 2021. Participants were eligible for inclusion if they were taking a proton pump inhibitor at the time of clinic admission. Appropriateness of proton pump inhibitor therapy was assessed based on indication and dosing regimen. Results: In total, 280 participants were included. The mean age was 79.6 years (SD 7.7) and 60% were female. Overall, 94 of 280 (33.6%) participants had a documented valid indication for their proton pump inhibitor. The clinic team intervened to reduce the dose or discontinue 76 of 186 (40.8%) inappropriate proton pump inhibitors. Interpretation: Only one-third of proton pump inhibitors used by ambulatory geriatric patients have a documented appropriate indication for use. Given the medical complexity of this population and their vulnerability to adverse effects, the ambulatory geriatric population should be a priority target for proton pump inhibitor deprescribing initiatives.
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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 | 0.003 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".