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Patterns of Outpatient Proton‒pump Inhibitors Use Among Older Adults in a Duplicative Health System: Comparing Public and Private Prescribing

Overview
Journal BMC Health Serv Res
Publisher Biomed Central
Specialty Health Services
Date 2025 Jan 6
PMID 39762802
Authors
Sonia Romano
Antonio Teixeira Rodrigues
Carla Torre
Julian Perelman
Affiliations
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Abstract

Background: Proton-pump-inhibitors (PPIs) are overprescribed, posing challenges to patients and healthcare systems. In Portugal, the public National Health Service (NHS) provides universal coverage and reimburses medication regardless of prescription origin, i.e., public or private. This study aimed to compare PPIs outpatient prescription patterns and costs among older adults in the private and public sectors.

Methods: A nationwide retrospective ecological study was conducted on PPIs prescribed for older adults in Portugal from 2020-2022. Data on defined daily doses (DDDs) and prices were obtained from a national public database by healthcare sector, sex, and age group (65-74, ≥ 75 years). The market share of DDD per 1000 older adults per day and the mean price per DDD (€/DDD) for all PPIs substances were compared between the public and private sectors.

Results: PPIs-DDDs accounted for 5.3% of all outpatient DDDs prescribed in the private sector and 5.9% in the public sector. The private sector prescribed PPIs at a 20% higher price (0.126 €/DDD) than the public (0.106 €/DDD), with greater differences among the most expensive substances (rabeprazole, lansoprazole and esomeprazole). Omeprazole (cheapest) was mostly prescribed in the public sector. In the private sector, a similar pattern was observed among those aged ≥ 75 years, whereas esomeprazole was most prescribed for those aged 65-74 years.

Conclusions: Given the widespread prescription of PPIs and the associated cost, it is crucial to reinforce incentives to promote rational PPIs prescription and encourage deprescription when necessary, in both sectors. Since the NHS also reimburses medications prescribed in private units, implementing monitoring measures and financial incentives to promote responsible prescribing in this sector should also be considered.

References
1.
Portela M, Campos Fernandes A . Medicines Compliance and Reimbursement Level in Portugal. Health Serv Res Manag Epidemiol. 2017; 2:2333392815601972. PMC: 5266445. DOI: 10.1177/2333392815601972. View
2.
Fass R . Erosive esophagitis and nonerosive reflux disease (NERD): comparison of epidemiologic, physiologic, and therapeutic characteristics. J Clin Gastroenterol. 2007; 41(2):131-7. DOI: 10.1097/01.mcg.0000225631.07039.6d. View
3.
Amorim W, Passos L, Gama R, Souza R, Graia L, Macedo J . Physician and patient-related factors associated with inappropriate prescribing to older patients within primary care: a cross-sectional study in Brazil. Sao Paulo Med J. 2021; 139(2):107-116. PMC: 9632519. DOI: 10.1590/1516-3180.2020.0411.R1.18112020. View
4.
Chiatti C, Bustacchini S, Furneri G, Mantovani L, Cristiani M, Misuraca C . The economic burden of inappropriate drug prescribing, lack of adherence and compliance, adverse drug events in older people: a systematic review. Drug Saf. 2013; 35 Suppl 1:73-87. DOI: 10.1007/BF03319105. View
5.
Wallace E, McDowell R, Bennett K, Fahey T, Smith S . Impact of Potentially Inappropriate Prescribing on Adverse Drug Events, Health Related Quality of Life and Emergency Hospital Attendance in Older People Attending General Practice: A Prospective Cohort Study. J Gerontol A Biol Sci Med Sci. 2016; 72(2):271-277. PMC: 5233913. DOI: 10.1093/gerona/glw140. View