Research is showing that the numbers of proton pump inhibitors (PPIs) are being over prescribed during hospital stays and subsequently on discharge. There are studies published that show there are opportunities for substantial cost savings in relation to PPI prescription if there were some clinical guidelines used across the board nationwide. In addition to the costs, there are also risks for devastating side effects of continued use. There is a need to have a more defined reason for the administration and continuation of PPI’s.
The need for proton pump inhibitors Being admitted to a hospital is a scary thing – especially when unexpected. There is a common trend seen among patients when they are admitted. They are usually less mobile, taking multiple medications and prone to stress ulcers from the hospital stay itself. All of the aforementioned reasons can cause stress ulcers. This means there is a reflux of stomach contents into the lower esophagus. Excess stomach acid occurs when the patient is immobile due to the gastric contents moving from a lower pressure to a higher pressure. (Lewis, 2007 p.1003) Typically, this occurs when the patient is in a supine position or with an increase in abdominal pressure. There are a variety of reasons why the decreased pressure in the lower esophageal sphincter - ranging from medications to diet.
Doctors know this is a common manifestation and for that reason they will prescribe a proton pump inhibitor or PPI when the patient is admitted. PPI’s work by decreasing the amount of acid produced in the stomach. Some examples of these medications are omeprazole, lansoprazole, and pantoprazole. These medications are used to treat erosive esophagitis, which is damage to the esophagus from stomach...
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...cking a PPI: It comes down to cost. Journal Of Family Practice, 57(4), 231-236.
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Hughes, J. D., Tanpurekul, W., Keen, N. C., & Ee, H. C. (2009). Reducing the cost of proton pump inhibitors by adopting best practice. Quality In Primary Care, 17(1), 15-21.
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In order to sustain the market share in this highly competitive industry, the pharmacies have to establish and maintain strong working relationships with PBMs that have power to divest particular clients from a pharmacy by denying reimbursement privileges to their customers. Buyer Power Strong It is not hard to obtain the same drugs from different sources, so the customer loyalty is virtually non-existent and the pharmacies have to try extremely hard to sustain their consumer base. Threats of substitutes Weak There are very few alternatives to drugs. Alternatives are practically limited to traditional medicine.
In a separate analysis we divided the patients to 2 groups, a group that used Proton pump inhibitor (omeprazole) and the control group; we found that out of 98 patients, 7 patients had PEP (5 sever, 1mild, 1 moderate) compared to 91patients that did not use PPI had 5 PEP. P value =0.7703
The cause for the acid-base balance would be the sedative, the patient’s weight which is obese, respiratory, bicarbonate and metabolic problem.
bottom edges are not tightly shut, and acid moves form the stomach up into the
In the article review, written by Michelle Andrews she explores the impact of out of pocket costs on prescriptions influence whether a patient fills them. The potentially lifesaving cholesterol lowering drugs such as PcSK9 inhibitors.
... (2013) IMS health study points to a declining cost curve for U.S. medicines in 2012 Retrieved from http://www.imshealth.com/portal/site/ims/menuitem.d248e29c86589c9c30e81c033208c22a/?vgnextoid=8659cf4add48e310VgnVCM10000076192ca2RCRD&vgnextchannel=437879d7f269e210VgnVCM10000071812ca2RCRD&vgnextfmt=default
In America, it has become a battle to earn a high paying job to cope with the expenses of a typical American. It has become even more of a battle for some people to afford medical prescriptions to keep healthy. Health becomes a crucial issue when discussed among people. No matter what, at one point or another, everyone is going to stand as a victim of the pharmaceutical industry. The bottom line is Americans are paying excessive amounts of money for medical prescriptions. Health-Care spending in the U.S. rose a stunning 9.3% in 2002, which is the greatest increase for the past eleven years. (Steele 46) Many pharmaceutical companies are robbing their clients by charging extreme rates for their products.
There are several basic approaches that can be utilized when conducting economic evaluations for any new health care intervention; which can include medications that are designed for the treatment and prevention of disease and how to relate the effectiveness with the overall monetary value of the new treatment. The economic tools that can be employed to perform such an analysis can be broken down into four basic parts that consist of cost-minimization analysis (CMA), cost-effectiveness analysis (CEA), cost-benefit analysis (CBA) and cost-utility analysis (CUA). These four categories will contain the major financial analytical techniques employed when evaluating medical treatments and interventions along with other types termed cost-consequence
The main causes of GERD occur because your lower esophageal sphincter (LES), or the sphincter that closes off the esophagus to the stomach becomes weakened or stops functioning correctly. Scientist are finding that different nutrition habits affect the workings of the LES. Things like dietary supplements, drugs, or anything containing caffeine will actually cause the malfunction of the LES.
Why are the prices so high? Some critics of the drug companies argue that the larger firms are ripping off the American public, are dishonest and, in some cases, unsafe. On the other hand, there are health care workers such as doctors and their supporters who claim that research and testing for drugs costs money. This supposedly justifies their prices for their products. Also, as an argument to their side, they say that their practice is a benefit to the improvement to mankind. It is a life saving business, but are these prices justified? As one can see, this is a very important issue in medicine today. It affects everyone involved with medicine, which is much of the American public. It also affects the physicians and drug makers.
Moreover, some of the new drugs being introduced at such large prices have only slight marginal improvements over the already pre-existing drugs. One example of this would be Zaltrap, a drug approved to treat colorectal cancer. Zaltrap was discovered by Regeneron, an emerging biopharmaceutical company, but sold by the French drug maker Sanofi. Yet it worked no better in clinical trials than Roche’s cancer drug called Avastin, which on average adds only 1.4 months to life expectancy for patients inflicted with advanced colorectal cancer. Sanofi priced Zaltrap at $11,000 a month, which is twice Avastin’s price. At any rate, there was resistance. Doctors at Memorial Sloan-Kettering in New York, which is one of the world’s leading cancer centers,
As the acid backwashes into the esophagus the lining in the lower esophagus can become irritated an start to become narrow (esophageal stricture) as well as sores can form which causes bleeding (esophageal ulcer). If this condition or changes to the lower esophagus progresses it could lead to esophageal cancer ( Barrett's esophagus).
Acid is produced naturally in your stomach to help you digest food and to kill bacteria. This acid irritates the stomach lining so our body produces a natural mucus barrier which protects it. Sometimes this barrier may be damaged thus allowing the acid to damage the stomach causing inflammation, ulcers and other conditions. Other times, there may be a problem with the muscular band at the top of the stomach that keeps the stomach tightly closed and this allows the acid to escape and irritate the oesophagus. This is called 'acid reflux' and can cause heartburn and/or oesophagitis. Proton pump inhibitors such as omeprazole stop cells in the lining of the stomach from producing too much acid. This can help prevent ulcers from forming or assist the healing process. By decreasing the amount of acid, they can also help to reduce acid reflux related symptoms such as heartburn.
...d a gap in the number of studies conducted regarding this issue. From the studies reviewed, the results demonstrate that the increasingly health related issue of polypharmacy among the elderly requires the immediate attention of health care professionals. The studies revealed that in conjunction with medication reviews (brown bag), the STOPP criteria is a tool in which can be effective in detecting PIMs. The studies also revealed that nurses are in the position to address and assess for adverse drug reactions associated with polypharmacy by utilizing the “brown bag”, medication review, and STOPP criteria. Regarding the PICO question, the results of these studies support the essential need of medication reviews to be implemented by nurses and healthcare professionals at every provider visit to reduce the risk of polypharmacy and its associated adverse reactions.
The first is that it may be because of a weakened lower esophageal sphincter or LES. This is the valve that keeps the stomach acid inside the stomach and prevents the acid from coming in contact with the esophagus. A weakened LES is one of the most common symptoms of GERD or Gastroesophageal Reflux Disease.