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Determinants of Initiation and Suboptimal Use of Anti‐ulcer Medication: A Study of the Quebec Older Population
Author(s) -
Moride Yola,
Melnychuk David,
Monette Johanne,
Abenhaim Lucien
Publication year - 1997
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1997.tb01514.x
Subject(s) - medicine , medical prescription , omeprazole , odds ratio , retrospective cohort study , population , concomitant , cohort , cohort study , pharmacy , logistic regression , pharmacoepidemiology , family medicine , environmental health , pharmacology
OBJECTIVES : To describe the use of anti‐ulcer medication in the Quebec older population; to examine determinants of initiation, suboptimal use, and switches between products. DESIGN : Population‐based retrospective cohort study. SETTING : Universal health program for older adults in Quebec. PARTICIPANTS : 5000 users and 5000 non‐users of antiulcer medications were selected randomly. Use was defined as the presence in the 1991 prescription database of an antiulcer prescription. Among users, 1697 (34%) were new users and were considered as the exposure group. Subjects were followed for 365 days after inclusion. MEASUREMENTS : Measured were patient's age, gender, prescribed duration of anti‐ulcer medication, concomitant medications, and gastrointestinal diagnostic procedures. RESULTS : A total of 17% of new users had unusually short courses; 18% were long‐term users. There was no difference in duration for omeprazole compared with other anti‐ulcer medications. First‐time use of NSAIDs was the strongest predictor of initiation of anti‐ulcer medication (odds ratio = 3.21; 95% CI, 2.66–3.88). Twenty‐six percent of users switched brands. Only 9.5% of new users underwent a diagnostic procedure before initiation of therapy, and 49% of long‐term users ever underwent such procedure. CONCLUSION : Despite a relatively homogeneous recommended duration of therapy, patterns of use of anti‐ulcer medication among older people are highly variable, and treatment is often not accompanied by a diagnostic procedure.