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Comparative Study
. 2025 Jan 6;25(1):30.
doi: 10.1186/s12913-024-12033-5.

Patterns of outpatient proton‒pump inhibitors use among older adults in a duplicative health system: comparing public and private prescribing

Sónia Romano  1   2   3 , António Teixeira Rodrigues  4   5   6 , Carla Torre  7   8 , Julian Perelman  9   10
Affiliations
Comparative Study

Patterns of outpatient proton‒pump inhibitors use among older adults in a duplicative health system: comparing public and private prescribing

Sónia Romano et al. BMC Health Serv Res. .

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.

Keywords: Overprescribing; Patterns; Private; Proton-pump inhibitors; Public; Rational prescribing.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. This manuscript does not contain clinical studies or patient-level data. Data were derived from a publicly open access online platform of the Portuguese NHS; therefore, no access authorization was required. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Mean Prevalence in DDD/1000 inhabitants/day of PPIs prescription in the public and private sectors stratified by sex and age group, for the years 2020 to 2022
Fig. 2
Fig. 2
Mean market share of DDD/1000 inhabitants/day (%) of each PPIs substance prescribed in public and private sectors, for the years 2020 to 2022
Fig. 3
Fig. 3
Mean market share of DDD/1000 inhabitants/day (%) of each PPIs substance prescribed in the public and private sectors, stratified by sex and age groups for the years 2020 to 2022
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