Background: Proton pump inhibitors (PPIs) are some of the most frequently prescribed medications, but they are often used inappropriately, either being prescribed without a clear indication or continued for longer than necessary. In such cases, deprescribing is recommended. However, despite its proven effectiveness, the implementation of deprescribing in clinical practice remains inconsistent and varied, making it challenging to identify the most effective strategies. The goal is to provide a comprehensive outline of deprescribing interventions for PPI therapy implemented across various settings and by different healthcare professionals. Methods: The study is designed to be a systematic review of the published literature. PubMed, Embase, and Web of Science databases were searched from 1 January 1989 (the first PPI on the market) to 30 September 2024 for articles assessing PPI deprescribing in adult patients, focusing on the implementation rate (primary outcome) or effects on symptoms (secondary outcome). Results: After screening, 66 studies were included, predominantly pragmatic trials (N = 32) or randomized controlled trials (N = 25). We found a variety of interventions promoting PPI deprescription. Collaborative efforts involving multiple healthcare professionals, the use of algorithms for clinical decision-making, and patient involvement have proven to be key elements in the most effective strategies. Discontinuing therapy may not be advisable in cases of recurrent symptoms, suggesting that on-demand therapy could be a recommended approach. Deprescribing is particularly relevant for individuals with mild illnesses and symptoms, where tapering can effectively mitigate the rebound symptoms often associated with abrupt discontinuation. Conclusions: Given the current prevalence of inappropriate PPI prescribing, it is imperative to raise awareness among both physicians and patients about the importance of the deprescribing process, which should be tailored to the specific needs of each patient, considering his/her medical history, current health status, and personal preferences.

Background: Potentially inappropriate polypharmacy (PIP) is among the major factors leading to adverse drug reactions, increased healthcare costs, reduced medication adherence, and worsened patient conditions. This study aims to identify existing interventions implemented to monitor and manage polypharmacy in the Italian setting. Methods: A systematic literature review (PROSPERO: CRD42023457049) was carried out according to the PRISMA statement guidelines. PubMed, Embase, ProQuest, and Web of Science were queried without temporal constraints, encompassing all published papers until October 2023. Inclusion criteria followed the PICO model: patients with polypharmacy; interventions to monitor/manage polypharmacy regimen versus no/any intervention; outcomes in terms of intervention effectiveness and cost variation. Results: After duplicate deletion, 153 potentially relevant publications were extracted. Following abstract and full-text screenings, nine articles met the inclusion criteria. Overall, 78% (n = 7) were observational studies, 11% (n = 1) were experimental studies, and 11% (n = 1) were two-phase studies. A total of 44% (n = 4) of the studies involved patients aged ≥ 65 years, while 56% (n = 5) were disease-specific. Monitoring was the most prevalent choice of intervention (67%; n = 6). Outcomes were mainly related to levels of polypharmacy (29%; n = 6) and comorbidities (29%; n = 6), effectiveness rates (14%; n = 3), and avoidable costs (9%; n = 2). Conclusions: This review outlines that Italy is still lacking in interventions to monitor/manage PIP, addressing an unmet need in developing patient-tailored strategies for reducing health-system burden.

Background: Medication adherence is one of the critical factors in optimizing treatment outcomes for chronic diseases such as atopic dermatitis (AD). Existing studies use aggregate data, but there is a need for assessment of medication adherence phases, such as the initiation and discontinuation of therapy. The aim of this study was to assess medication adherence across patients with moderate to severe AD, investigating the impact of drug treatment characteristics, particularly the route of administration, on adherence levels during treatment. Methods: A retrospective observational study on an Italian sample included 821 newly diagnosed AD patients from January 2021 to June 2022. Medication adherence was evaluated by EMERGE guidelines, focusing on initiation and discontinuation. Discontinuation was assessed at 6 and 12 months, comprising sensitivity analysis. Statistical analysis included chi-square tests and descriptive statistics on treatment duration. Results: Treatment initiation is significantly lower for tacrolimus ointment (38% non-initiation) than for dupilumab injection (12% non-initiation), due to initial healthcare support for dupilumab patients. After six months, 75.6% of dupilumab injection patients remained on therapy, while 24.4% of patients continued tacrolimus ointment treatment. After one year, therapy persistence was 68.7% among users of dupilumab, while only 22.5% of patients remained on tacrolimus therapy. Dupilumab demonstrated a significantly longer median treatment duration compared to tacrolimus (4.4 vs. 2.6 months; p < 0.01). Conclusions: The observed differences in adherence patterns between topical tacrolimus and subcutaneous dupilumab suggest that distinct contextual and behavioral factors influence patient adherence during therapy.

Background: General practitioners (GPs) should regularly review patients’ medications and, when they are potentially harmful or no longer necessary, implement deprescribing approach. We aimed to assess the perceptions and potential barriers to deprescribing among Italian GPs. Methods: GPs were invited to participate in an observational cross-sectional study through an online survey containing 20 questions addressing attitudes towards deprescribing, including physicians’ perceptions, potential barriers, and how this process is addressed in daily clinical practice. The survey, accessible for responses from 4th May 2023 to 15th January 2024, was distributed through social media, networks, medical associations, and involving primary care departments of local health authorities. Results: Over 8 months, 617 answers were collected. Less than 2% ( n = 11) reported to not implement deprescribing interventions in daily practice, primarily due to perceived insufficient experience ( n = 7) or lack of specific education ( n = 6). Conversely, 23.1%( n = 142) of respondents reported frequently or very frequently implementing deprescribing. Among barriers, GPs reported difficulties in dealing with specialists ( n = 438, 71.7%), distrust of patients in drug discontinuation ( n = 326, 53.4%), poor availability of deprescribing guidelines ( n = 231, 37.8%), and time constraints ( n = 213, 34.9%). Guidelines and targeted training were mostly demanded (by 66.1% and 59.6%, respectively). Regarding specific drug classes, the proportion of GPs reporting to frequently implement deprescribing for proton pump inhibitors was 51.8% ( n = 313), while percentage was lower for benzodiazepines ( n = 166, 27.4%), bisphosphonates ( n = 147, 24.3%), statins ( n = 128, 21.2%), antihypertensives ( n = 108, 17.9%), and antidepressants ( n = 96, 15.9%). Conclusion: The study shows that while GPs recognize the importance of deprescribing, however, they face significant barriers, including a lack in targeted education and specific guidelines to enhance their confidence and knowledge in implementing this process effectively in daily clinical practice.

Background Falls are a leading cause of hospitalisation among older adults, with substantial impacts on quality of life and healthcare costs. Fall-risk-increasing drugs represent an important risk factor. Objective This study aimed to evaluate the association between fall-risk-increasing drug use and the risk of fall-related hospitalisation. Methods A nested case-control study was conducted using administrative healthcare data from a sample of Italian community-dwelling older adults. Cases included individuals aged ≥65 years hospitalised for fall-related injuries in 2018, matched 1:1 by sex and age with controls who had no fall-related injuries. Fall-risk-increasing drug exposure was assessed by drug class, duration and recency of use. Adjusted odds ratios (aORs) were estimated using logistic regression, controlling for polypharmacy and comorbidities. Results Among 16,118 cases and 16,118 controls (68.77% female, mean age 79.76 years), cases showed a higher prevalence of polypharmacy (five to nine drugs: 42.03 vs 37.16%; ten or more drugs: 7.02 vs 5.44%; p < 0.0001) and multimorbidity (three or more diseases: 6.42 vs 2.82%; p < 0.0001). Fall-risk-increasing drug use was higher in cases (37.70 vs 26.49%, p < 0.0001), with a 51% increased risk of fall-related hospitalisation (aOR 1.51, 95% confidence interval [CI] 1.44–1.59). Opioids (aOR 1.40, 95% CI 1.31–1.50) and antidepressants (aOR 1.45, 95% CI 1.36–1.54) were associated with the highest risk. Prolonged fall-risk-increasing drug exposure (>9 months; aOR 1.69, 95% CI 1.57–1.83) and current exposure (within 30 days before hospitalisation; aOR 1.78, 95% CI 1.68–1.89) showed higher odds. Conclusions Fall-risk-increasing drug use was associated with a higher risk of fall-related hospitalisations in older adults. These findings support the importance of optimising prescribing and managing polypharmacy as potential strategies to improve patient safety and reduce the healthcare burden.