PROMPT criterion | Baseline n (%) | Follow-up n (%) | Change in % prevalence (95% CI)† |
Gastrointestinal system | |||
Other than for opioid-induced constipation, stimulant laxatives (eg, bisacodyl, senna) should not be prescribed as first-line treatment in constipation for greater than 4 weeks | 0 (0.0) | 0 (0.0) | 0.0 (−0.1, 0.1) |
Proton pump inhibitors (PPIs) should not be prescribed at doses above the recommended maintenance dosage for greater than 8 weeks | 136 (14.8) | 177 (19.2) | 4.5 (2.1, 6.8)***‡ |
Esomeprazole or omeprazole should not be used in combination with clopidogrel | 11 (1.2) | 7 (0.8) | −0.4 (−1.2, 0.3) |
Cardiovascular system | |||
The use of alpha-adrenoceptor blocking drugs (eg, doxazosin, prazosin) as monotherapy for hypertension should be avoided | 2 (0.2) | 2 (0.2) | 0.0 (−0.4, 0.4) |
Aspirin doses should not exceed 150 mg/day for antiplatelet therapy | 5 (0.5) | 5 (0.5) | 0.0 (−0.4, 0.4) |
Cardioselective calcium-channel blockers (eg, verapamil, diltiazem) should not be used in combination with beta-adrenoceptor blocking drugs | 4 (0.4) | 4 (0.4) | 0.0 (−0.4, 0.4) |
The use of oral short-acting dipyridamole should not be used as monotherapy in antiplatelet treatment | 0 (0.0) | 0 (0.0) | 0.0 (−0.1, 0.1) |
Respiratory system | |||
First-generation antihistamines (eg, chlorphenamine, promethazine) should not be used as first-line agents for greater than 7 days. | 8 (0.9) | 5 (0.5) | −0.3 (−1.1, 0.5) |
A concomitant bisphosphonate should be prescribed if oral corticosteroids are used long term (greater than 3 months) | 14 (1.5) | 14 (1.5) | 0.0 (−1.1, 1.1) |
Theophylline should not be used as monotherapy for asthma or COPD | 1 (0.1) | 1 (0.1) | 0.0 (−0.4, 0.4) |
Mucolytic agents (eg, carbocisteine, mecysteine) should not be used routinely in stable COPD | 1 (0.1) | 6 (0.7) | 0.5 (0.0, 1.1) |
Central nervous system | |||
Selective serotonin reuptake inhibitors (SSRIs) should not be used in combination with venlafaxine | 1 (0.1) | 0 (0.0) | −0.1 (−0.4, 0.2) |
Tricyclic antidepressants (TCAs) should not be used as first-line in treatment of depression | 0 (0.0) | 0 (0.0) | 0.0 (−0.1, 0.1) |
Benzodiazepines should not be used long term (greater than 4 weeks) | 70 (7.6) | 76 (8.3) | 0.6 (−0.9, 2.2)‡ |
Non-benzodiazepine hypnotics (zolpidem, zaleplon, zopiclone) should not be used long term (greater than 4 weeks) | 70 (7.6) | 85 (9.2) | 1.6 (0.0, 3.3)*‡ |
Carbamazepine should not be used in combination with clarithromycin or erythromycin | 3 (0.3) | 1 (0.1) | −0.2 (−0.8, 0.3) |
Strong opioids (eg, buprenorphine, diamorphine, fentanyl, morphine, oxycodone) should not be prescribed without the coprescribing of at least osmotic or stimulant laxative (same month) | 128 (13.9) | 131 (14.2) | 0.3 (−2.4, 3.0)‡ |
Infections | |||
Nitrofurantoin should not be prescribed for greater than 7 days for the management of uncomplicated lower urinary tract infections | 2 (0.2) | 8 (0.9) | 0.7 (−0.1, 1.4) |
Endocrine system | |||
In relation to the management of diabetes, the use of oral long-acting sulfonylureas (glibenclamide) should be avoided | 0 (0.0) | 0 (0.0) | 0.0 (−0.1, 0.1) |
Musculoskeletal system | |||
Non-steroidal anti-inflammatory drugs (NSAIDs) should not be used long term (greater than 3 months) | 57 (6.2) | 76 (8.3) | 2.1 (0.3, 3.8)*‡ |
Unless Gl protection is provided with PPI/H2-receptor antagonist, NSAIDs should not be used in combination with low-dose aspirin | 40 (4.3) | 20 (2.2) | −2.2 (−2.2, 0.7)‡ |
Unless Gl protection is provided with PPI/H2-receptor antagonist, NSAIDs should not be used in combination with SSRIs | 26 (2.8) | 15 (1.6) | −1.2 (−1.0, 1.7)‡ |
Duplication of drug classes | |||
Non-benzodiazepine (Z drug) hypnotics | 0 (0.0) | 1 (0.1) | 0.1 (−0.2, 0.4) |
Benzodiazepines | 20 (2.2) | 12 (1.3) | −0.9 (−1.8, 0.0) |
Opioids | 7 (0.8) | 21 (2.3) | 1.5 (0.3, 2.7)**‡ |
Loop diuretics | 0 (0.0) | 0 (0.0) | 0.0 (−0.1, 0.1) |
NSAIDs | 9 (1.0) | 5 (0.5) | −0.4 (−1.3, 0.5) |
ACE inhibitors | 0 (0.0) | 0 (0.0) | 0.0 (−0.1, 0.1) |
Angiotensin II receptor blockers | 2 (0.2) | 0 (0.0) | −0.2 (−0.6, 0.2) |
SSRI | 0 (0.0) | 0 (0.0) | 0.0 (−0.1, 0.1) |
Tricyclic antidepressants | 0 (0.0) | 0 (0.0) | 0.0 (−0.1, 0.1) |
Calcium channel blockers | 2 (0.2) | 1 (0.1) | −0.1 (−0.4, 0.2) |
Beta blockers | 1 (0.1) | 1 (0.1) | 0.0 (−0.4, 0.4) |
Statins | 0 (0.0) | 1 (0.1) | 0.1 (−0.2, 0.4) |
Thiazide diuretics | 0 (0.0) | 0 (0.0) | 0.0 (−0.1, 0.1) |
Any above duplicate drug class | 40 (4.3) | 40 (4.3) | 0.0 (−1.7, 1.7) |
Any of above PROMPT criteria | 361 (39.2) | 395 (42.9) | 3.7 (0.4, 6.9)*‡ |
Number of PROMPT criteria | |||
1 | 199 (21.6) | 211 (22.9) | – |
2 | 95 (10.3) | 102 (11.1) | – |
3 | 44 (4.8) | 52 (5.7) | – |
4 | 16 (1.7) | 21 (2.3) | – |
5 | 7 (0.8) | 8 (0.9) | – |
6 | 0 (0.0) | 1 (0.1) | – |
†Change in prevalence may not sum to exact difference in reported baseline and follow-up prevalence due to rounding.
***p value <0.001; ** p value <0.01; * p value <0.05.
‡Significant McNemar’s test (p<0.05) calculated using non-exact p value if >20 individuals changed exposure status between time periods (ie, had criterion during one time period only).
ACE, angiotensin converting enzyme; COPD, chronic obstructive pulmonary disease; H2, histamine-2 receptor.