Journal of General Internal Medicine

, Volume 28, Issue 7, pp 930–937

Proton Pump Inhibitor Prescriptions and Subsequent Use in US Veterans Diagnosed with Gastroesophageal Reflux Disease

Authors

    • Division of Gastroenterology & Hepatology, Feinberg School of MedicineNorthwestern University
    • Center for Healthcare Studies, Feinberg School of MedicineNorthwestern University
    • Center for Management of Complex Chronic Care, Department of Veterans AffairsEdward Hines, Jr. VA Hospital
  • John E. Pandolfino
    • Division of Gastroenterology & Hepatology, Feinberg School of MedicineNorthwestern University
  • Scott Miskevics
    • Center for Management of Complex Chronic Care, Department of Veterans AffairsEdward Hines, Jr. VA Hospital
  • Sherri L. LaVela
    • Center for Healthcare Studies, Feinberg School of MedicineNorthwestern University
    • Center for Management of Complex Chronic Care, Department of Veterans AffairsEdward Hines, Jr. VA Hospital
Original Research

DOI: 10.1007/s11606-013-2345-0

Cite this article as:
Gawron, A.J., Pandolfino, J.E., Miskevics, S. et al. J GEN INTERN MED (2013) 28: 930. doi:10.1007/s11606-013-2345-0

ABSTRACT

BACKGROUND

Empiric proton pump inhibitor use is common for gastroesophageal reflux disease (GERD), but initial proton pump inhibitor (PPI) prescription patterns in Veterans are unknown.

OBJECTIVE

The study aims were to determine initial PPI prescriptions in Veterans diagnosed with GERD, and to characterize subsequent PPI use over the 2 years following initial prescription.

DESIGN

We conducted a retrospective study using Veteran’s Administration (VA) administrative data and chart review.

STUDY POPULATION

Patients diagnosed with GERD and provided an initial PPI prescription at Hines VA Hospital from 2003 to 2007, with 2 year follow-up for each patient (through 2009).

MEASURES and OUTCOMES

Initial PPI prescriptions were categorized as standard total daily dose or high total daily dose, and accuracy was confirmed by manual chart review. Descriptive statistics were calculated and bivariate analyses were used to assess for differences in demographics, prescriptions, and subsequent use by initial PPI dosage category.

RESULTS

Of the 1,621 patients included in the study, 378 (23.3 %) had high total daily dose initial PPI prescriptions and 1,243 (76.7 %) patients had standard total daily dose initial prescriptions. The majority of patients (65.8 %) received a 90-day or greater initial prescription. Over the 2 years following the initial PPI prescription, 13.0 % of patients with initial standard daily dose prescriptions had evidence of step-up therapy. Only 7.1 % of patients with initial high daily dose PPI prescriptions had evidence of step-down therapy. A large majority of patients (83.8 %) had at least one refill over 2 years, and the overall medication possession ratio was 0.86.

CONCLUSIONS

Many Veterans receive high total daily dose PPI prescriptions as initial therapy for a GERD diagnosis, and few patients have evidence for cessation or reduction of therapy. These results provide detailed data on prescribing and use of PPIs to help guide efforts for optimal PPI use in US Veterans.

KEY WORDS

drug GERD prescriptions Veteran Health Affairs

Abbreviations

GERD

Gastroesophageal reflux disease

PPI

Proton pump inhibitor

H2RA

Histamine receptor 2 antagonists

VA

Veteran’s administration

NSAID

Non-steroidal anti-inflammatory drug

DSS

Decision support system

NDE

National data extracts

MPR

Medication possession ratio

CCR

Computerized clinical reminders

ABIM

American Board of Internal Medicine

AGA

American Gastroenterology Association

Copyright information

© Society of General Internal Medicine 2013