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The inappropriate use of proton pump inhibitors during admission and after discharge: a prospective cross-sectional study

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Abstract

Background Proton pump inhibitors are often inappropriately prescribed during hospital admission and after discharge. The inappropriate prescription may be associated with increased and unnecessary healthcare costs. Objective To determine the prevalence of inappropriate prescription of proton pump inhibitors during hospital admission and after discharge at Thailand’s largest national tertiary referral center. Setting Medicine wards at Siriraj Hospital (Bangkok, Thailand) during September 2016 to September 2017. Method This prospective observational cross-sectional study in hospitalized patients who were prescribed, or who were already taking proton pump inhibitors. Medical records were reviewed to determine whether proton pump inhibitors were prescribed at discharge and at the 1-month follow-up. Main outcome measure Prevalence of inappropriate prescription of proton pump inhibitors during hospital admission and after discharge, indication of inappropriate prescription. Results Two hundred and sixty-five patients (mean age: 65.8 ± 18.3 years, 50.9% men) were included. Approximately half of patients had proton pump inhibitor treatment initiated in the hospital, and the other 50.6% started treatment earlier. Among all patients, 50.6% were inappropriately prescribed proton pump inhibitors, in which 79.1% resulted from invalid indications. Fifty-two percent and 47.3% of patients who were prescribed proton pump inhibitors at discharge and at the 1-month follow-up had no indications for them. Gastrointestinal ulcer prophylaxis in low-risk patients was the most commonly observed incorrect indication. Aspirin (p = 0.030) and corticosteroids (p = 0.038) were both found to be significantly associated with the inappropriate prescription of proton pump inhibitors. The estimated cost of inappropriate use among inpatients and outpatients was $118,659 and $214,663 per year, respectively. Conclusion Proton pump inhibitors are excessively and inappropriately prescribed during hospital admission and after discharge in Thailand. The cost of this overprescribing is excessive and needs to be controlled.

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Acknowledgements

The authors gratefully acknowledge the patients that generously agreed to participate in this study, and Ms. Khemajira Karaketklang of the Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University for assistance with statistical analysis. We would like to thank Mr. Kevin P. Jones (medical research manuscript editor) for proofreading this article.

Funding

This study was supported by a grant from the Siriraj Hospital Research Fund, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

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Authors and Affiliations

  1. Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Onuma Sattayalertyanyong

  2. Research Group in Immunobiology and Therapeutic Sciences, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Premrutai Thitilertdecha

  3. Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Premrutai Thitilertdecha

  4. Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand

    Chonticha Auesomwang

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  1. Onuma Sattayalertyanyong
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Correspondence to Chonticha Auesomwang.

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Sattayalertyanyong, O., Thitilertdecha, P. & Auesomwang, C. The inappropriate use of proton pump inhibitors during admission and after discharge: a prospective cross-sectional study. Int J Clin Pharm 42, 174–183 (2020). https://doi.org/10.1007/s11096-019-00955-8

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