Digestive Diseases and Sciences

, Volume 60, Issue 8, pp 2280–2286 | Cite as

The Inappropriate Prescription of Oral Proton Pump Inhibitors in the Hospital Setting: A Prospective Cross-Sectional Study

  • Orlaith B. Kelly
  • Catherine Dillane
  • Stephen E. Patchett
  • Gavin C. Harewood
  • Frank E. Murray
Original Article

Abstract

Proton pump inhibitors (PPIs) are used to treat upper gastrointestinal tract disorders. Their efficacy and perceived safety have led to widespread prescription. This is not without effect, in terms of adverse events and resource utilization.

Aim

To prospectively assess oral PPI prescription in hospitalized patients.

Methods

PPI prescription in consecutive hospitalized patients was assessed. Indication and dose were assessed by patient interview and medical record review. Comparisons with current published prescribing guidelines were made.

Results

Four hundred and forty-seven patients were included. 57.5 % were prescribed PPIs. 26.8 % prescriptions were for inappropriate or unclear indications. 68.4 % were on higher doses than guidelines recommended, of which 41.6 % could have undergone dose reduction, and 26.5 % discontinued. In a multivariate analysis, age, gender, and length of stay had no association with PPI prescription. Although aspirin use was appropriately associated with PPI prescription (RR: 1.8, 95 % CI 1.127–3.69; p < 0.05), the PPI was often given at higher than recommended doses (p < 0.001). This may reflect older age and multiple risk factors in this subset. Surgical patients commenced more PPIs and at higher dosages (p < 0.001). Omeprazole and lansoprazole were most often inappropriately prescribed (p < 0.01, p < 0.001, respectively).

Conclusion

Inappropriate PPI therapy is still a problem in hospitals, though it appears to be at a lower level compared with previous studies. Awareness of evidence-based guidelines and targeted medicine reconciliation strategies are essential for cost-effective and safe use of these medications.

Keywords

Proton pump inhibitors Inappropriate prescribing Prescribing patterns Physician Inpatients 

Abbreviations

PPI

Proton pump inhibitor

NSAID

Nonsteroidal anti-inflammatories

PUD

Peptic ulcer disease

GERD

Gastro-esophageal reflux disease

EGD

Esophagogastroduodenoscopy

Notes

Conflict of interest

None.

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Orlaith B. Kelly
    • 1
  • Catherine Dillane
    • 1
  • Stephen E. Patchett
    • 1
  • Gavin C. Harewood
    • 1
  • Frank E. Murray
    • 1
  1. 1.Department of GastroenterologyBeaumont HospitalDublin 9Ireland

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