Proton Pump Inhibitor Prescriptions and Subsequent Use in US Veterans Diagnosed with Gastroesophageal Reflux Disease
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Empiric proton pump inhibitor use is common for gastroesophageal reflux disease (GERD), but initial proton pump inhibitor (PPI) prescription patterns in Veterans are unknown.
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.
We conducted a retrospective study using Veteran’s Administration (VA) administrative data and chart review.
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.
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.
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 WORDSdrug GERD prescriptions Veteran Health Affairs
Gastroesophageal reflux disease
Proton pump inhibitor
Histamine receptor 2 antagonists
Non-steroidal anti-inflammatory drug
Decision support system
National data extracts
Medication possession ratio
Computerized clinical reminders
American Board of Internal Medicine
American Gastroenterology Association
We would like to acknowledge Dr. Elizabeth Tarlov, Ph.D. (VA Information Resource Center (VIReC), Edward Hines Jr. VA) for her assistance with defining measures from the VA pharmacy data set.
This work was directly funded by a VA HSR&D grant (LIP#42-131) provided through the Center for Management of Complex Chronic Care (co-PIs: Drs. Gawron and LaVela). Dr. Gawron is a National Research Service Award postdoctoral fellow at the Center for Healthcare studies under an institutional award from the Agency for Healthcare Research and Quality, T-32 HS 000078 (PI: Jane L. Holl, MD MPH).
Portions of this work were previously presented in abstract form (oral presentation) at Digestive Disease Week (May 2012, San Diego, CA).
Conflict of Interest
This material is based on work supported by the Office of Research and Development, Health Services Research and Development of the Department of Veterans Affairs. This paper reflects only the authors’ opinions and does not necessarily reflect the official position of the Department of Veterans Affairs. Dr. Pandolfino serves as a consultant for Given, Sandhill, and Shire, and on the advisory board for Crospon. None of the authors have a financial or other relationship that might signify a direct conflict of interest.
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