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Inappropriate Prescribing of Proton Pump Inhibitors in Older Patients

Effects of an Educational Strategy

  • Original Research Article
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Abstract

Background

An increasing number of older patients are prescribed proton pump inhibitors (PPIs). However, the extent of inappropriate PPI prescribing in this group is largely unknown.

Objective

We sought to identify clinical and demographic factors associated with inappropriate PPI prescribing in older patients and to assess the effects of a targeted educational strategy in a controlled hospital environment.

Methods

Clinical and demographic characteristics and full medication exposure on admission were recorded in 440 consecutive older patients (mean ± SD age 84 ± 7 years) admitted to a teaching hospital between 1 February 2011 and 30 June 2011. A 4-week educational strategy to reduce inappropriate PPI prescribing during hospital stay, either by stopping or reducing PPI doses, was conducted within the study period. The main outcome measures of the study were the incidence of inappropriate PPI prescribing and the effects of interventions to reduce it.

Results

On admission, PPIs were established therapy in 164 patients (37%). This was considered inappropriate in 100 patients (61%). Lower Charlson Comorbidity Index score (odds ratio [OR] 0.76; 95% CI 0.57, 0.94; p = 0.006) and history of dementia (OR 1.65; 95% CI 1.28, 1.83; p = 0.005) were independently associated with inappropriate PPI prescribing. Interventions to reduce inappropriate PPI prescribing occurred more frequently during and after the education phase (frequency of interventions in patients with inappropriate PPI prescribing: pre-education phase 9%, during education phase 43%, and post-education phase 46%, p=0.006). Prescribing interventions were not associated with acid rebound symptoms.

Conclusions

Inappropriate PPI prescribing in older patients is frequent and independently associated with co-morbidities and dementia. A targeted inhospital educational strategy can significantly and safely reduce inappropriate PPI prescribing in the short term.

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Acknowledgements

Hanifat Hamzat and Hao Sun equally contributed to this work. Arduino A. Mangoni, Joan MacLeod, Joanna C. Ford and Roy L. Soiza formulated the study’s hypothesis and planned the study. Hanifat Hamzat and Hao Sun collected the data. All authors were involved in data analysis and interpretation. Arduino A. Mangoni wrote the manuscript draft. Joan MacLeod, Joanna C. Ford, Roy L. Soiza, Hanifat Hamzat and Hao Sun critically reviewed the manuscript in its final version.

The authors declare no conflicts of interest. The study received no financial support.

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Authors and Affiliations

  1. Division of Applied Medicine, Section of Translational Medical Sciences, School of Medicine and Dentistry, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK

    Hanifat Hamzat, Hao Sun, Roy L. Soiza &  Arduino A. Mangoni

  2. Department of Medicine for the Elderly, Woodend Hospital NHS Grampian, Aberdeen, UK

    Joanna C. Ford, Roy L. Soiza &  Arduino A. Mangoni

  3. Aberdeen City Community Health Partnership, NHS Grampian, Aberdeen, UK

    Joan MacLeod

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  1. Hanifat Hamzat
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  2. Hao Sun
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  3. Joanna C. Ford
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  6. Arduino A. Mangoni
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Correspondence to Arduino A. Mangoni.

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Hamzat, H., Sun, H., Ford, J.C. et al. Inappropriate Prescribing of Proton Pump Inhibitors in Older Patients. Drugs Aging 29, 681–690 (2012). https://doi.org/10.1007/BF03262283

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