Skip to main content
SpringerLink
Log in

Inappropriate Prescribing of Proton Pump Inhibitors in Older Patients

Effects of an Educational Strategy

  • Original Research Article
  • Published:
Drugs & Aging Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Table II
Table III
Table IV
Table V

Similar content being viewed by others

References

  1. Shi S, Klotz U. Proton pump inhibitors: an update of their clinical use and pharmacokinetics. Eur J Clin Pharmacol 2008; 64 (10): 935–51.

    Article  PubMed  CAS  Google Scholar 

  2. Hollingworth S, Duncan EL, Martin JH. Marked increase in proton pump inhibitors use in Australia. Pharmacoepidemiol Drug Saf 2010; 19 (10): 1019–24.

    Article  PubMed  Google Scholar 

  3. Chen TJ, Chou LF, Hwang SJ. Trends in prescribing proton pump inhibitors in Taiwan: 1. Int J Clin Pharmacol Ther 2003; 41 (5): 207–12.

    PubMed  CAS  Google Scholar 

  4. Martin RM, Lim AG, Kerry SM, et al. Trends in prescribing H2-receptor antagonists and proton pump inhibitors in primary care. Aliment Pharmacol Ther 1998; 12 (8): 797–805.

    Article  PubMed  CAS  Google Scholar 

  5. Bashford JN, Norwood J, Chapman SR. Why are patients prescribed proton pump inhibitors? Retrospective analysis of link between morbidity and prescribing in the General Practice Research Database. BMJ 1998; 317 (7156): 452–6.

    Article  PubMed  CAS  Google Scholar 

  6. Forgacs I, Loganayagam A. Overprescribing proton pump inhibitors. BMJ 2008; 336 (7634): 2–3.

    Article  PubMed  Google Scholar 

  7. Sheen E, Triadafilopoulos G. Adverse effects of long-term proton pump inhibitor therapy. Dig Dis Sci 2011; 56 (4): 931–50.

    Article  PubMed  CAS  Google Scholar 

  8. McCarthy DM. Adverse effects of proton pump inhibitor drugs: clues and conclusions. Curr Opin Gastroenterol 2010; 26 (6): 624–31.

    Article  PubMed  CAS  Google Scholar 

  9. Ali T, Roberts DN, Tierney WM. Long-term safety concerns with proton pump inhibitors. Am J Med 2009; 122 (10): 896–903.

    Article  PubMed  CAS  Google Scholar 

  10. Jackson SH, Mangoni AA, Batty GM. Optimization of drug prescribing. Br J Clin Pharmacol 2004; 57 (3): 231–6.

    Article  PubMed  CAS  Google Scholar 

  11. Mangoni AA, Jackson SH. Age-related changes in pharmacokinetics and pharmacodynamics: basic principles and practical applications. Br J Clin Pharmacol 2004; 57 (1): 6–14.

    Article  PubMed  CAS  Google Scholar 

  12. Reimer C, Sondergaard B, Hilsted L, et al. Proton-pump inhibitor therapy induces acid-related symptoms in healthy volunteers after withdrawal of therapy. Gastroenterology 2009; 137 (1): 80–7, 87.

    Article  PubMed  CAS  Google Scholar 

  13. Niklasson A, Lindstrom L, Simren M, et al. Dyspeptic symptom development after discontinuation of a proton pump inhibitor: a double-blind placebo-controlled trial. Am J Gastroenterol 2010; 105 (7): 1531–7.

    Article  PubMed  CAS  Google Scholar 

  14. Jones MI, Greenfield SM, Jowett S, et al. Proton pump inhibitors: a study of GPs’ prescribing. Fam Pract 2001; 18 (3): 333–8.

    Article  PubMed  CAS  Google Scholar 

  15. de GV, Beckerman H, Lankhorst GJ, et al. How to measure comorbidity: a critical review of available methods. J Clin Epidemiol 2003; 56 (3): 221–9.

    Article  PubMed  Google Scholar 

  16. Hall WH, Ramachandran R, Narayan S, et al. An electronic application for rapidly calculating Charlson comorbidity score. BMC Cancer 2004; 4: 94.

    Article  PubMed  Google Scholar 

  17. Maconi G, Manes G, Porro GB. Role of symptoms in diagnosis and outcome of gastric cancer. World J Gastroenterol 2008; 14 (8): 1149–55.

    Article  PubMed  Google Scholar 

  18. Proton pump inhibitors. In: British Medical Association and the Royal Pharmaceutical Society. British national formulary. 61st ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2011.

  19. National Institute of Clinical Excellence (NICE). Guidance on the use of proton pump inhibitors in the treatment of dyspepsia. NICE Technology Appraisal Guidance No. 7. London: NICE, 2000.

    Google Scholar 

  20. Pasina L, Nobili A, Tettamanti M, et al. Prevalence and appropriateness of drug prescriptions for peptic ulcer and gastro-esophageal reflux disease in a cohort of hospitalized elderly. Eur J Intern Med 2011; 22 (2): 205–10.

    Article  PubMed  CAS  Google Scholar 

  21. Shrestha K, Hughes JD, Lee YP, et al. The prevalence of co-administration of clopidogrel and proton pump inhibitors. Qual Prim Care 2011; 19 (1): 35–42.

    PubMed  Google Scholar 

  22. van Dijk KN, ter Huurne K, de Vries CS, et al. Prescribing of gastroprotective drugs among elderly NSAID users in the Netherlands. Pharm World Sci 2002; 24 (3): 100–3.

    Article  PubMed  Google Scholar 

  23. Ntaios G, Chatzinikolaou A, Kaiafa G, et al. Evaluation of use of proton pump inhibitors in Greece. Eur J Intern Med 2009; 20 (2): 171–3.

    Article  PubMed  Google Scholar 

  24. Gillen D, McColl KE. Does concern about missing malignancy justify endoscopy in uncomplicated dyspepsia in patients aged less than 55? Am J Gastroenterol 1999; 94 (1): 75–9.

    Article  PubMed  CAS  Google Scholar 

  25. Wayman J, Hayes N, Raimes SA, et al. Prescription of proton pump inhibitors before endoscopy: a potential cause of missed diagnosis of early gastric cancers. Arch Fam Med 2000; 9 (4): 385–8.

    Article  PubMed  CAS  Google Scholar 

  26. Naunton M, Peterson GM, Bleasel MD. Overuse of proton pump inhibitors. J Clin Pharm Ther 2000; 25 (5): 333–40.

    Article  PubMed  CAS  Google Scholar 

  27. Bramble MG, Suvakovic Z, Hungin AP. Detection of upper gastrointestinal cancer in patients taking antisecretory therapy prior to gastroscopy. Gut 2000; 46 (4): 464–7.

    Article  PubMed  CAS  Google Scholar 

  28. Brauner DJ, Muir JC, Sachs GA. Treating nondementia illnesses in patients with dementia. JAMA 2000; 283 (24): 3230–5.

    Article  PubMed  CAS  Google Scholar 

  29. Krol N, Wensing M, Haaijer-Ruskamp F, et al. Patient-directed strategy to reduce prescribing for patients with dyspepsia in general practice: a randomized trial. Aliment Pharmacol Ther 2004; 19 (8): 917–22.

    Article  PubMed  CAS  Google Scholar 

  30. Batuwitage BT, Kingham JG, Morgan NE, et al. Inappropriate prescribing of proton pump inhibitors in primary care. Postgrad Med J 2007; 83 (975): 66–8.

    Article  PubMed  Google Scholar 

  31. van Vliet EP, Steyerberg EW, Otten HJ, et al. The effects of guideline implementation for proton pump inhibitor prescription on two pulmonary medicine wards. Aliment Pharmacol Ther 2009; 29 (2): 213–21.

    Article  PubMed  Google Scholar 

  32. Waldum HL, Arnestad JS, Brenna E, et al. Marked increase in gastric acid secretory capacity after omeprazole treatment. Gut 1996; 39 (5): 649–53.

    Article  PubMed  CAS  Google Scholar 

  33. Sanduleanu S, Stridsberg M, Jonkers D, et al. Serum gastrin and chromogranin A during medium- and long-term acid suppressive therapy: a case-control study. Aliment Pharmacol Ther 1999; 13 (2): 145–53.

    Article  PubMed  CAS  Google Scholar 

  34. Farup PG, Juul-Hansen PH, Rydning A. Does short-term treatment with proton pump inhibitors cause rebound aggravation of symptoms? J Clin Gastroenterol 2001; 33 (3): 206–9.

    Article  PubMed  CAS  Google Scholar 

  35. Howden CW, Kahrilas PJ. Editorial: just how “difficult” is it to withdraw PPI treatment? Am J Gastroenterol 2010; 105 (7): 1538–40.

    Article  PubMed  Google Scholar 

  36. Ishihara M, Ito M. Influence of aging on gastric ulcer healing activities of cimetidine and omeprazole. Eur J Pharmacol 2002; 444 (3): 209–15.

    Article  PubMed  CAS  Google Scholar 

  37. Khalil T, Singh P, Fujimura M, et al. Effect of aging on gastric acid secretion, serum gastrin, and antral gastrin content in rats. Dig Dis Sci 1988; 33 (12): 1544–8.

    Article  PubMed  CAS  Google Scholar 

Download references

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.

Author information

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

Authors
  1. Hanifat Hamzat
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hao Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joanna C. Ford
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joan MacLeod
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Roy L. Soiza
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Arduino A. Mangoni
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Arduino A. Mangoni.

Rights and permissions

Reprints and permissions

About this article

Cite this article

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

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03262283

Keywords

Search

Navigation