Why are patients prescribed proton pump inhibitors? Retrospective analysis of link between morbidity and prescribing in the General Practice Research Database.
OBJECTIVE
To establish the relation between new prescriptions for proton pump inhibitors and recorded upper gastrointestinal morbidity within a large computerised general practitioner database.


METHODS
Retrospective survey of morbidity and prescribing data linked to new prescriptions for proton pump inhibitors and comparison with licensed indications between 1991 and 1995.


METHODS
General Practice Research Database and prescribing analysis and cost (PACT) data for the former West Midlands region.


METHODS
Information for 612 700 patients in the General Practice Research Database. Anonymous PACT data for all general practitioners in West Midlands region.


METHODS
Diagnostic codes linked to the first prescriptions issued for proton pump inhibitors; relation between new prescriptions and licensed indications; yearly change in ratio of new to repeat prescriptions and prescribing volumes measured as defined daily doses.


RESULTS
Oesophagitis was the commonest recorded indication in 1991, accounting for 31% of new prescriptions, but was third in 1995 (14%). During the study new prescriptions increased substantially, especially for duodenal disease (780%) and non-ulcer dyspepsia (690%). In 1995 non-specific morbidity accounted for 46% of new prescriptions. The total volume of prescribing rose 10-fold between 1991 and 1995, when repeat prescribing accounted for 77% of the total.


CONCLUSIONS
Changes in recorded morbidity associated with new prescriptions of proton pump inhibitors did not necessarily reflect changes in licensed indications. Although general practitioners seemed to respond to changes in licensing, particularly for duodenal and gastric disease, prescribing for unlicensed indications non-ulcer dyspepsia and non-specific abdominal pain increased.
Bashford
J N
JN
Department of Medicines Management, Keele University, Keele ST5 5BG.
Norwood
J
J
Chapman
S R
SR
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents / Q000009:adverse effects / Q000627:therapeutic use; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005194:Family Practice; D005767:Gastrointestinal Diseases / Q000188:drug therapy*; D006801:Humans; D064747:Lansoprazole; D009853:Omeprazole / Q000031:analogs & derivatives / Q000627:therapeutic use; D010818:Practice Patterns, Physicians'; D054328:Proton Pump Inhibitors; D006113:United Kingdom
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors; D064747:Lansoprazole; D009853:Omeprazole