Concordance between use of proton pump inhibitors and prescribing guidelines.
OBJECTIVE
To determine (i) the relationship between prescriptions for proton pump inhibitors (PPIs) and upper gastrointestinal conditions, and (ii) compliance with Pharmaceutical Benefits Scheme (PBS) prescribing guidelines for PPIs.


METHODS
Drug utilisation evaluation.


METHODS
800-bed metropolitan teaching hospital.


METHODS
253 patients dispensed PPIs from the hospital pharmacy over five consecutive weeks (11 January to 15 February 1999).


METHODS
Recorded gastrointestinal conditions; previous trial of H2-antagonist therapy; compliance with PBS criteria for prescribing PPIs.


RESULTS
Seventy patients (27.7%) had no appropriate upper gastrointestinal tract investigations, and 62 patients (24%) did not receive an adequate trial of H2-antagonist therapy before the commencement of a PPI. The major indications for use of PPIs in investigated patients were gastro-oesophageal reflux in 99 (54%) and peptic ulcer disease in 30 (16.4%). In only 57 patients (22.5%) did PPI prescriptions comply with PBS prescribing guidelines. Clinical indications that failed to meet prescribing criteria included milder forms of gastro-oesophageal reflux, gastritis/duodenitis, and non-specific dyspepsia with normal endoscopy results.


CONCLUSIONS
Drug utilisation data indicate widespread use of PPIs outside current prescribing guidelines. Many patients have not had relevant investigations and/or an adequate trial of H2-antagonist therapy. These findings explain the considerable hospital expenditure on PPIs.
Pillans
P I
PI
Department of Clinical Pharmacology, Princess Alexandra Hospital, Brisbane, QLD. pillansp@health.qld.gov.au
Kubler
P A
PA
Radford
J M
JM
Overland
V
V
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D017723:Drug Utilization Review / Q000592:standards*; D004791:Enzyme Inhibitors / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006746:Hospital Bed Capacity, 500 and over; D006784:Hospitals, Teaching; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009853:Omeprazole / Q000191:economics / Q000627:therapeutic use*; D010437:Peptic Ulcer / Q000188:drug therapy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D054328:Proton Pump Inhibitors; D011793:Queensland; D012189:Retrospective Studies
D004791:Enzyme Inhibitors; D054328:Proton Pump Inhibitors; D009853:Omeprazole