Predictors of inappropriate utilization of intravenous proton pump inhibitors.
BACKGROUND
Inappropriate use of intravenous proton pump inhibitors is prevalent.


OBJECTIVE
To assess appropriateness of intravenous proton pump inhibitor prescribing.


METHODS
Retrospective review of in-patient prescribing of intravenous pantoprazole over a 2-month period in 2004, in an academic centre. Prescribing was deemed appropriate before and after endoscopic haemostasis, and in fasting individuals requiring a proton pump inhibitor.


RESULTS
Amongst 107 patients, 49 (46%) had upper gastrointestinal bleeding. Overall, 33 (31%, 95% CI: 22-41%) received appropriate therapy (indication, dose and duration), 61 (57%, 95% CI: 47-67%) had an inappropriate indication, and 13 (12%, 95% CI: 7-20%) had an incorrect treatment dose or duration. Therapy was appropriate in 20 (41%, 95% CI: 27-55%) with upper gastrointestinal bleeding, and 13 (22%, 95% CI: 12-33%) in the non-upper gastrointestinal bleeding group. Appropriate prescribing rates decreased (from 41% to 16%, 95% on difference CI: 14-38%) when considering intravenous proton pump inhibitor use while awaiting endoscopy as inappropriate. Significant predictors of inappropriate use were increasing age and decreasing mean daily dose, with a trend for prescriptions written during evening shifts.


CONCLUSIONS
Inappropriate intravenous proton pump inhibitor utilization was most frequent in the non-upper gastrointestinal bleeding group, mostly for unrecognized indications. Educational interventions to optimize utilization should target prescribing in older patients, those receiving lower mean daily doses, and, perhaps, prescribing outside regular hours.
Afif
W
W
Division of Gastroenterology, McGill University, Montréal, Québec, Canada.
Alsulaiman
R
R
Martel
M
M
Barkun
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AN
D000368:Aged; D004363:Drug Utilization; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000592:standards; D054328:Proton Pump Inhibitors; D017494:Proton Pumps / Q000008:administration & dosage*; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies
D054328:Proton Pump Inhibitors; D017494:Proton Pumps