title: Inappropriate prescription of proton pump inhibitors on two pulmonary medicine wards.
abstract: OBJECTIVE
  We recently noticed that proton pump inhibitor (PPI) use was high on a pulmonary medicine ward of a university clinic and reasons for this high usage were not clear. Our aim was to determine the indications for PPI use on two pulmonary medicine wards and to assess whether this use was appropriate.
  
  
  METHODS
  We assessed prospectively the number of patients on PPIs and the indications for PPI use on two pulmonary medicine wards, one from a university and one from a regional clinic in The Netherlands.
  
  
  RESULTS
  On admission, 88 of 300 (29%) patients already used PPIs. The use of PPIs was discontinued in three (1%) patients, whereas PPIs were initiated in 45 (15%) patients, resulting in 130 (43%) patients on PPIs during hospitalization. The most common indication for PPI use was the prevention of medication-associated complications. In 78 of 130 (60%) patients on PPIs, this medication was used for a registered indication, whereas in 52 (40%) patients a registered indication was not present (overuse). In contrast, 19 of 300 (6%) patients were not prescribed PPIs despite the presence of a registered indication for its use (underuse). No differences were found in prescription rate and indications for PPI use between the university and the regional clinic.
  
  
  CONCLUSIONS
  PPI use was very common on two pulmonary medicine wards in the Netherlands. Forty percent of the patients used their PPIs for a nonregistered indication. As use of PPIs is costly and may be associated with side effects, hospital physicians should to be better educated on guidelines for its use.
authors.affiliation: Department of aGastroenterology and Hepatology, Erasmus MC-University Medical Center Rotterdam, The Netherlands. evelynvanvliet@hotmail.com
authors.forename: Evelyn P M
authors.initials: EP
authors.lastname: van Vliet
authors.forename: Henk J A M
authors.initials: HJ
authors.lastname: Otten
authors.forename: Arjan
authors.initials: A
authors.lastname: Rudolphus
authors.forename: Pieter D
authors.initials: PD
authors.lastname: Knoester
authors.forename: Henk C
authors.initials: HC
authors.lastname: Hoogsteden
authors.forename: Ernst J
authors.initials: EJ
authors.lastname: Kuipers
authors.forename: Peter D
authors.initials: PD
authors.lastname: Siersema
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D011307:Drug Prescriptions / Q000592:standards; D004363:Drug Utilization / Q000706:statistics & numerical data; D017723:Drug Utilization Review; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D015272:Pulmonary Medicine / Q000592:standards*
chemical_list: D054328:Proton Pump Inhibitors