Therapeutic intent of proton pump inhibitor prescription among elderly nonsteroidal anti-inflammatory drug users.
BACKGROUND
Prescription of proton pump inhibitors (PPIs) has increased dramatically.


OBJECTIVE
To assess therapeutic intent of PPI prescription among elderly veterans prescribed nonsteroidal anti-inflammatory drugs.


METHODS
Medical-record abstraction identified therapeutic intent of PPI prescription. An 'appropriate therapeutic intent' was defined as symptomatic gastro-oesophageal reflux disease or endoscopic oesophagitis, Zollinger-Ellison disease, dyspepsia, upper gastrointestinal event, Helicobacter pylori infection or nonsteroidal anti-inflammatory drug gastroprotection. Logistic regression predicted the outcome while adjusting for clinical characteristics.


RESULTS
Of 1491 patients [mean 73 years (s.d. 5.6), 73% white and 99.8% men], among those charts which did document a therapeutic indication, 88.8% were appropriate. Prior gastroscopy was predictive of an appropriate therapeutic intent (OR 2.7; 95% CI: 1.9-3.7). Prescription to patients who used VA pharmacy services only, to in-patients, or by a cardiologist or an otolaryngologist were less likely to be appropriate. Gastroprotection was poorly recognized as an indication for PPI prescription, except by rheumatologists (OR 46.7; 95% CI: 15.9-136.9), or among highly co-morbid patients (OR 1.8; 95% CI: 1.1-2.9). Among in-patients, 45% of PPI prescriptions were initiated for unknown or inappropriate reasons.


CONCLUSIONS
Type of provider predicts appropriate PPI use. In-patient prescription is associated with poor recognition of necessary gastroprotection and unknown therapeutic intent.
Dries
A M
AM
Division of Gastroenterology, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA.
Richardson
P
P
Cavazos
J
J
Abraham
N S
NS
D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D004363:Drug Utilization; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy*; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians' / Q000592:standards*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D054328:Proton Pump Inhibitors