Co-prescription of gastro-protectants in hospitalized patients: an analysis of what we do and what we think we do.
BACKGROUND
Proton pump inhibitors (PPIs) reduce the risk of upper gastrointestinal hemorrhage (UGIH) associated with the use of many medications.


OBJECTIVE
To examine how clinicians perceive such risk and whether PPI co-prescribing is based on an accurate assessment.


METHODS
Clinicians in a single teaching hospital were asked to estimate risk of UGIH and comment on PPI co-prescription in hypothetical patients. Records of 160 hospital in-patients (median age; 74 y) were then reviewed to examine PPI prescribing and risk factors for UGIH.


RESULTS
In general, clinicians estimated UGIH risk accurately and reported low thresholds for PPI co-prescription. Prescribing records showed regular PPI use increased between admission and discharge of patients from 61/160 (38%) to 93/160 (58%). Ten percent had a prior history of peptic ulcer disease. Proton pump inhibitor prescription was significantly associated with the use of aspirin and clopidogrel. Half of the patients with multiple risk factors for UGIH on admission and almost a third at discharge were not co-prescribed a PPI.


CONCLUSIONS
Clinicians generally estimate correctly the risk of UGIH and report a low threshold for prescribing gastro-protection. Despite this, prescribing practice does not consistently take account of relative risk of UGIH. Targeted PPI co-prescribing on the basis of risk factors would lead to more rational PPI use.
Doherty
Glen A
GA
Division of Gastroenterology and Hepatology, Beaumont Hospital, Royal College of Surgeons, Beaumont, Dublin, Ireland
Cannon
Mary D
MD
Lynch
Karen M
KM
Ayoubi
Karim Z
KZ
Harewood
Gavin C
GC
Patchett
Stephen E
SE
Murray
Frank E
FE
D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D000077144:Clopidogrel; D003625:Data Collection; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000150:complications / Q000188:drug therapy; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D010818:Practice Patterns, Physicians' / Q000592:standards*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012307:Risk Factors; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use
D010975:Platelet Aggregation Inhibitors; D054328:Proton Pump Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin