Factors associated with inappropriate inpatient prescribing of acid-suppressive therapy.
OBJECTIVE
Acid-suppressive therapy is used for 54-70% of inpatients, and is frequently prescribed for inappropriate indications. The objective of this study was to identify characteristics associated with inappropriate prescribing of acid-suppressive therapy.


METHODS
A random sample of adult internal medicine inpatients admitted between 1 July 2005 and 30 June 2006 was screened for acid-suppressive therapy. Patients receiving such therapy without an accepted indication and those not prescribed acid-suppressive therapy were included in group 1 and group 2, respectively. Significant characteristics from separate univariate regression models were entered into a multivariate logistic regression to determine characteristics associated with inappropriate use. The setting was internal medicine units at a tertiary care academic medical centre.


RESULTS
There were 108 patients in group 1 and 134 patients in group 2. Group 1 patients were older, had a longer median length of stay, a greater number of comorbidities, a greater median number of medications upon admission, and a higher rate of cirrhosis. Factors associated with use of acid-suppressive therapy without an accepted indication were use of a proton-pump inhibitor (odds ratio, 15.3; 95% confidence interval, 4.1-56.3) or histamine2 receptor antagonist (14.5; 2.8-74.8) prior to admission, cirrhosis (6.4; 1.02-39.5), use of inpatient anticoagulants (2.7; 1.4-5.2) and length of stay (1.1; 1.1-1.3).


CONCLUSIONS
The strongest factors associated with use of acid-suppressive therapy without an accepted indication were use of a proton-pump inhibitor or histamine2 receptor antagonist prior to admission, a diagnosis of cirrhosis and use of inpatient anticoagulants.
Palkovic
Lindsay B
LB
Department of Pharmacy Practice and Pharmacy Administration, University of the Sciences in Philadelphia-Philadelphia College of Pharmacy, Philadelphia, Pennsylvania 19104, USA. l.palkovic@usp.edu
Coley
Kim C
KC
Sokos
Denise R
DR
D000046:Academic Medical Centers; D000367:Age Factors; D000863:Antacids / Q000627:therapeutic use*; D000925:Anticoagulants / Q000627:therapeutic use; D005355:Fibrosis / Q000150:complications; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D007388:Internal Medicine; D007902:Length of Stay; D016015:Logistic Models; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000592:standards*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies
D000863:Antacids; D000925:Anticoagulants; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors