title: Appropriateness of treatment recommendations for PPI in hospital discharge letters.
abstract: OBJECTIVE
  The reasons for the dramatic increase in proton pump inhibitors (PPI) prescriptions remain unclear and cannot be explained solely by increased morbidity, new indications or a decrease in alternative medication. Inappropriate use and discharge recommendations in hospitals are considered to be possible explanations. As the quality of PPI recommendations in hospital discharge letters in Germany has not been investigated to date, we have studied the appropriateness of these referrals.
  
  
  METHODS
  Hospital discharge letters with recommendations for PPI medication from 35 primary care practices in the county of Mecklenburg-Western Pomerania (MV; North-east Germany) were collected and analysed, and the appropriateness of the PPI indication was rated.
  
  
  RESULTS
  No information justifying the recommendation for continuous PPI medication could be identified in 54.5% of the discharge letters; in 12.7%, the indication was uncertain, and in 32.7%, we found an evidence-based indication for PPI medication. The most common indication for adequate PPI use was nonsteroidal anti-inflammatory drug-prophylaxis in high-risk patients.
  
  
  CONCLUSIONS
  Inadequate recommendations for PPIs in discharge letters are frequent. This may lead to a continuation of this therapy in primary care, thereby unnecessarily increasing polypharmacy and the risk of adverse events as well as burdening the public health budget. Hospitals should therefore critically review recommendations for PPI medication and the dosage thereof in their discharge letters and clearly document the reason for PPI use and the need for continuous prescription in primary care.
authors.affiliation: Department of General Practice, University of Göttingen, Humboldtallee 38, Göttingen, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Ahrens
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Chenot
authors.forename: Gesa
authors.initials: G
authors.lastname: Behrens
authors.forename: Thomas
authors.initials: T
authors.lastname: Grimmsmann
authors.forename: Michael M
authors.initials: MM
authors.lastname: Kochen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D017410:Practice Guidelines as Topic; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*
chemical_list: D054328:Proton Pump Inhibitors