title: Prevalence and appropriateness of drug prescriptions for peptic ulcer and gastro-esophageal reflux disease in a cohort of hospitalized elderly.
abstract: BACKGROUND
  Proton pump inhibitors (PPI) are among the most commonly prescribed medicines and their overuse is widespread in both primary and secondary care. Inappropriate prescription is of particular concern among elderly patients, who have often multiple comorbidities and need many drugs.
  
  
  METHODS
  We evaluate the appropriateness of drugs for peptic ulcer or gastro-esophageal reflux disease (GERD) in a sample of elderly patients (65 years old or older) at admission and discharge in 38 internal medicine wards between January 2008 and December 2008, according to the presence of specific conditions or gastro-toxic drug combinations.
  
  
  RESULTS
  Among 1155 patients eligible for the analysis, 466 (40.3%) were treated with drugs for GERD or peptic ulcer were at hospital admission and 647 (56.0%) at discharge; 62.4% of patients receiving a drug for peptic ulcer or GERD at admission and 63.2% at discharge were inappropriately treated. Among these, the number of other drugs prescribed was associated with greater use of drugs for peptic ulcer or GERD, even after adjustment for age, sex and number of diagnoses at admission (OR 95% CI=1.26 (1.18-1.34), p=.0001) or discharge (OR 95% CI=1.11 (1.05-1.18), p=0.0003).
  
  
  CONCLUSIONS
  Prevalence of inappropriate prescription of drugs for peptic ulcer or GERD remained almost the same at admission and discharge. Inappropriate use of these drugs is related to the concomitant use of other drugs. Careful assessment of clinical conditions and stricter adherence to evidence-based guidelines are essential for a rational and cost-effective use of drugs for peptic ulcer or GERD.
authors.affiliation: Mario Negri Institute for Pharmacological Research, Milan, Italy. luca.pasina@marionegri.it
authors.forename: L
authors.initials: L
authors.lastname: Pasina
authors.forename: A
authors.initials: A
authors.lastname: Nobili
authors.forename: M
authors.initials: M
authors.lastname: Tettamanti
authors.forename: F
authors.initials: F
authors.lastname: Salerno
authors.forename: S
authors.initials: S
authors.lastname: Corrao
authors.forename: A
authors.initials: A
authors.lastname: Marengoni
authors.forename: A
authors.initials: A
authors.lastname: Iorio
authors.forename: M
authors.initials: M
authors.lastname: Marcucci
authors.forename: P M
authors.initials: PM
authors.lastname: Mannucci
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004359:Drug Therapy, Combination / Q000009:adverse effects; D019317:Evidence-Based Medicine; D005260:Female; D005764:Gastroesophageal Reflux / Q000628:therapy*; D019983:Guideline Adherence; D006760:Hospitalization; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008297:Male; D010437:Peptic Ulcer / Q000188:drug therapy*; D015995:Prevalence