title: Inappropriate prescribing of proton pump inhibitors in older patients: effects of an educational strategy.
abstract: BACKGROUND
  An increasing number of older patients are prescribed proton pump inhibitors (PPIs). However, the extent of inappropriate PPI prescribing in this group is largely unknown.
  
  
  OBJECTIVE
  We sought to identify clinical and demographic factors associated with inappropriate PPI prescribing in older patients and to assess the effects of a targeted educational strategy in a controlled hospital environment.
  
  
  METHODS
  Clinical and demographic characteristics and full medication exposure on admission were recorded in 440 consecutive older patients (mean ± SD age 84 ± 7 years) admitted to a teaching hospital between 1 February 2011 and 30 June 2011. A 4-week educational strategy to reduce inappropriate PPI prescribing during hospital stay, either by stopping or reducing PPI doses, was conducted within the study period. The main outcome measures of the study were the incidence of inappropriate PPI prescribing and the effects of interventions to reduce it.
  
  
  RESULTS
  On admission, PPIs were established therapy in 164 patients (37%). This was considered inappropriate in 100 patients (61%). Lower Charlson Comorbidity Index score (odds ratio [OR] 0.76; 95% CI 0.57, 0.94; p = 0.006) and history of dementia (OR 1.65; 95% CI 1.28, 1.83; p = 0.005) were independently associated with inappropriate PPI prescribing. Interventions to reduce inappropriate PPI prescribing occurred more frequently during and after the education phase (frequency of interventions in patients with inappropriate PPI prescribing: pre-education phase 9%, during education phase 43%, and post-education phase 46%, p = 0.006). Prescribing interventions were not associated with acid rebound symptoms.
  
  
  CONCLUSIONS
  Inappropriate PPI prescribing in older patients is frequent and independently associated with co-morbidities and dementia. A targeted in-hospital educational strategy can significantly and safely reduce inappropriate PPI prescribing in the short term.
authors: Division of Applied Medicine, University of Aberdeen, Aberdeen, UK.
authors: Hanifat
authors: H
authors: Hamzat
authors: Hao
authors: H
authors: Sun
authors: Joanna C
authors: JC
authors: Ford
authors: Joan
authors: J
authors: Macleod
authors: Roy L
authors: RL
authors: Soiza
authors: Arduino A
authors: AA
authors: Mangoni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control* / Q000706:statistics & numerical data*; D008297:Male; D010353:Patient Education as Topic / Q000379:methods*; D011320:Primary Health Care / Q000706:statistics & numerical data; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies
chemical_list: D054328:Proton Pump Inhibitors