title: Proton pump inhibitor prescriptions and subsequent use in US veterans diagnosed with gastroesophageal reflux disease.
abstract: BACKGROUND
  Empiric proton pump inhibitor use is common for gastroesophageal reflux disease (GERD), but initial proton pump inhibitor (PPI) prescription patterns in Veterans are unknown.
  
  
  OBJECTIVE
  The study aims were to determine initial PPI prescriptions in Veterans diagnosed with GERD, and to characterize subsequent PPI use over the 2 years following initial prescription.
  
  
  METHODS
  We conducted a retrospective study using Veteran's Administration (VA) administrative data and chart review.
  
  
  METHODS
  Patients diagnosed with GERD and provided an initial PPI prescription at Hines VA Hospital from 2003 to 2007, with 2 year follow-up for each patient (through 2009). MEASURES AND OUTCOMES: Initial PPI prescriptions were categorized as standard total daily dose or high total daily dose, and accuracy was confirmed by manual chart review. Descriptive statistics were calculated and bivariate analyses were used to assess for differences in demographics, prescriptions, and subsequent use by initial PPI dosage category.
  
  
  RESULTS
  Of the 1,621 patients included in the study, 378 (23.3 %) had high total daily dose initial PPI prescriptions and 1,243 (76.7 %) patients had standard total daily dose initial prescriptions. The majority of patients (65.8 %) received a 90-day or greater initial prescription. Over the 2 years following the initial PPI prescription, 13.0 % of patients with initial standard daily dose prescriptions had evidence of step-up therapy. Only 7.1 % of patients with initial high daily dose PPI prescriptions had evidence of step-down therapy. A large majority of patients (83.8 %) had at least one refill over 2 years, and the overall medication possession ratio was 0.86.
  
  
  CONCLUSIONS
  Many Veterans receive high total daily dose PPI prescriptions as initial therapy for a GERD diagnosis, and few patients have evidence for cessation or reduction of therapy. These results provide detailed data on prescribing and use of PPIs to help guide efforts for optimal PPI use in US Veterans.
authors: Division of Gastroenterology & Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60613, USA. agawron@fsm.northwestern.edu
authors: Andrew J
authors: AJ
authors: Gawron
authors: John E
authors: JE
authors: Pandolfino
authors: Scott
authors: S
authors: Miskevics
authors: Sherri L
authors: SL
authors: Lavela
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D011307:Drug Prescriptions; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014728:Veterans; D055815:Young Adult
chemical_list: D054328:Proton Pump Inhibitors
references: Am J Gastroenterol. 2006 Oct;101(10):2200-5
references: 16952283
references: Eur J Clin Pharmacol. 2012 Oct;68(10):1425-33
references: 22447297
references: Am J Gastroenterol. 2009 Sep;104(9):2161-7
references: 19568229
references: Gastroenterology. 2005 Oct;129(4):1171-8
references: 16230071
references: Arch Intern Med. 2010 May 10;170(9):765-71
references: 20458083
references: JAMA. 2006 Dec 27;296(24):2947-53
references: 17190895
references: Am J Manag Care. 2010 Sep;16(9):e228-34
references: 21250399
references: N Engl J Med. 2008 Oct 16;359(16):1700-7
references: 18923172
references: Aliment Pharmacol Ther. 2008 Jun;27(12):1293-9
references: 18363892
references: Pharmacoepidemiol Drug Saf. 2010 Oct;19(10):1019-24
references: 20623646
references: Aliment Pharmacol Ther. 2006 Jul 15;24(2):377-85
references: 16842465
references: Arch Intern Med. 2010 May 10;170(9):772-8
references: 20458084
references: Neurogastroenterol Motil. 2012 Aug;24(8):747-57, e350
references: 22309489
references: Am J Geriatr Pharmacother. 2008 Dec;6(5):249-54
references: 19161927
references: Intern Med J. 2012 May;42(5):e68-73
references: 20492006
references: Gastroenterology. 2008 Oct;135(4):1383-1391, 1391.e1-5
references: 18789939
references: J Chronic Dis. 1987;40(5):373-83
references: 3558716
references: J Neurogastroenterol Motil. 2011 Oct;17(4):387-94
references: 22148108
references: Gastroenterology. 2009 Feb;136(2):376-86
references: 19124023
references: J Clin Pharm Ther. 2000 Oct;25(5):333-40
references: 11123484
references: Clin Gastroenterol Hepatol. 2012 Feb;10(2):109-16
references: 21782770
references: Am J Gastroenterol. 2003 Sep;98(9):1940-4
references: 14499769
references: Value Health. 2009 Jan-Feb;12(1):34-9
references: 19895371
references: Am J Gastroenterol. 2008 Feb;103(2):323-32
references: 18289200
references: Am J Gastroenterol. 2006 Aug;101(8):1727-33
references: 16817844
references: Am J Gastroenterol. 2009 Mar;104 Suppl 2:S27-32
references: 19262544
references: Best Pract Res Clin Gastroenterol. 2010 Dec;24(6):923-36
references: 21126704
references: Arch Intern Med. 2010 May 10;170(9):784-90
references: 20458086
references: Clin Ther. 2001 Jul;23(7):998-1017
references: 11519776
references: Gastrointest Endosc. 2009 Apr;69(4):917-30, 930.e1
references: 19249037
references: Med Care. 2011 Jan;49(1):24-36
references: 20966784
references: Nat Rev Cardiol. 2011 Jan;8(1):7-8
references: 21170003
references: Med J Aust. 2000 Jan 3;172(1):16-8
references: 10682010
references: Gastroenterology. 2008 Oct;135(4):1392-1413, 1413.e1-5
references: 18801365
references: Am J Gastroenterol. 2011 Jul;106(7):1209-18; quiz 1219
references: 21483462