title: Four-year trends of inappropriate proton pump inhibitor use after hospital discharge.
abstract: BACKGROUND
  Several hospital-based studies have determined that physicians often inappropriately prescribe acid-suppressive medications for stress ulcer prevention in hospitalized patients and continue these drugs after discharge. We sought to determine the frequency of inappropriate proton pump inhibitor (PPI) use continued at discharge within our geographic region.
  
  
  METHODS
  We undertook a retrospective review of the medical records and pharmacy prescription database of a large regional insurance carrier from January 2005 through December 2008 (total hospital admissions 96,669). The primary inclusion criterion was hospital-initiated PPI therapy and continuation on hospital discharge without an appropriate indication. Patients receiving a PPI at the time of admission were excluded from the analysis.
  
  
  RESULTS
  The number of patients per year discharged on a PPI decreased during the study period: 876 (2005), 763 (2006), 562 (2007), and 485 (2008). Of the patients discharged on a PPI, the number (%) of patients receiving PPIs inappropriately were 695 (79%; 2005); 627 (82%; 2006), 441 (78%; 2007), and 397 (82%; 2008). The annual number of PPI prescriptions and PPI doses dispensed decreased from 2015 to 1263 and from 60,608 to 38,742, respectively, during the study period. The estimated 4-year cost of inappropriate PPI use was $595,809, although cost savings from the absolute reduction in inappropriate PPI use over time was $65,598.
  
  
  CONCLUSIONS
  We report a significant decrease of 39% in the number of inappropriate discharge prescriptions for PPIs during the study period; however, the percentage of inappropriate use of PPIs remains high. There is room for improvement in cost-effective use of PPIs.
authors.affiliation: Department of Clinical Pharmacy and the Section of Cardiology, Moses Taylor Hospital, Scranton, PA, USA. leri333@msn.com
authors.forename: Frederick
authors.initials: F
authors.lastname: Leri
authors.forename: Mark
authors.initials: M
authors.lastname: Ayzenberg
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Voyce
authors.forename: Adam
authors.initials: A
authors.lastname: Klein
authors.forename: Leo
authors.initials: L
authors.lastname: Hartz
authors.forename: Raymond A
authors.initials: RA
authors.lastname: Smego
mesh_terms: D016009:Chi-Square Distribution; D016527:Drug Costs; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008297:Male; D010351:Patient Discharge; D010437:Peptic Ulcer / Q000517:prevention & control*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D054328:Proton Pump Inhibitors / Q000008:administration & dosage* / Q000191:economics; D012189:Retrospective Studies; D014481:United States
chemical_list: D054328:Proton Pump Inhibitors