title: Proton pump inhibitor prescribing and costs in a large outpatient clinic.
abstract: Concerns have been raised regarding potential adverse effects and high costs of proton pump inhibitors (PPIs). Our objective was to assess issues of PPI utilization and expense in a large outpatient clinic population.
  
  
  METHODS
  Two hundred-fifty-nine outpatient records were reviewed regarding PPI prescribing and indications during 2009. A cost analysis was performed to project cost differences if histamine-2 receptor antagonists (H2RAs) were used as an alternative to PPIs in appropriate clinical situations.
  
  
  RESULTS
  Eighty-three (32.0%) were taking PPIs. Problem-listed gastroesophageal reflux disease (GERD) was the primary diagnosis in 69 (83.1%) of patients on PPIs. GERD was not apparent by documented history and/or endoscopy in 46.3% of problem-listed GERD patients. Symptom severity had been documented in only 36.2%. Cost analysis projected substantial savings if H2RAs had been used initially for mild to moderate symptoms.
  
  
  CONCLUSIONS
  Outpatient PPI prescribing indications are not well documented and PPI use is probably excessive. H2RA therapy is likely underutilized.
authors.forename: William
authors.initials: W
authors.lastname: Hood
authors.forename: Brittain
authors.initials: B
authors.lastname: McJunkin
authors.forename: Alicia
authors.initials: A
authors.lastname: Warnock
authors.forename: Aditi
authors.initials: A
authors.lastname: Girme
authors.forename: Nelson
authors.initials: N
authors.lastname: Smith
authors.forename: Brandon
authors.initials: B
authors.lastname: Robinson
mesh_terms: D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D011307:Drug Prescriptions / Q000191:economics* / Q000706:statistics & numerical data; D005764:Gastroesophageal Reflux / Q000188:drug therapy; D006635:Histamine H2 Antagonists / Q000008:administration & dosage / Q000191:economics; D006801:Humans; D054328:Proton Pump Inhibitors / Q000008:administration & dosage* / Q000191:economics*; D012189:Retrospective Studies
chemical_list: D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors