Rising rates of proton pump inhibitor prescribing in US emergency departments.
OBJECTIVE
There have been mounting safety concerns over increasing prescription rates for proton pump inhibitors (PPIs). Trends in PPI use have not been studied in emergency departments (EDs). We characterize trends in PPI use in US EDs.


METHODS
We used data from the National Hospital Ambulatory Care Survey, from 2001 to 2010, focusing on encounters with a reason for visit with a potential indication for a PPI, histamine receptor (H2) blocker, or antacid. Patient, provider, visit, and hospital-level factors associated with increases in PPI use were evaluated.


RESULTS
Among included visits, ED PPI prescribing more than doubled from 3.0 (95% confidence interval [CI]: 2.4-3.8) to 7.2% (95% CI: 6.3-8.3) from 2001 to 2010. Histamine receptor blocker use decreased from 6.8% (95% CI: 6.0-7.7) to 5.7% (95% CI: 4.9-6.7) and antacids from 7.2% (95% CI: 6.3-8.2) to 5.5% (95% CI: 4.8-6.3). Proton pump inhibitor prescribing was higher in males and whites yet increased across all demographics, including in adults aged 65 years and older. Proton pump inhibitor prescribing increased significantly in all US regions and across all hospital and payer types. Pantoprazole was the agent with the largest increase in use.


CONCLUSIONS
Over the past decade, there have been considerable increases in PPI prescribing in US EDs. This trend occurred despite rising safety concerns, even in populations at higher risk for adverse events such as older adults. More education may be needed to ensure that ED providers are familiar with indications for PPIs.
Department of Emergency Medicine, The George Washington University, Washington, DC, USA; Department of Clinical Pharmacology, Children's National Medical Center, Washington, DC, USA. Electronic address: maryannmazer@gmail.com.
Maryann
M
Mazer-Amirshahi
The George Washington University, School of Medicine and Health Sciences, Washington, DC, USA.
Peter M
PM
Mullins
Department of Clinical Pharmacology, Children's National Medical Center, Washington, DC, USA; Department of Pediatrics, The George Washington University, Washington, DC, USA; Intensive Care, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Paediatric Pharmacology, University Children's Hospital, Basel, Switzerland.
John
J
van den Anker
Department of Emergency Medicine, The George Washington University, Washington, DC, USA.
Andrew
A
Meltzer
Department of Emergency Medicine, The George Washington University, Washington, DC, USA.
Jesse M
JM
Pines
D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D000077402:Pantoprazole; D010351:Patient Discharge / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D054328:Proton Pump Inhibitors; D000077402:Pantoprazole