The influence of hospital drug formulary policies on the prescribing patterns of proton pump inhibitors in primary care.
OBJECTIVE
This study had two aims: Firstly, to describe how prescriptions for proton pump inhibitor (PPI) in primary care were influenced by a change of the hospital drug policy, and secondly, to describe if a large discount on an expensive PPI (esomeprazole) to a hospital would influence prescribing patterns after discharge.


METHODS
This register study was conducted at Odense University Hospital, Denmark, and by use of pharmacy dispensing data and a hospital-based pharmacoepidemiological database, the medication regimens of patients were followed across hospitalisation. The influence of hospital drug policy on prescribings in primary care was measured by the likelihood of having a high-cost PPI prescribed before and after change of drug policy.


RESULTS
In total, 9,341 hospital stays in 2009 and 2010 were included. The probability of a patient to be prescribed an expensive PPI after discharge decreased from 33.5 to 9.4%, corresponding to a risk ratio of 0.28. In primary care after discharge, 13.4% of esomeprazole use was initiated in the hospital, and this was 8.4% for PPIs in general. After the change of hospital drug policy, this decreased to 6.5% for esomeprazole and increased for the recommended PPIs pantoprazole and lansoprazole to 14.6 and 26.1%, respectively. The effect of a large discount on expensive PPI to hospital was 14.7%, and this decreased to 2.6% when coordinating drug policy in hospital and primary care.


CONCLUSIONS
The likelihood of having an expensive PPI prescribed after hospital stay decreased when coordinating drug policy and the influence of a large discount to hospital could be minimised.
Faculty of Health Sciences, Institute of Public Health, Clinical Pharmacology, University of Southern Denmark, J. B. Winsløwsvej 19, 2. sal, Odense M, 5000, Denmark, michael.due.larsen@rsyd.dk.
Michael Due
MD
Larsen
Mette
M
Schou
Anja Sparre
AS
Kristiansen
Jesper
J
Hallas
D000368:Aged; D000369:Aged, 80 and over; D017046:Cost Savings; D003718:Denmark; D016527:Drug Costs; D011307:Drug Prescriptions; D017723:Drug Utilization Review; D005260:Female; D005572:Formularies, Hospital as Topic; D017721:Hospital Costs; D006785:Hospitals, University / Q000191:economics / Q000458:organization & administration / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011050:Policy Making; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000639:trends*; D011320:Primary Health Care / Q000191:economics / Q000639:trends*; D054328:Proton Pump Inhibitors / Q000191:economics / Q000627:therapeutic use*; D012042:Registries
D054328:Proton Pump Inhibitors