title: The Inappropriate Prescription of Oral Proton Pump Inhibitors in the Hospital Setting: A Prospective Cross-Sectional Study.
abstract: Proton pump inhibitors (PPIs) are used to treat upper gastrointestinal tract disorders. Their efficacy and perceived safety have led to widespread prescription. This is not without effect, in terms of adverse events and resource utilization.
  
  
  OBJECTIVE
  To prospectively assess oral PPI prescription in hospitalized patients.
  
  
  METHODS
  PPI prescription in consecutive hospitalized patients was assessed. Indication and dose were assessed by patient interview and medical record review. Comparisons with current published prescribing guidelines were made.
  
  
  RESULTS
  Four hundred and forty-seven patients were included. 57.5 % were prescribed PPIs. 26.8 % prescriptions were for inappropriate or unclear indications. 68.4 % were on higher doses than guidelines recommended, of which 41.6 % could have undergone dose reduction, and 26.5 % discontinued. In a multivariate analysis, age, gender, and length of stay had no association with PPI prescription. Although aspirin use was appropriately associated with PPI prescription (RR: 1.8, 95 % CI 1.127-3.69; p < 0.05), the PPI was often given at higher than recommended doses (p < 0.001). This may reflect older age and multiple risk factors in this subset. Surgical patients commenced more PPIs and at higher dosages (p < 0.001). Omeprazole and lansoprazole were most often inappropriately prescribed (p < 0.01, p < 0.001, respectively).
  
  
  CONCLUSIONS
  Inappropriate PPI therapy is still a problem in hospitals, though it appears to be at a lower level compared with previous studies. Awareness of evidence-based guidelines and targeted medicine reconciliation strategies are essential for cost-effective and safe use of these medications.
authors.affiliation: Department of Gastroenterology, Beaumont Hospital, Dublin 9, Ireland, orlaithbkelly@gmail.com.
authors.forename: Orlaith B
authors.initials: OB
authors.lastname: Kelly
authors.forename: Catherine
authors.initials: C
authors.lastname: Dillane
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Patchett
authors.forename: Gavin C
authors.initials: GC
authors.lastname: Harewood
authors.forename: Frank E
authors.initials: FE
authors.lastname: Murray
mesh_terms: D000284:Administration, Oral; D000368:Aged; D003430:Cross-Sectional Studies; D004415:Dyspepsia / Q000188:drug therapy / Q000209:etiology; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D054328:Proton Pump Inhibitors
references.citation: J Eval Clin Pract. 2009 Apr;15(2):299-306
references.pmid: 19335488
references.citation: Am J Gastroenterol. 2000 Feb;95(2):395-407
references.pmid: 10685741
references.citation: Int J Clin Pract. 2005 Jan;59(1):31-4
references.pmid: 15707461
references.citation: Ir J Med Sci. 2010 Mar;179(1):73-5
references.pmid: 19763673
references.citation: QJM. 2008 Jun;101(6):445-8
references.pmid: 18411220
references.citation: Ir Med J. 2005 Mar;98(3):78-80
references.pmid: 15869064
references.citation: Am J Gastroenterol. 2007 May;102(5):942-50
references.pmid: 17313495
references.citation: BMJ. 2008 Jan 5;336(7634):2-3
references.pmid: 18174564
references.citation: Am J Gastroenterol. 2008 Sep;103(9):2308-13
references.pmid: 18702653
references.citation: J Cardiovasc Pharmacol. 2010 Nov;56(5):532-9
references.pmid: 20729752
references.citation: JAMA. 2004 Oct 27;292(16):1955-60
references.pmid: 15507580
references.citation: Clin Gastroenterol Hepatol. 2006 Sep;4(9):1082-9
references.pmid: 16877048
references.citation: Fam Pract. 2007 Oct;24(5):403-11
references.pmid: 17728288
references.citation: J Manag Care Pharm. 2010 Mar;16(2):122-9
references.pmid: 20178397
references.citation: Eur J Gastroenterol Hepatol. 2008 Jul;20(7):608-12
references.pmid: 18679061