title: Reasons for initiation of proton pump inhibitor therapy for hospitalised patients and its impact on outpatient prescription in primary care.
abstract: BACKGROUND
  Proton-pump-inhibitors are often prescribed unnecessarily in hospitals, which in turn induces their prescriptions after discharge.
  
  
  OBJECTIVE
  To evaluate patients starting treatment with proton-pump-inhibitors during hospitalisation and proportion of inappropriate prescriptions. Patient risk factors and whether initiation in hospital induced their continuation in ambulatory care were also analyzed.
  
  
  METHODS
  An observational, cross-sectional study in a tertiary hospital (1350 beds) was carried out on the first Tuesday in February 2015. Pharmacists screened admitted patients treated with proton-pump-inhibitors using an electronic prescription program (FarmaTools®-5.0). They also checked patients' home medications before admission by accessing a primary care program (Horus®). Authorized indications according to Spanish-Medicines-Agency and those recommended in Spanish-Clinical-Practice-Guidelines were considered appropriate. Hospital-medical-records were checked to know whether proton-pump-inhibitors were prescribed at discharge.
  
  
  RESULTS
  Three hundred seventy nine patients were analysed. Two hundred ninety four of them were prescribed proton-pump-inhibitors (77.6%). Treatment was initiated during admission for 143 patients (48.6%, 95% CI: 42.8-54.5). Of them, 91 (63.6%, 95% CI: 55.2-71.5) were inappropriate, mainly due to its inclusion unnecessarily in protocols associated with surgeries or diseases (56 cases of 91, 61.5%). Additional inappropriate indications were surgical stress ulcer prophylaxis for surgeries without bleeding risks (19.8%) and polypharmacy without drugs that increase the risk of bleeding (18.7%). Of 232 discharge reports assessed, in 153 (65.9%, 95% CI: 59.5-72), proton-pump-inhibitor continuation was recommended, of them, 51 (33.3%) were initiated at admission.
  
  
  CONCLUSIONS
  In hospitalized patients there is a high prevalence of prescription of proton-pump-inhibitors unnecessarily. The superfluous use is often associated with the prescription of treatment protocols. Those treatments started in the hospital generally did not contribute to over-use existing primary care, most of them were removed at discharge.
authors.affiliation: Farmacia, Hospital Univresitario La Paz, España.
authors.forename: Elena
authors.initials: E
authors.lastname: Villamañán
authors.affiliation: Hospital Universitario La Paz. Madrid.
authors.forename: Margarita
authors.initials: M
authors.lastname: Ruano
authors.affiliation: Hospital Universitario La Paz. Madrid.
authors.forename: Catalina
authors.initials: C
authors.lastname: Lara
authors.affiliation: Hospital Universitario La Paz. Madrid.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Suárez-de-Parga
authors.affiliation: Hospital Universitario La Paz. Madrid.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Armada
authors.affiliation: Hospital Universitario La Paz. Madrid.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Álvarez-Sala
authors.affiliation: Hospital Universitario La Paz. Madrid.
authors.forename: Ester
authors.initials: E
authors.lastname: Pérez
authors.affiliation: Hospital Universitario La Paz. Madrid.
authors.forename: Alicia
authors.initials: A
authors.lastname: Herrero
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010595:Pharmacists; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D013030:Spain / Q000453:epidemiology
chemical_list: D054328:Proton Pump Inhibitors