title: Appropriateness of Proton Pump Inhibitor (PPI) prescription in patients admitted to hospital: Attitudes of general practitioners and hospital physicians in Italy.
abstract: BACKGROUND
  Proton pump inhibitor (PPI) prescriptions have raised concern for both huge increase of health expenditure and possible long-term adverse effects.
  
  
  OBJECTIVE
  To evaluate appropriateness of PPI prescription in ambulatory and hospital care.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  Patients admitted to the Internal Medicine Unit of Bologna S. Orsola Hospital between 15/09/2013 and 15/12/2013. Data on clinical condition and drug therapy were collected at three time points: admission (reflecting GP's prescription), hospital stay and discharge.
  
  
  METHODS
  Appropriateness of PPI use was evaluated as follows: (1) agreement between PPI use/non-use and appropriate clinical condition; (2) in PPI users, assessment of Medication Appropriateness Index (MAI). Differences in appropriateness among time points were analyzed by chi-square test. Logistic regression model was used to identify possible determinants of PPI appropriateness.
  
  
  RESULTS
  Among 280 patients, 56% received PPI at least once in the three time points. Appropriateness, according to indication of use, was similar between admission and hospital stay (61% vs. 62%; p=0.82) and between hospital stay and discharge (62% vs. 59%; p=0.94). MAI score showed important, although statistically non-significant, change in appropriateness between admission and hospital stay (20% vs. 28%; p=0.16). Age≥65 was always associated with appropriate PPI use (up to OR=4.37; p<0.01), whereas cardiovascular comorbidity and conditions requiring analgesic treatment influenced appropriateness only at admission (OR=3.84; p<0.01 and OR=0.34; p<0.01, respectively).
  
  
  CONCLUSIONS
  Hospital clinicians only rarely reconsidered GP's choice to prescribe PPI. Room for improvement in PPI appropriateness is represented by (1) assessing gastrointestinal risk in each patient under analgesics and anti-inflammatory drugs, and (2) short-term re-evaluation of PPI prescription after discharge.
authors.affiliation: Unit of Internal Medicine, S. Orsola-Malpighi Hospital and Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. Electronic address: francesca.lodato@aosp.bo.it.
authors.forename: Francesca
authors.initials: F
authors.lastname: Lodato
authors.affiliation: Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. Electronic address: elisabetta.poluzzi@unibo.it.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Poluzzi
authors.affiliation: Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. Electronic address: emanuel.raschi@unibo.it.
authors.forename: Emanuel
authors.initials: E
authors.lastname: Raschi
authors.affiliation: Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. Electronic address: carlo.piccinni@unibo.it.
authors.forename: Carlo
authors.initials: C
authors.lastname: Piccinni
authors.affiliation: Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. Electronic address: ariola.koci@unibo.it.
authors.forename: Ariola
authors.initials: A
authors.lastname: Koci
authors.affiliation: Unit of Internal Medicine, S. Orsola-Malpighi Hospital and Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. Electronic address: valentina.olivelli@aosp.bo.it.
authors.forename: Valentina
authors.initials: V
authors.lastname: Olivelli
authors.affiliation: Unit of Internal Medicine, S. Orsola-Malpighi Hospital and Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. Electronic address: chiara.napoli@aosp.bo.it.
authors.forename: Chiara
authors.initials: C
authors.lastname: Napoli
authors.affiliation: Unit of Internal Medicine, S. Orsola-Malpighi Hospital and Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. Electronic address: giulia.corvalli@aosp.bo.it.
authors.forename: Giulia
authors.initials: G
authors.lastname: Corvalli
authors.affiliation: Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. Electronic address: nalonelena@gmail.com.
authors.forename: Elena
authors.initials: E
authors.lastname: Nalon
authors.affiliation: Pharmacology Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. Electronic address: fabrizio.deponti@unibo.it.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: De Ponti
authors.affiliation: Unit of Internal Medicine, S. Orsola-Malpighi Hospital and Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. Electronic address: marco.zoli@unibo.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Zoli
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D058005:General Practitioners; D020445:Hospitalists; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*
chemical_list: D054328:Proton Pump Inhibitors
keywords: Ambulatory care; Hospital medicine; Pharmaceutical care; Proton pump inhibitors; Quality improvement; Utilization