title: Stress Ulcer Prophylaxis in Hospitalized Patients, Subsequent Use in Primary Care, and Physicians' Opinions About Acid-Suppressive Therapy.
abstract: OBJECTIVE
  Stress ulcer prophylaxis (SUP) is not indicated in most hospitalized patients. This study determined the prevalence of the use of proton pump inhibitors (PPI) and histamine receptor 2 blockers (H2B) in hospitalized patients, continued PPI/H2B use after discharge, and physicians' opinions about SUP.
  
  
  METHODS
  A retrospective electronic chart review, as well as a national survey of residents and faculty in primary care residency programs to determine the appropriateness of SUP.
  
  
  RESULTS
  Of 753 charts reviewed, 332 hospitalized patients with outpatient follow-up were included; 303 of them had either PPI or H2B ordered during hospitalization, but only 120 patients had an indication for SUP. Stepwise logistic regression results showed patients with a history of PPI/H2B use were 16.6 times more likely to receive SUP (odds ratio 16.6; 95% confidence interval 2.2-124.7). In addition, a PPI/H2B indication also significantly predicted SUP use (odds ratio 5.1; 95% confidence interval 1.2-22.2). A total of 171 completed surveys were received: 73% residents and 27% faculty. Only 24% reported being aware of SUP guidelines; 17% reported using electronic health record order set suggestions for SUP.
  
  
  CONCLUSIONS
  More than 90% of hospitalized patients received SUP; less than half of them had an indication for needing SUP. A large number of patients discharged on PPI/H2B continued to receive it in the outpatient setting at 6 months follow-up. Only 24% of physicians reported using SUP based on guidelines. Physician education and evidence-based validation of electronic health record order sets are potential areas for improvement.
authors.affiliation: From the Department of Family and Community Medicine, University of California, San Francisco, Fresno, and the Twin Cities Community Hospital, Templeton, California.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Riaz
authors.affiliation: From the Department of Family and Community Medicine, University of California, San Francisco, Fresno, and the Twin Cities Community Hospital, Templeton, California.
authors.forename: Susan
authors.initials: S
authors.lastname: Hughes
authors.affiliation: From the Department of Family and Community Medicine, University of California, San Francisco, Fresno, and the Twin Cities Community Hospital, Templeton, California.
authors.forename: Ivan A
authors.initials: IA
authors.lastname: Gomez
authors.affiliation: From the Department of Family and Community Medicine, University of California, San Francisco, Fresno, and the Twin Cities Community Hospital, Templeton, California.
authors.forename: Roger B
authors.initials: RB
authors.lastname: Mortimer
mesh_terms: D001291:Attitude of Health Personnel; D005260:Female; D006633:Histamine Antagonists / Q000627:therapeutic use*; D006801:Humans; D007297:Inpatients; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D010820:Physicians; D011320:Primary Health Care / Q000379:methods*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D013276:Stomach Ulcer / Q000517:prevention & control*; D013315:Stress, Psychological / Q000150:complications*; D011795:Surveys and Questionnaires
chemical_list: D006633:Histamine Antagonists; D054328:Proton Pump Inhibitors