title: Appropriateness of Acid Suppression Therapy.
abstract: BACKGROUND
  The inappropriate startup of long-term acid suppressive therapy (AST) can have clinical and pharmacoeconomic impacts on ambulatory care.
  
  
  OBJECTIVE
  To assess the proportion of patients with appropriate initiation of long-term AST in non-critically ill patients. To describe possible risk factors for nonappropriate AST. To calculate the potential savings when eliminating the nonappropriate startup of AST.
  
  
  METHODS
  This observational, retrospective study evaluated the appropriateness of startup of long-term AST in medical records using a broad variety of international criteria and guidelines and using a validated screening instrument.
  
  
  RESULTS
  A sample of 597 patients was included in the analysis. In 57% of them, AST was appropriately initiated. No specific risk profile could be defined. There was some indication that the availability of a clinical pharmacist and the use of standing orders were correlated to the outcome. Extrapolation to the total population (ie, 2836 patients) led to a total cost of €8880 during hospital stay plus an extra €40 391 per month after discharge. Avoiding inappropriate initiation of AST could lead to a saving of €3805 plus €17 441 per month.
  
  
  CONCLUSIONS
  In all, 43% of initiation of long-term AST in the hospital was inappropriate. The potential savings from avoiding this could be substantial from a health care payer perspective. No patient characteristics that could predict for inappropriate initiation of AST were identified. A correlation between inappropriate initiation and medical disciplines using standing orders that include AST was seen.
authors.affiliation: 1 University Hospitals Leuven, Belgium.
authors.forename: Thomas
authors.initials: T
authors.lastname: De Rijdt
authors.affiliation: 1 University Hospitals Leuven, Belgium.
authors.forename: Isabel
authors.initials: I
authors.lastname: Spriet
authors.affiliation: 1 University Hospitals Leuven, Belgium.
authors.forename: Ludo
authors.initials: L
authors.lastname: Willems
authors.affiliation: 1 University Hospitals Leuven, Belgium.
authors.forename: Marianne
authors.initials: M
authors.lastname: Blanckaert
authors.affiliation: 1 University Hospitals Leuven, Belgium.
authors.forename: Martin
authors.initials: M
authors.lastname: Hiele
authors.affiliation: 1 University Hospitals Leuven, Belgium.
authors.forename: Alexander
authors.initials: A
authors.lastname: Wilmer
authors.affiliation: 2 Catholic University Leuven, Belgium.
authors.forename: Steven
authors.initials: S
authors.lastname: Simoens
mesh_terms: D000328:Adult; D005260:Female; D006635:Histamine H2 Antagonists / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D057970:Inappropriate Prescribing / Q000191:economics / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010595:Pharmacists; D054328:Proton Pump Inhibitors / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D000071065:Standing Orders; D016896:Treatment Outcome
chemical_list: D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors
keywords: AST; H2A; PPI; acid suppression; appropriate therapy; cost saving; economic; hospital; initiation; long-term; start-up