title: Characterizing Potentially Inappropriate Prescribing of Proton Pump Inhibitors in Older People in Primary Care in Ireland from 1997 to 2012.
abstract: To characterize prescribing of proton pump inhibitors (PPIs) and medicines that increase gastrointestinal bleeding risk (ulcerogenic) in older people from 1997 to 2012 and assess factors associated with maximal-dose prescribing in long-term PPI users.
  
  
  
  Repeated cross-sectional study of pharmacy claims data.
  
  
  
  Eastern Health Board region of Ireland.
  
  
  
  Individuals aged 65 and older from a means-tested health plan in 1997, 2002, 2007, and 2012 (range 78,489-133,884 individuals).
  
  
  
  PPI prescribing prevalence was determined per study year, categorized according to duration (≤8 or >8 weeks), dosage (maximal or maintenance), and co-prescribed drugs. Logistic regression in long-term PPI users was used to determine whether age, sex, polypharmacy, and ulcerogenic medicine use were associated with being prescribed a maximal dose rather than a maintenance dose. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) are presented.
  
  
  
  Half of this older population received a PPI in 2007 and 2012. Long-term use (>8 weeks) of maximal doses rose from 0.8% of individuals in 1997 to 23.6% in 2012. Although some ulcerogenic medicines and polypharmacy were significantly associated with maximal PPI doses, any nonsteroidal anti-inflammatory drug use was significantly associated with lower odds of maximal PPI dose (adjusted OR = 0.87, 95% CI = 0.85-0.89), as were aspirin use and older age. Adjusting for medication and demographic factors, odds of being prescribed a maximal PPI dose were significantly higher in 2012 than in 1997 (adjusted OR = 6.30, 95% CI = 5.76-6.88).
  
  
  
  Long-term maximal-dose PPI prescribing is highly prevalent in older adults and is not consistently associated with gastrointestinal bleeding risk factors. Interventions involving prescribers and patients may promote appropriate PPI use, reducing costs and adverse effects of PPI overprescribing.
authors.affiliation: Health Research Board Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Frank
authors.initials: F
authors.lastname: Moriarty
authors.affiliation: Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Bennett
authors.affiliation: Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Caitriona
authors.initials: C
authors.lastname: Cahir
authors.affiliation: Health Research Board Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Tom
authors.initials: T
authors.lastname: Fahey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing; D007494:Ireland; D008297:Male; D019338:Polypharmacy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D012307:Risk Factors
chemical_list: D054328:Proton Pump Inhibitors
keywords: gastrointestinal bleeding; older persons; potentially inappropriate prescribing; primary care; proton pump inhibitors