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Appropriateness of Proton Pump Inhibitor prescription in patients admitted to hospital: Attitudes of general practitioners and hospital physicians in Italy

Published:February 26, 2016DOI:https://doi.org/10.1016/j.ejim.2016.01.025

      Highlights

      • More than 50/% of patients received PPIs before, during, or after hospitalization.
      • Hospital clinicians changed PPI therapy prescribed by GPs only rarely.
      • Appropriateness of PPI use/non-use was found in about 2/3 of cases.
      • The most common inappropriate behavior was over- rather than under-prescription.

      Abstract

      Introduction

      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.

      Design

      Observational cohort study.

      Patients

      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.

      Main measures

      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.

      Key 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.

      Abbreviations:

      PPI (Proton pump inhibitor), GP (General practitioner), MAI (Medication Appropriateness Index), OR (Odds ratio), OTC (Over the counter), GERD (Gastroesophageal reflux disease), NSAID (Non-steroidal anti-inflammatory drug), ASA (Acetylsalicylic acid)

      Keywords

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