Inappropriate use of proton pump inhibitors among medical inpatients: a questionnaire-based observational study

Abstract

ObjectivesTo evaluate the appropriateness of proton pump inhibitor (PPI) prescribing by conducting an audit of medical inpatients against recommended guidelines.DesignQuestionnaire-based study. All medical wards were audited and different information was documented by patients' medical records review (both hospital visit notes and general practitioner's letters) and short interview, where we asked them to name the clinical reason for using PPI.SettingThis study was carried out in the setting of a regional hospital (537-bed, secondary care referral centre) in Ireland.ParticipantsThe study participants were all consecutive medical patients admitted to the medical wards at Waterford Regional Hospital, Waterford.Main outcome measuresThe appropriateness of PPI usage in our regional hospital by assessing the level of its prescribing against published guidelines (NICE, 2000).ResultsDuring the audit period, 205 consecutive medical inpatients were assessed. Seventy-nine percent (162 out of 205) of the studied patients were found to be using PPI. For 45% (n = 73) of patients, there was no documentation of valid indication for being on PPI. Overall, 64% of patients were prescribed PPI by hospital doctors, either during their current or previous admissions. We noted that 31% (n = 51) of patients were taking PPI for ≥2 years and another 25% of patients were using PPI for about one year. Only 12% (n = 20) of patients had undergone endoscopy procedures.ConclusionInappropriate use of PPI remains common in hospital practice. The risks of using long-term PPI must be weighed against the benefits.

Proton pump inhibitors: Are we still prescribing them without valid indications?

“…20 Other recent studies have shown that physicians do not review and document PPI indications in a large number of cases, which often results in their long-term or even indefinite continuation. 1,19,20 This is of interest because even among the 16 patients in our study with newly prescribed PPI prescriptions at discharge, only two patients were discharged with any documented justification.…”

“…However, all recent studies have reported a very high prevalence of inappropriate PPI prescribing and our result findings are consistent with these studies. 2,3,4,[18][19][20] Finally, as the guidelines recommend periodic assessment for the continued use of PPI, it may be challenging to assess symptoms among the very elderly, frail, and debilitated elderly with dementia and communication issues. This may have posed difficulties for the prescribing physicians in determining the need for a prescription.…”

Proton pump inhibitors overuse: only inappropriate prescriptions or further iatrogenic damage?

“…5 The aim was to evaluate the appropriateness of PPIs prescription by conducting an audit against recommended guidelines (NICE 2000).…”

Antitrombotic therapy in patients with acute gastrointestinal bleeding

“…Prethodni pepički ulkus ili kardiogeni šok su bili značajni nezavisni faktori rizika. Istovremena primena IPP značajno redukukuje rizik 5,[20][21][22] .…”