Therapeutic intent of proton pump inhibitor prescription among elderly nonsteroidal anti‐inflammatory drug users

• Published in: Alimentary pharmacology & therapeutics 2009-09, Vol.30 (6), p.652-661
• Main Authors: DRIES, A. M., RICHARDSON, P., CAVAZOS, J., ABRAHAM, N. S.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Anti-Inflammatory Agents, Non-Steroidal - therapeutic use; Biological and medical sciences; Cross-Sectional Studies; Digestive system; Drug Utilization; Female; Gastroenterology. Liver. Pancreas. Abdomen; Gastroesophageal Reflux - drug therapy; Helicobacter pylori; Humans; Male; Medical sciences; Pharmacology. Drug treatments; Practice Patterns, Physicians' - standards; Proton Pump Inhibitors - therapeutic use
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/j.1365-2036.2009.04085.x

Summary Background  Prescription of proton pump inhibitors (PPIs) has increased dramatically. Aim  To assess therapeutic intent of PPI prescription among elderly veterans prescribed nonsteroidal anti‐inflammatory drugs. Methods  Medical‐record ion identified therapeutic intent of PPI prescription. An ‘appropriate therapeutic intent’ was defined as symptomatic gastro‐oesophageal reflux disease or endoscopic oesophagitis, Zollinger–Ellison disease, dyspepsia, upper gastrointestinal event, Helicobacter pylori infection or nonsteroidal anti‐inflammatory drug gastroprotection. Logistic regression predicted the outcome while adjusting for clinical characteristics. Results  Of 1491 patients [mean 73 years (s.d. 5.6), 73% white and 99.8% men], among those charts which did document a therapeutic indication, 88.8% were appropriate. Prior gastroscopy was predictive of an appropriate therapeutic intent (OR 2.7; 95% CI: 1.9–3.7). Prescription to patients who used VA pharmacy services only, to in‐patients, or by a cardiologist or an otolaryngologist were less likely to be appropriate. Gastroprotection was poorly recognized as an indication for PPI prescription, except by rheumatologists (OR 46.7; 95% CI: 15.9–136.9), or among highly co‐morbid patients (OR 1.8; 95% CI: 1.1–2.9). Among in‐patients, 45% of PPI prescriptions were initiated for unknown or inappropriate reasons. Conclusions  Type of provider predicts appropriate PPI use. In‐patient prescription is associated with poor recognition of necessary gastroprotection and unknown therapeutic intent.