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Therapeutic intent of proton pump inhibitor prescription among elderly nonsteroidal anti‐inflammatory drug users
Author(s) -
DRIES A. M.,
RICHARDSON P.,
CAVAZOS J.,
ABRAHAM N. S.
Publication year - 2009
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2009.04085.x
Subject(s) - medicine , medical prescription , proton pump inhibitor , nonsteroidal , drug , omeprazole , logistic regression , pharmacy , helicobacter pylori , disease , pharmacology , family medicine
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 abstraction 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.