Proton pump inhibitors (PPIs) are indicated to treat a variety of diseases, including gastroesophageal reflux disease, peptic ulcer disease, and Helicobactor pylori infection. Studies have shown that, despite being linked to an increased risk of pneumonia, fractures, and Clostridium difficile infection, PPIs are being overprescribed. Given the known potential adverse effects of PPIs and the high frequency of inappropriate usage, it seems prudent to implement evidence‐based guidelines for their use.
This is a retrospective pre‐ and post‐ intervention cohort study that included patients started on a PPI during their hospital admission between June 1, 2010 to August 31, 2010 as well as September 10, 2011 to October 20, 2011. Patients were excluded if they had a PPI on their prior to admission medication list. Patient demographic, diagnostic, laboratory, medical history, admission procedures, and medication use data was extracted from electronic medical records from two university affiliated hospitals. This data was reevaluated by a physician via chart review to determine adherence to the guideline indications. Additionally, for the post‐intervention group, the electronic medical record was used to extract the indication that the ordering physician entered as the reason for PPI use. In cases where the indication for PPI use was unclear (21), three other physicians reviewed the chart to collectively determine if the PPI had been appropriately prescribed.
There were 223 patients in the pre‐intervention cohort and 211 patients in the post‐intervention cohort. Four patients were later excluded from the post‐intervention cohort after determining that they were never prescribed a PPI. A pre/post‐intervention analysis was conducted using chi‐square test and log regression. Post‐intervention adherence to appropriate PPI use guidelines was 74.4% compared to 64.1% in the pre‐intervention group. (P= 0.022). Intensive care unit admission (OR 4.8, P=0.02), gastrointestinal bleed (OR 10, P<0.001), esophagogastroduodenoscopy (OR 5.3, P=0.02), mechanical ventilation (OR 8, P=0.004) and aspirin use (OR 32, P<0.001) were all significantly associated with guideline adherence.
Overall, implementation of an electronic indication‐based order set improved PPI guideline adherence. We are now in the process of studying how this improvement affects clinical outcomes. Variables strongly associated with guideline adherence in our study were ICU admission, gastrointestinal bleed, mechanical ventilation, esophagogastroduodenoscopy, and aspirin use
To cite this abstract:Lovetro B, Popa A, Lane J, Ha D, Martin L, Jenkins I, Bordin‐Wosk T, Clay B, James C. Clinical Predictors Associated with Proton Pump Inhibitor Guideline Adherence. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 121. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/clinical-predictors-associated-with-proton-pump-inhibitor-guideline-adherence/. Accessed May 23, 2019.