Proton Pump Inhibitors Overuse among Academic and Nonacademic Hospitalists

1Good Samaritan Hospital of Maryland, Baltimore, MD
2Johns Hopkins Bayview Medical Center Baltimore, MD
3Johns Hopkins School of Medicine, Baltimore, MD
4Johns Hopkins Bayview Medical Center, Baltimore, MD
5Johns Hopkins Bayview Medical Center, Baltimore, MD
6Johns Hopkins Bayview Medical Center, Baltimore, MD

Meeting: Hospital Medicine 2010, April 8-11, Washington, D.C.

Abstract number: 107

Background:

Over the past decade, several studies reported a sharp increase in the use of proton pump inhibitors (PPIs) in the hospital setting. Between 33% and 65% of these prescriptions were found to be noncompliant with the guidelines, 50% of which were continued after discharge. Besides being expensive, PPIs have been associated with increased risk of pulmonary and colonic infections, osteoporosis, and fatal drug interactions. In the current study, we describe the trends and characteristics of PPI prescriptions by academic and nonacademic hospitalists, an understudied yet important prescriber group in the hospital setting.

Methods:

Charts were reviewed for oral PPI prescriptions initiated by 4 hospitalists groups during the study period. A group was called academic if hospitalists were involved in teaching and research in addition to clinical practice. Prescription indications were recorded when explicitly stated in the chart. Otherwise, qualified physicians carefully reviewed the chart to make such determination. Indications found were then compared to the published prescription guidelines. Patients' characteristics were also captured.

Results:

Two hundred and thirty‐eight PPI prescriptions were examined (71 written by nonacademic groups and 164 written by academic groups). Only 41% were guideline compliant. The most common indications for those were symptomatic GERD, dyspepsia, and gastritis/gastric ulcer (25% each), whereas the most common indication for guideline‐noncompliant ones was gastrointestinal (Gl) prophylaxis for low‐risk patients (78%). Patients in both groups did not differ with regard to mean age (52 and 55 years), sex (55% and 45% males), use of anticoagulants (10% vs. 11%), non‐steroidal anti‐inflammatory drugs (12% vs. 13%), being discharged home (95% vs, 88%), or whether the attending of records was the one who started the PPI (39% vs. 45%). However, patients who received compliant prescriptions were significantly more likely to have a history of Gl bleed (14% vs. 6%), be discharged by their admitting service (90% vs. 80%), have the PPI listed on their discharge sheet (72% vs. 32%), and its indication documented in the chart (81% vs. 36%). Compared with nonacademic hospitalists, the academic groups were significantly more compliant with the PPI prescription guidelines (49% vs. 21%), Gl prophylaxis for low‐risk patients remained the most common indication for noncompliant prescriptions for both groups.

Conclusions:

Both academic and nonacademic hospitalists overprescribe PPIs at a level comparable to that of the nonhospitalists providers in the literature. Academic hospitalists, however, were significantly more compliant with the PPI prescription guidelines in our study. The leading indication for noncompliance was Gl prophylaxis for low‐risk patients. Understanding the determinants of increased compliance among this group will be instrumental for designing intervention strategies aimed at increasing PPI prescription compliance and will be our next step.

Author Disclosure:

S. Paranji, none; C. Mativo, none; A. Boueiz, none; R. Hess, none; S. Eid, none; M. Abougergi, none.

To cite this abstract:

Paranji S, Mativo C, Boueiz A, Hess R, Eid S, Abougergi M. Proton Pump Inhibitors Overuse among Academic and Nonacademic Hospitalists. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 107. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/proton-pump-inhibitors-overuse-among-academic-and-nonacademic-hospitalists/. Accessed November 14, 2019.

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