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

A. M. Dries, P. Richardson, J. Cavazos, Neena Susan Abraham

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)652-661
Number of pages10
JournalAlimentary Pharmacology and Therapeutics
Volume30
Issue number6
DOIs
StatePublished - Sep 2009
Externally publishedYes

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Proton Pump Inhibitors
Drug Users
Prescriptions
Anti-Inflammatory Agents
Therapeutics
Esophageal Diseases
Gastroscopy
Pharmaceutical Services
Esophagitis
Dyspepsia
Helicobacter Infections
Veterans
Gastroesophageal Reflux
Helicobacter pylori
Pharmaceutical Preparations
Medical Records
Logistic Models

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

Therapeutic intent of proton pump inhibitor prescription among elderly nonsteroidal anti-inflammatory drug users. / Dries, A. M.; Richardson, P.; Cavazos, J.; Abraham, Neena Susan.

In: Alimentary Pharmacology and Therapeutics, Vol. 30, No. 6, 09.2009, p. 652-661.

Research output: Contribution to journalArticle

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abstract = "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.",
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