Inappropriate prescribing of proton pump inhibitors in hospitalized patients

BACKGROUND: Proton pump inhibitors have numerous important side effects, yet they are prescribed for outpatients who do not have recognized indications. Less is known with respect to prescribing for inpatients. OBJECTIVE: To determine the rate of inappropriate prescribing of protein pump inhibitors and to assess reasons why they are prescribed. DESIGN AND PARTICIPANTS: The study was a retrospective review of administrative data for adult hospital patients discharged from the Medicine service of Denver Health (DH) and from the University HealthSystem Consortium (UHC) between January 1, 2008 and December 31, 2009. MEASUREMENTS: Valid indications for proton pump inhibitors were sought from discharge diagnoses, prescription records, and, in a randomly selected group of patients from DH, from direct review of records. RESULTS: Inclusion criteria were met by 9875 DH patients and 6,592,100 UHC patients; of patients receiving a proton pump inhibitor, 61% and 73%, respectively, did not have a valid indication. Increased rates of Clostridium difficile infection were found in both groups of patients receiving proton pump inhibitors. Chart reviews found valid indications for proton pump inhibitors in 19% of patients who did not have a valid indication on the basis of the administrative data, and prophylaxis was the justification for inappropriate prescribing in 56%. CONCLUSION: Proton pump inhibitors are frequently inappropriately prescribed to Medicine inpatients who do not have a valid indication and this practice is associated with an increase in C. difficile infection. Interventions are needed to curtail this inappropriate prescribing practice. Journal of Hospital Medicine 2012; (c) 2011 Society of Hospital Medicine