Co-prescription of Gastro-protectants in Hospitalized Patients An Analysis of What We Do and What We Think We Do

Background: Proton pump inhibitors (PPIs) reduce the risk of upper gastrointestinal hemorrhage (UGIH) associated with the use of many medications. Goals: To examine how clinicians perceive such risk and whether PPI coprescribing is based on an accurate assessment. Study Methods: Clinicians in a single teaching hospital were asked to estimate risk of UGIH and comment on PPI coprescription in hypothetical patients. Records of 160 hospital in-patients ( median age; 74 y) were then reviewed to examine PPI prescribing and risk factors for UGIH. Results: In general, clinicians estimated UGIH risk accurately and reported low thresholds for PPI coprescription. Prescribing records showed regular PPI use increased between admission and discharge of patients from 61/160 (38%) to 93/160 (58%). Ten percent had a prior history of peptic ulcer disease. Proton pump inhibitor prescription was significantly associated with the use of aspirin and clopidogrel. Half of the patients with multiple risk factors for UGIH on admission and almost a third at discharge were not coprescribed a PPI. Conclusions: Clinicians generally estimate correctly the risk of UGIH and report a low threshold for prescribing gastro-protection. Despite this, prescribing practice does not consistently take account of relative risk of UGIH. Targeted PPI coprescribing on the basis of risk factors would lead to more rational PPI use.