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

被引:17
作者
Dries, A. M. [2 ]
Richardson, P. [1 ]
Cavazos, J. [1 ]
Abraham, N. S. [1 ]
机构
[1] Michael E DeBakey VA Med Ctr, Houston Ctr Qual Care & Utilizat Studies, Geriatr GI Outcomes Res Unit, Houston, TX 77030 USA
[2] Baylor Coll Med, Dept Med, Div Gastroenterol, Houston, TX 77030 USA
关键词
HELICOBACTER-PYLORI; APPROPRIATE USE; PEPTIC-ULCERS; HEALTH-CARE; RISK; OUTCOMES; OMEPRAZOLE; ADHERENCE; UNDERUTILIZATION; METAANALYSIS;
D O I
10.1111/j.1365-2036.2009.04085.x
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
P>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.
引用
收藏
页码:652 / 661
页数:10
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