Proton pump inhibitors

Published Date: 19th July 2016

Publication Authors: Mavinamane S

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Objective

Proton pump inhibitor (PPI) prescribing has increased dramatically over recent years and has significant cost implications. It is estimated that up to two-thirds of PPI prescriptions are inappropriate and costs the National Health Service approximately 100 million in unnecessary PPI prescribing. PPIs are associated with serious adverse effects including clostridium difficile infection, increased risk of hip fracture and community-acquired pneumonia. The aim of this audit was to ascertain whether patients on PPIs admitted to the Geriatric Medicine wards had a clear indication for their use and how long they had been taking the PPI. PPI prescription was reviewed whilst in hospital and whether the PPI had been initiated in primary or secondary care was also analysed. The adequacy of documentation of the written communication from the hospital to the primary care setting was assessed as well.

Method

A retrospective audit of patients discharged from the Geriatric Medicine wards between December 2012 and January 2013 was conducted. Data was collected by analysing case notes and contacting GP surgeries.

Results

50 patients were included in the audit. 52% of patients did not have a clear indication for their PPI prescription. 52% of patients had also been on the PPI for 4 or more years. Only 12 % of patients had their PPI prescription reviewed whilst in hospital, and 80% of PPI prescriptions had been initiated in Primary Care. Analysis of the data also showed that 66% of patients on the Geriatric Medicine wards had been prescribed antibiotics at some point during their admission whilst also taking a PPI. 90% of the written documentation between the hospital and the general practitioner in primary care did not have any information regarding the indication or appropriate review date for the PPI.

Conclusions

Patients are being prescribed PPIs for several years and a large number of these patients do not have a clear indication for their use. Patients that do not have a clear indication for PPI use are being exposed to unwanted adverse effects without necessarily experiencing any benefit from being on a PPI. It is important that when patients are admitted to Geriatric Medicine wards their PPI prescription is reviewed and discontinued if it is not indicated or reduced to the lower strength when clinically possible. This is particularly important as 66% of patients who were admitted to the geriatric medicine wards were being prescribed antibiotics at the same time as taking a PPI which increases the risk of these patients developing clostridium difficile infection. Patients on PPIs also need to have their prescription regularly reviewed within the Primary Care setting. It is essential that written communication between the hospital to primary care has clear documentation about the indication for PPI use and the appropriate review date of the PPI so that general practitioners are prompted to review the need for continuation of the PPI once a patient is discharged back into the community.

Jacob, A; Mavinamane, S. (2013).  Are proton pump inhibitors being prescribed appropriately in elderly patients? . European Journal of Internal Medicine,. 24 (Supp 1), e75-76.

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