Inappropriate use of proton pump inhibitors in a local setting

• Published in: Singapore medical journal Vol. 55; no. 7; pp. 363 - 366
• Main Authors: Chia, Christopher Tze Wei, Lim, Wan Peng, Vu, Charles Kien Fong
• Format: Journal Article
• Language: English
• Published: Singapore Singapore Medical Association 01.07.2014
• Subjects: Anemia - drug therapy; Dyspepsia - drug therapy; Electronic Health Records; Hospitalization; Humans; Inappropriate Prescribing - statistics & numerical data; Original; Platelet Aggregation Inhibitors - therapeutic use; Practice Guidelines as Topic; Prevalence; Proton Pump Inhibitors - therapeutic use; Retrospective Studies; Singapore; Stomach Diseases - drug therapy; United States; United States Food and Drug Administration; United States; Singapore
• ISSN: 0037-5675
• DOI: 10.11622/smedj.2014087

There are growing concerns that the use of proton pump inhibitors (PPIs) may be inappropriate in instances that do not conform to evidence-based indications. This point-prevalence study aimed to investigate the frequency, indications and appropriateness of use of PPIs in hospitalised patients on a randomly chosen day. On a randomly chosen day, all inpatients were documented, and those on any form of PPIs on that day were determined. Indications for maintaining these patients on PPIs were obtained from the electronic medical records, which were then recorded and cross-referenced against a list of accepted indications adapted from the US Food and Drug Administration (FDA)-approved list. In all, 1,025 inpatients were documented. Of the 477 (46.5%) inpatients using PPIs, only 219 (45.9%) fulfilled the FDA-approved indications, while the majority (n = 258, 54.1%) did not. Overall, PPIs were not strictly indicated for use in 206 (43.2%) inpatients, according to FDA criteria. Of the 477 inpatients on PPIs, 52 (10.9%) had borderline indications based on expert consensus/guidelines other than FDA criteria. Although the use of PPIs is prevalent in hospitals, less than half of the hospitalised patients using PPIs in our study had evidence-based indications that supported such use. The overuse of PPIs has a negative impact on healthcare costs and may lead to adverse effects. Steps to curb the inappropriate use of PPIs should address factors such as indications for the initiation of PPIs, and reassessment of the need for ongoing PPI use in inpatients upon discharge and during outpatient reviews.