Among elderly patients prescribed proton pump inhibitors at hospital discharge, 81.2% had no valid documented indications, most commonly for primary gastrointestinal bleeding prophylaxis.
Observational (n=150)
No
Inappropriate prescribing of PPIs without documented valid indications is highly prevalent (81.2% of prescriptions) among elderly patients at hospital discharge in Singapore, often for primary gastrointestinal bleeding prophylaxis in low-risk aspirin users.
BACKGROUND: Evidence from several Western studies has shown an alarmingly high and inappropriate rate of prescription of proton pump inhibitors (PPIs), which may be associated with increased healthcare costs and adverse outcomes. PPI prescribing patterns remain largely unknown in well-developed healthcare systems in Southeast Asia. AIMS: We aimed to determine the prevalence of inappropriate prescription of PPI among elderly patients without documentation of valid indications, in a tertiary teaching hospital in Singapore. METHOD: We carried out a retrospective clinical records review of 150 elderly patients aged ≥65 years that had been admitted to two internal medicine wards between 25 May 2011 and 28 June 2011 to determine the appropriateness of indications for PPIs prescribed at hospital discharge. PPI indications were categorised as "valid", "likely invalid", and "probable" based on current clinical literature. Pre-admission and discharge prescriptions were reviewed to determine continuation of pre-admission and new PPI prescriptions at discharge. Data on clinical characteristics and concurrent use of ulcerogenic medications were collected. RESULTS: From a total of 150 patients, 80 (53 per cent) received prescriptions for PPIs. Of these, 65 (81.2 per cent) had no valid documented indications (i.e., the indication was classed as "likely invalid"); 10 (12.5 per cent) had valid indications; and in five cases (6.2 per cent) the indication was "probable". The most common "likely invalid" indication was primary gastrointestinal bleeding prophylaxis (GIP) among low-dose aspirin users in 28 patients (43 per cent) of invalid PPI prescriptions. CONCLUSION: Inappropriate prescribing of PPIs without documented valid indications was prevalent among elderly patients at our tertiary teaching hospital in Singapore, providing evidence that shows a similar trend to PPI prescribing to data from Western countries.
Akram et al. (Sun,) conducted a observational in Proton pump inhibitor prescribing in elderly patients (n=150). Proton pump inhibitors was evaluated on Proportion of PPI prescriptions without valid documented indications (likely invalid). Among elderly patients prescribed proton pump inhibitors at hospital discharge, 81.2% had no valid documented indications, most commonly for primary gastrointestinal bleeding prophylaxis.