Label-discordant prescribing of proton pump inhibitor in elderly outpatients: Prevalence and associated factors

OBJECTIVE: We aimed to evaluate the rationality of proton pump inhibitor (PPI) prescription in elderly outpatients aged ≥ 65 years, characterize inappropriate prescription patterns, and identify the factors associated with label-discordant prescription. MATERIALS AND METHODS: A retrospective single-center study was conducted at Beijing Tongren Hospital. Data were extracted for outpatients aged ≥ 65 years who received PPIs between November 2024 and October 2025. Only the first visit of each patient was included (n = 3,038) to avoid non-independence. Prescription rationality was assessed using the Clinical Application Guidelines for Proton Pump Inhibitors (2020 Edition) and package inserts. Two binary outcomes were defined: any label-discordant prescription (composite of inappropriate indication, dose, drug interaction, or label-discordant frequency) and pure excessive frequency (twice-daily dosing without other discordance). Logistic regression analysis was conducted to identify the associated factors. RESULTS: Among 3,038 first-visit patients, 281 (9.25%) had label-discordant prescriptions (rational use rate: 90.75%). Excessive frequency (twice-daily dosing) was the most common type of label-discordant prescription (206 patients, 73.31% of discordant cases), of whom 204 exhibited no other discordance (pure excessive frequency). Inappropriate drug interactions were observed in 34 patients (12.10%), inappropriate indications were detected in 19 (6.76%) patients, and inappropriate single-dose was found in 13 (4.63%) patients. Multivariable analysis showed that male sex (OR = 0.681), having ≥ 5 diagnoses (OR = 0.721), and non-gastroenterology department (OR = 0.235) were associated with lower odds of label-discordant prescription, while senior physician title (OR = 1.628) was associated with higher odds of label-discordant prescription. Age ≥ 75 years did not show a significant association (p = 0.981). Results for pure excessive frequency were directionally consistent. CONCLUSION: In this sample of elderly outpatients, the label-discordant prescription rate of PPI was 9.25%, with excessive frequency representing the predominant type. Male sex, a higher number of diagnoses, and non-gastroenterology departments were associated with lower odds, whereas a senior physician title was associated with higher odds. Given the exclusion of prophylactic use and single-center design, these findings should not be generalized to all PPI prescription practices. Future studies should include prophylactic prescriptions and disease severity measures.