Proton Pump Inhibitor Prescription: an inpatient point prevalence study
Aoife O'Sullivan, Clodagh Murphy, Rachel Kearns, Yusuk Malik, Syed Zulquernain
Cork University Hospital, Department of gastroenterology
Proton pump inhibitors (PPIs) are a commonly prescribed medication in the adult population. As per the British National Formulary therapeutic indications for PPIs include the treatment of gastric and duodenal ulcers, dyspepsia, gastro oesophageal reflux disease (GORD), and prevention of NSAID associated ulcers. PPIs are often over utilised. The potential adverse consequences of long term PPI prescription include hypergastrinemia, enterochromaffin-like cell hyperplasia, and parietal cell hypertrophy which can cause a rebound acid hypersecretion. There have also been links to Clostridium difficile-associated diarrhoea, community-acquired pneumonia, bone fracture and nutritional deficiencies. preprocess
This cross sectional study conducted in the Cork University Hospital (CUH) sought to identify the point prevalence of PPI prescription in an inpatient adult population. A secondary aim was to identify whether there was a documented indication for PPI prescription in the patient’s medical notes. preprocess
A chart review was conducted over the course of a week in one medical and one surgical ward in the CUH. All data collected were anonymised. PPI use was recorded, as was indication for prescription as per medical notes. Previous endoscopy procedures were also recorded. preprocess
A total of 83 patients were included. 52% of patients in the cohort were male. 44.5% of patients were taking PPIs. 78% of patients who were prescribed a PPI did not have a documented indication in the medical notes. Of those who did have a documented indication; 1 case was for peptic ulcer disease, 4 cases were for oesophagitis, 3 cases were for GORD and 1 case was for dyspepsia. 2 taking PPIs had previous undergone endoscopy.
One of the reasons for PPI over utilisation have been reported as failure to re-evaluate the need for continuation of therapy. In this study, a relatively large proportion of the patients were prescribed PPIs. Very few had a documented indication for this. Although this is a point prevalence study, it raises the suggestion that the need for therapy is not being re-evaluated in the inpatient setting. preprocess