Overuse of Acid-Suppression Therapy at an Urban Tertiary Hospital

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Abstract

Objectives

Acid-suppressive therapy (AST) is widely used for gastrointestinal prophylaxis in hospitalized patients, particularly to prevent stress-related mucosal bleeding in critically ill individuals. Previous reports suggest gross overutilization and continuation of unnecessary therapy, which have been linked to several adverse effects.

Methods

Retrospective chart review at a large tertiary care hospital, evaluating the use of AST for ulcer prophylaxis in accordance with American Society of Health-System Pharmacists’ guidelines and the less commonly studied nonsteroidal anti-inflammatory drug–related ulcer prophylaxis guidelines.

Results

A total of 119 (39.3%) patients who received AST met either American Society of Health-System Pharmacists guidelines or nonsteroidal anti-inflammatory drug–related prophylaxis guidelines. Subjects whose AST was appropriate were older, had a higher Charlson Comorbidity Index (P < 0.001), and were more often men (P = 0.005). The rate of discontinuation at discharge was 70.7%; subjects whose prescriptions were not discontinued were older, had a higher Charlson Comorbidity Index, and longer hospital and intensive care unit lengths of stay (P < 0.001). Family medicine physicians, hospitalists, and surgeons prescribed AST similarly; internal medicine physicians demonstrated higher adherence with guidelines than all others (P = 0.02). Adherence varied by etiology; cardiology patients were treated with the highest level of appropriateness (53.6%), whereas those admitted for gastrointestinal diagnoses demonstrated the lowest (17.6%, P = 0.03).

Conclusions

Inappropriate prescribing of AST for ulcer prophylaxis remains problematic. There may be differences in prescribing habits of physicians of different specialties. Age and comorbidity scores were associated with inappropriate prescribing and continuation of medication at discharge. Interventions to raise prescribers’ awareness of ulcer risk factors in hospitalized patients, both in the intensive care unit and those who are noncritically ill, are needed.

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