Proton Pump Inhibitors Prescription Patterns: A Retrospective Analysis of Internal Medicine Wards Admissions of a Tertiary Hospital

Padrões de Prescrição de Inibidores da Bomba de Protões: Uma Análise Retrospetiva das Admissões em Enfermarias de Medicina Interna de um Hospital Terciário

Abstract

Introduction: Proton pump inhibitors (PPIs) have revolutionized the treatment of various medical conditions, including gastroesophageal reflux disease and peptic ulcer disease. Due to their affordability, widespread availability, and favourable safety profile, they are among the most commonly prescribed medications today. However, they are often prescribed without a valid medical reason, a practice that can be observed in up to 80% of cases.

Methods: A retrospective study was conducted with the
primary objective of assessing the proportion of patients on
PPIs and the presence or absence of a valid indication for their use. Additionally, we examined whether PPI usage had any impact on hospitalization duration and mortality. Finally, a brief cost analysis of these medications was performed. The study was carried out using a sample of patients admitted to a tertiary university hospital over nine months in internal medicine wards. Electronic records were consulted to collect pertinent information.

Results: A total of 164 patients, with an average age of
82.7 ± 10.6 years, were assessed. The mean length of hospitalization was 12.7 ± 10.0 days. Approximately 61% of patients on PPIs lacked a valid indication for their use, while
approximately one-fifth of patients not on PPIs had a valid
indication. In both patient groups, the most common indication for PPI usage was prophylaxis in high-risk patients taking nonsteroidal anti-inflammatory drugs (NSAIDs). PPIs did not demonstrate any influence on the length of hospitalization or mortality. On average, each patient on PPIs spent €25.8 per year, contributing to an unnecessary total public funds expenditure of €679.1 in the assessed sample.

Conclusion: Considering the advanced age of the individuals, many of them were taking NSAIDs or antiplatelet agents, which is likely the reason for PPI prescription even in the absence of a valid indication. Various efforts have been made to implement measures to reverse this prescribing trend, with some showing effectiveness, notably educational outreach visits.