Study Assesses Appropriate Prescription of Proton-Pump Inhibitors among Elderly Veterans Using NSAIDs
Proton-pump inhibitors (PPIs) are the second-leading therapeutic class of drug, with two PPIs ranking as the third and fourth most prescribed drugs in the US. Non-steroidal anti-inflammatory drugs (NSAIDs) are also widely prescribed, with between 10% and 15% of older Americans using a prescription NSAID. A significant proportion of patients suffer NSAID-related gastrointestinal complications, but concomitant gastro-protection with a PPI can significantly reduce the risk of these complications. However, studies have shown an under-utilization of gastro-protective measures in high-risk NSAID users, with only 11-27% receiving appropriate prophylaxis. Using VA data, this observational study assessed VA provider awareness of NSAID gastro-protection and the therapeutic intent of PPI prescription among 1491 elderly Veterans at one VAMC. In other words, investigators sought to better understand why VA physicians were prescribing these drugs. Investigators also examined variables that might explain why a patient had been prescribed a PPI (i.e., demographics, comorbidities, provider specialty).
Findings show that among elderly Veterans who were prescribed a PPI, a therapeutic intent was documented in 71% of the cases, and of these prescriptions, 88.8% were considered appropriate. However, practitioner recognition of the need for gastro-protection in elderly patients was remarkably low (10%). Variables associated with the appropriate recognition of the need for PPI therapy included: prescription by a rheumatologist, the patient being African American, and having more than three comorbidities. Results also show that poor rates of appropriate therapeutic intent were noted when the PPI was initiated by the inpatient service, by certain sub-specialties (e.g., cardiology, otolaryngology), and for Veterans using the VA for medication refill only.
Dries A, Richardson P, Cavazos J, and Abraham N. Therapeutic intent of proton-pump inhibitor prescription among elderly non-steroidal anti-inflammatory drug users. Alimentary Pharmacology & Therapeutics September 15, 2009;30(6):652-661.
This study was partly funded by HSR&D. Drs. Richardson, Cavazos, and Abraham are part of HSR&D's Houston Center for Quality of Care and Utilization Studies.