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Appropriateness of treatment recommendations for PPI in hospital discharge letters.

Ahrens D, Chenot JF, Behrens G, Grimmsmann T, Kochen MM - Eur. J. Clin. Pharmacol. (2010)

Bottom Line: The reasons for the dramatic increase in proton pump inhibitors (PPI) prescriptions remain unclear and cannot be explained solely by increased morbidity, new indications or a decrease in alternative medication.No information justifying the recommendation for continuous PPI medication could be identified in 54.5% of the discharge letters; in 12.7%, the indication was uncertain, and in 32.7%, we found an evidence-based indication for PPI medication.This may lead to a continuation of this therapy in primary care, thereby unnecessarily increasing polypharmacy and the risk of adverse events as well as burdening the public health budget.

View Article: PubMed Central - PubMed

Affiliation: Department of General Practice, University of Göttingen, Humboldtallee 38, Göttingen, Germany.

ABSTRACT

Purpose: The reasons for the dramatic increase in proton pump inhibitors (PPI) prescriptions remain unclear and cannot be explained solely by increased morbidity, new indications or a decrease in alternative medication. Inappropriate use and discharge recommendations in hospitals are considered to be possible explanations. As the quality of PPI recommendations in hospital discharge letters in Germany has not been investigated to date, we have studied the appropriateness of these referrals.

Methods: Hospital discharge letters with recommendations for PPI medication from 35 primary care practices in the county of Mecklenburg-Western Pomerania (MV; North-east Germany) were collected and analysed, and the appropriateness of the PPI indication was rated.

Results: No information justifying the recommendation for continuous PPI medication could be identified in 54.5% of the discharge letters; in 12.7%, the indication was uncertain, and in 32.7%, we found an evidence-based indication for PPI medication. The most common indication for adequate PPI use was nonsteroidal anti-inflammatory drug-prophylaxis in high-risk patients.

Conclusions: Inadequate recommendations for PPIs in discharge letters are frequent. This may lead to a continuation of this therapy in primary care, thereby unnecessarily increasing polypharmacy and the risk of adverse events as well as burdening the public health budget. Hospitals should therefore critically review recommendations for PPI medication and the dosage thereof in their discharge letters and clearly document the reason for PPI use and the need for continuous prescription in primary care.

Show MeSH
Patient flow. PPI Proton pump inhibitor
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Related In: Results  -  Collection


getmorefigures.php?uid=PMC2982961&req=5

Fig1: Patient flow. PPI Proton pump inhibitor

Mentions: Recruitment of practices We invited all 933 registered general practitioner (GP) practices in MV to participate in the study. Addresses were obtained from the Association of Statutory Health Insurance Physicians (Kassenaerztliche Vereinigung). A total of 97 GPs agreed to participate the study, respresenting 35 practices (Fig. 1) The sample was stratified by area: two practices from each of 12 rural districts and six major towns in MV were randomly selected.Fig. 1


Appropriateness of treatment recommendations for PPI in hospital discharge letters.

Ahrens D, Chenot JF, Behrens G, Grimmsmann T, Kochen MM - Eur. J. Clin. Pharmacol. (2010)

Patient flow. PPI Proton pump inhibitor
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2982961&req=5

Fig1: Patient flow. PPI Proton pump inhibitor
Mentions: Recruitment of practices We invited all 933 registered general practitioner (GP) practices in MV to participate in the study. Addresses were obtained from the Association of Statutory Health Insurance Physicians (Kassenaerztliche Vereinigung). A total of 97 GPs agreed to participate the study, respresenting 35 practices (Fig. 1) The sample was stratified by area: two practices from each of 12 rural districts and six major towns in MV were randomly selected.Fig. 1

Bottom Line: The reasons for the dramatic increase in proton pump inhibitors (PPI) prescriptions remain unclear and cannot be explained solely by increased morbidity, new indications or a decrease in alternative medication.No information justifying the recommendation for continuous PPI medication could be identified in 54.5% of the discharge letters; in 12.7%, the indication was uncertain, and in 32.7%, we found an evidence-based indication for PPI medication.This may lead to a continuation of this therapy in primary care, thereby unnecessarily increasing polypharmacy and the risk of adverse events as well as burdening the public health budget.

View Article: PubMed Central - PubMed

Affiliation: Department of General Practice, University of Göttingen, Humboldtallee 38, Göttingen, Germany.

ABSTRACT

Purpose: The reasons for the dramatic increase in proton pump inhibitors (PPI) prescriptions remain unclear and cannot be explained solely by increased morbidity, new indications or a decrease in alternative medication. Inappropriate use and discharge recommendations in hospitals are considered to be possible explanations. As the quality of PPI recommendations in hospital discharge letters in Germany has not been investigated to date, we have studied the appropriateness of these referrals.

Methods: Hospital discharge letters with recommendations for PPI medication from 35 primary care practices in the county of Mecklenburg-Western Pomerania (MV; North-east Germany) were collected and analysed, and the appropriateness of the PPI indication was rated.

Results: No information justifying the recommendation for continuous PPI medication could be identified in 54.5% of the discharge letters; in 12.7%, the indication was uncertain, and in 32.7%, we found an evidence-based indication for PPI medication. The most common indication for adequate PPI use was nonsteroidal anti-inflammatory drug-prophylaxis in high-risk patients.

Conclusions: Inadequate recommendations for PPIs in discharge letters are frequent. This may lead to a continuation of this therapy in primary care, thereby unnecessarily increasing polypharmacy and the risk of adverse events as well as burdening the public health budget. Hospitals should therefore critically review recommendations for PPI medication and the dosage thereof in their discharge letters and clearly document the reason for PPI use and the need for continuous prescription in primary care.

Show MeSH