Factors associated with inappropriate inpatient prescribing of acid-suppressive therapy

Acid-suppressive therapy is used for 54-70% of inpatients, and is frequently prescribed for inappropriate indications. The objective of this study was to identify characteristics associated with inappropriate prescribing of acid-suppressive therapy.

A random sample of adult internal medicine inpatients admitted between 1 July 2005 and 30 June 2006 was screened for acid-suppressive therapy. Patients receiving such therapy without an accepted indication and those not prescribed acid-suppressive therapy were included in group 1 and group 2, respectively. Significant characteristics from separate univariate regression models were entered into a multivariate logistic regression to determine characteristics associated with inappropriate use. The setting was internal medicine units at a tertiary care academic medical centre.

There were 108 patients in group 1 and 134 patients in group 2. Group 1 patients were older, had a longer median length of stay, a greater number of comorbidities, a greater median number of medications upon admission, and a higher rate of cirrhosis. Factors associated with use of acid-suppressive therapy without an accepted indication were use of a proton-pump inhibitor (odds ratio, 15.3; 95% confidence interval, 4.1-56.3) or histamine2 receptor antagonist (14.5; 2.8-74.8) prior to admission, cirrhosis (6.4; 1.02-39.5), use of inpatient anticoagulants (2.7; 1.4-5.2) and length of stay (1.1; 1.1-1.3).

The strongest factors associated with use of acid-suppressive therapy without an accepted indication were use of a proton-pump inhibitor or histamine2 receptor antagonist prior to admission, a diagnosis of cirrhosis and use of inpatient anticoagulants.