Proton pump inhibitor prescription patterns in hospitalized patients before and after targeted intervention

The increasing utilization of proton pump inhibitors (PPIs) in patients without clear medical indications has raised concerns regarding potential risks, highlighting the importance of de-prescription. Ensuring the appropriate use of PPIs is an important hospital patient safety measure. The aim of this study is to describe the impact of a targeted quality improvement intervention on the use of PPIs in patients admitted to the hospital.

This cross-sectional study consisted of two phases looking at PPI prescription in patients admitted to a community hospital in Lebanon. A total of 400 patients were included, with 200 patients in each phase. An educational non-coercive intervention was implemented between the phases to promote the understanding of the appropriate indications for PPI prescription. The primary outcome was the change in PPI overuse between phase I and phase II, defined as PPI prescribing among patients that are admitted without a valid indication for its use. To control for confounding, a multivariable logistic regression was performed adjusting for age, sex, and hospital ward.

During phase I, 84% of patients were prescribed a PPI upon admission, compared with 78.5% during phase II. Among patients with no valid indication for PPI prescription, 77.5% received PPI in phase I versus 69.3% in phase II (reflecting PPI overuse). This difference was not statistically significant (p = 0.18). After adjusting for age, sex, and ward category, the difference in inappropriate PPI prescription between the two phases remained statistically non-significant (adjusted OR = 0.911, 95% CI: 0.454-1.82, p = 0.792). Among patients with valid indication for PPI prescription, 10.8% did not receive PPI in phase I versus 5.5% in phase II (reflecting underuse). This difference was not statistically significant (p = 0.21).

This study demonstrated that a non-coercive targeted educational intervention did not significantly reduce PPI overuse among hospitalized patients, even after controlling for the confounding variables. More rigorous and sustained educational efforts, together with improved adherence to prescribing guidelines, may be necessary to achieve statistically significant results.