Appropriateness of Oral Proton Pump Inhibitors Prescribing in Sri Aman Hospital

Abstract

Introduction:

Given the utility, safety profile, efficacy, and tolerability of proton pump inhibitors (PPIs), these medications have been overprescribed globally. Recently, reported adverse events associated with PPIs have raised safety concerns. This study aimed to determine the appropriateness of oral PPIs prescribing pattern in Sri Aman Hospital, the factors associated with them and the costs incurred.

Methods:
In this study, all prescriptions for adults prescribed at the outpatient clinics between 1st April 2024 and 30th June 2024 that fulfilled the inclusion criteria were reviewed, together with patient’s clinic card, to determine the appropriateness of PPIs prescribing based on the 2024 National Health Service (NHS) guidelines. Data such as patient demographics, types of PPIs, indication, dosage, duration, prescribing discipline and concurrent medications were recorded. Chi-square test was used to analyse the associated factors of inappropriate oral PPIs prescribing.

Results:
We found that 58.1% of the oral PPIs were inappropriate with the majority (51.0%) lacking proper or documented indication. Among the documented indications, PPIs were mostly used for nonsteroidal anti-inflammatory drug (NSAIDs) prophylaxis, which recorded 6.6% of inappropriate indication. Inappropriate PPIs prescribing was associated with several factors, including age (P<0.001), number of concurrent medications (P=0.005) and the concomitant use of anticoagulants (P=0.001) and corticosteroids (P=0.045). The inappropriate use of PPIs was most prevalent among patients aged below 65 years (n=80, 70.8%). Inappropriate PPIs prescribing was also most commonly observed in patients receiving 2–4 concurrent medications (n=31, 75.6%). Additionally, a high prevalence of inappropriate PPIs prescriptions was identified among patients receiving concurrent anticoagulants (n=26, 86.7%) and corticosteroids (n=11, 84.6%). Approximately 53.0% of PPIs were prescribed for duration of more than 52 weeks. The inappropriate prescribing of oral PPIs was estimated to incur RM20882.40 during the study period in our setting.

Conclusion:
It is imperative that prescribers adhere to prescribing guidelines and review the need for continued therapy to ensure rational use of PPIs and reduce unnecessary healthcare costs.