Patients, Prescribers, and Institutional Factors Associated with Inappropriate Use of Acid Suppressive Therapy in Medical Wards: An Experience of a Single-Center in Saudi Arabia

Abstract

Purpose: To identify factors associated with inappropriate acid-suppressive therapy (AST) use in hospitalized medical ward patients. Patients and Methods: This was a combined retrospective cohort study reviewing the electronic medical records of medical ward in a secondary university hospital between January 2018 and July 2019, in addition to prescriber surveys about AST knowledge. We included adult patients (≥18 years old) admitted to the medical ward who received at least one dose of AST during their hospitalization. Statistical analyses included descriptive statistics and logistic regression. Results: A total of 335 patients were included. Most of the patients were female (66.6%), with a mean age of 42.37 ± 17.72 years; 76% (n=256) of the study subjects were prescribed AST for an inappropriate indication. Patients who were not receiving any home medications associated with high bleeding risk had higher odds of being prescribed AST inappropriately (OR, 4.06; 95% CI, 1.09-13.8). A total of 27 physicians completed the prescriber survey, and the average prescriber's knowledge score was 46.8 ± 15.6%. This score did not differ by the prescriber's position. Conclusion:This study demonstrated the overuse of AST in the medical ward. Therefore, improving providers' awareness about AST and implementing an AST stewardship program in institutions is necessary to limit this long-lasting issue.

Evaluation of Proton Pump Inhibitors Prescribing Among Hospitalized Patients: A Cross-Sectional Study

“…risk medications had higher odds of being prescribed AST inappropriately. 24 This finding reflects the practitioner’s behavior in prescribing PPIs to most patients upon admission and discharge rather than not prescribing them because PPIs are well-known drugs with reasonable safety profiles and few complications, making prescribers less hesitant to order and prescribe them. Many reports have shown that PPIs are associated with long-term complications such as osteoporosis, which increases the risk of C. difficile infection.…”

“…26 Other studies conducted in Saudi Arabia, Portugal, and Shanghai found higher rates of inappropriate use; 76.4%, 61.5%, and 47%, respectively. 24 , 27 , 28 …”

“…21 This result is higher than that of a similar regional study conducted in Saudi Arabia, where the appropriate dose of acid-suppressive therapy (AST) was only 12.7% of patients (n= 256). 24 …”

Evaluation of Potential Drug Interactions with Proton Pump Inhibitors: A Retrospective Study

“…11 In another study, it was determined that 63% of the doctors who prescribe PPIs were internal medicine specialists. 12 Since the pharmacy where our study was conducted was located just across from the family health center, we think that the prescriptions containing PPIs in our study were mostly written by family physicians.…”

“…In the same study, this rate was determined as 11% for omeprazole. 12 A study conducted in Ireland found that the most commonly prescribed PPIs in the hospital was esomeprazole (54%). 14 In a study conducted in Italy, the most commonly prescribed PPIs drug was found to be omeprazole.…”