HOLLYWOOD, FLA. — Many patients may enter nursing facilities on an unnecessary proton pump inhibitor, according to research presented at the annual symposium of the American Medical Directors Association.
In a study of 98 consecutive patients admitted to a skilled nursing facility, nearly two-thirds had been prescribed a proton pump inhibitor (PPI) at admission and half had no clear indication for the drug, Dr. Russell J. Rentler and his colleagues at the Lehigh Valley Hospital in Allentown, Pa., wrote in a poster.
The researchers performed a chart review of 98 patients admitted to a skilled nursing facility to determine how many were transferred from the hospital on an appropriately prescribed PPI. They defined an appropriate diagnosis-indicating PPI prescription as patients with gastroesophageal reflux disease (GERD), upper gastrointestinal bleeding, or peptic ulcer disease with or without bleeding, and presumptive treatment for patients with Hemoccult-positive stool or GI bleeding.
Of 98 patients, 63 were women. Most were aged 75 or older. About 48% were between 75 and 84 years, 43% were age 85 and older, and 9% were under age 74.
Of the 60 patients who were taking PPIs upon transfer to the nursing home, only 30 had an appropriate diagnosis under the study criteria. In addition, three patients with a diagnosis of GERD were not prescribed a PPI. Only three patients were prescribed an H2 receptor blocker. In two of the patients, the researchers determined that the drug was appropriately prescribed.
Although side effects are infrequent on PPIs, the drugs can interact with the absorption of other medications. Studies also have shown a possible link between the use of PPIs for over a year and hip fracture. PPI use also may be a risk factor for Clostridium difficile-associated diarrhea, the researchers wrote.
Prescribing unnecessary medications also has a significant cost impact, researchers found. A commonly prescribed PPI, pantoprazole, costs about $116 for a 30-day supply. Eliminating the medication for 30 of 60 patients would result in savings of about $3,480 a month. Even with a less-expensive medication, such as Prilosec OTC, the savings from eliminating the drug among 30 of 60 patients would result in about $771 a month.
Part of the reason physicians prescribe PPIs so frequently may be defensive, Dr. Rentler said in an interview, because it is seen as preventing GI bleeding with few side effects. He suggested more education is needed for attending physicians about the limited benefit in prescribing PPIs as prophylaxis against gastric ulceration.
The researchers concluded that physicians may want to stop the drug and monitor the patient if it is not clear why a PPI was prescribed.