Eid Shaker M, Boueiz Adel, Paranji Suchitra, Mativo Christine, Landis Regina, Abougergi Marwan S
Department of Internal Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, USA.
Intern Med. 2010;49(23):2561-8. doi: 10.2169/internalmedicine.49.4064. Epub 2010 Dec 1.
In the hospital setting, several studies have reported proton pump inhibitor (PPI) overuse, a majority of which is continued after discharge. In addition to being expensive, PPIs are associated with an increased risk of infections, osteoporosis and serious drug interactions. We examined the trends and predictors of PPI guidelines non-compliance among academic and non-academic hospitalists in USA.
Oral PPI prescriptions initiated by 2 academic and 2 non-academic hospitalist groups were reviewed. Prescription indications were recorded when explicitly stated in the chart. Otherwise, qualified physicians reviewed the chart to make such determination. Indications were then compared to the published guidelines. Several variables were tested to determine independent predictors of initiation and post discharge continuation of guideline non-compliant prescriptions.
Of the 400 PPI prescriptions 39% were guideline compliant. Academic hospitalists were significantly more compliant with PPI prescription guidelines (50 vs 29%). Gastrointestinal ulcer bleeding prophylaxis (GIP) for low risk patients was the most common indication for non-compliant prescriptions, while that of guideline compliant prescriptions was dyspepsia treatment. Independent predictors of the initiation of guideline non-compliant prescriptions were non-academic hospitalist group, PPI indication not documented in the chart, and GIP as part of the admission orderset. The latter was an independent predictor of those prescriptions continuation post-discharge (protective) in addition to non-academic hospitalists group.
Hospitalists overprescribe PPI to a level comparable to that of the non-hospitalist providers in the literature. Understanding the determinants of increased compliance among academic groups is instrumental to design interventions aimed at increasing PPI prescription compliance.
在医院环境中，多项研究报告了质子泵抑制剂（PPI）的过度使用情况，其中大部分在出院后仍在继续。除了价格昂贵外，PPI还与感染风险增加、骨质疏松症以及严重的药物相互作用有关。我们研究了美国学术型和非学术型住院医师中PPI指南不依从的趋势和预测因素。
对2个学术型和2个非学术型住院医师团队开具的口服PPI处方进行了审查。当病历中明确注明时，记录处方指征。否则，由合格的医生查看病历以做出此类判断。然后将指征与已发表的指南进行比较。测试了几个变量，以确定指南不依从处方起始和出院后持续使用的独立预测因素。
在400份PPI处方中，39%符合指南。学术型住院医师对PPI处方指南的依从性明显更高（50%对29%）。低风险患者的胃肠道溃疡出血预防（GIP）是不依从处方最常见的指征，而符合指南处方的指征是消化不良治疗。指南不依从处方起始的独立预测因素是非学术型住院医师团队、病历中未记录PPI指征以及GIP作为入院医嘱集的一部分。除了非学术型住院医师团队外，后者还是出院后这些处方持续使用（有保护作用）的独立预测因素。
住院医师过度开具PPI的程度与文献中报道的非住院医师提供者相当。了解学术团队依从性增加的决定因素有助于设计旨在提高PPI处方依从性的干预措施。
