Appropriateness of treatment recommendations for PPI in hospital discharge letters.

PURPOSE: The reasons for the dramatic increase in proton pump inhibitors (PPI) prescriptions remain unclear and cannot be explained solely by increased morbidity, new indications or a decrease in alternative medication. Inappropriate use and discharge recommendations in hospitals are considered to be possible explanations. As the quality of PPI recommendations in hospital discharge letters in Germany has not been investigated to date, we have studied the appropriateness of these referrals. METHODS: Hospital discharge letters with recommendations for PPI medication from 35 primary care practices in the county of Mecklenburg-Western Pomerania (MV; North-east Germany) were collected and analysed, and the appropriateness of the PPI indication was rated. RESULTS: No information justifying the recommendation for continuous PPI medication could be identified in 54.5% of the discharge letters; in 12.7%, the indication was uncertain, and in 32.7%, we found an evidence-based indication for PPI medication. The most common indication for adequate PPI use was nonsteroidal anti-inflammatory drug-prophylaxis in high-risk patients. CONCLUSIONS: Inadequate recommendations for PPIs in discharge letters are frequent. This may lead to a continuation of this therapy in primary care, thereby unnecessarily increasing polypharmacy and the risk of adverse events as well as burdening the public health budget. Hospitals should therefore critically review recommendations for PPI medication and the dosage thereof in their discharge letters and clearly document the reason for PPI use and the need for continuous prescription in primary care.

Why do GPs continue inappropriate hospital prescriptions of proton pump inhibitors? A qualitative study.

BACKGROUND: Inappropriate prescriptions of Proton pump inhibitors (PPIs) initiated in hospitals are frequently continued in primary care. No research has explored why general practitioners (GPs) continue or discontinue inappropriate drug therapy. OBJECTIVES: This study aims to describe factors and motives associated with the continuation of inappropriate prescriptions of PPIs in primary care. METHODS: Semi-structured qualitative interviews on basis of a purposive sampling of five GPs who often continued inappropriate prescriptions and five GPs who frequently discontinued inappropriate drug therapy with PPIs (10 GPs total, of which four were female and six male). RESULTS: Although all GPs enrolled in the study were enthusiastic about the effectiveness of PPIs, differences between the continuing and discontinuing GPs exists in three areas: The two groups varied ( 1 ) in awareness of indications and general attitudes towards prescribing ( 2 ) in perception of the hospital physicians' competence in prescribing and ( 3 ) appreciation of general prescribing conditions in hospitals. CONCLUSION: Differences between the continuing and discontinuing GPs were found in their level of knowledge and their perceptions of the hospital physicians' competence and the threshold to prescribing in hospitals. Financial pressure and possible adverse effects demand a more balanced and evidence-based prescribing of PPIs. Attempts to change behaviour should focus on the GPs' awareness of indications for PPIs, NSAID risks, and prescribing approaches in hospitals. Default prescribing in hospital demands critical examination.