Low-value PPI prescriptions common among older patients

  • Mafi JN & al.
  • J Am Geriatr Soc
  • 05.09.2019

  • von Craig Hicks
  • Clinical Essentials
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Takeaway

  • More than one-third of proton pump inhibitor (PPI) prescriptions for older patients are potentially low value, without any documented evidence-based indication.

Why this matters

  • Older adults are particularly vulnerable to PPI-associated complications, such as Clostridioides difficile infections, kidney toxicity, and osteoporotic fractures.
  • Targeted physician interventions or electronic health record (EHR)-based stopping rules could protect patients from harm.

Study design

  • Researchers reviewed the health records of 399 patients aged ≥65 years prescribed any PPI by primary care physicians in a large academic health system (63.9% women; 67.9% white; mean age, 76.2±8.5 years).
  • Potentially low-value prescriptions were defined as those lacking a guideline-based indication for treatment.
  • Funding: None disclosed.

Key results

  • More than one-third (35.8%) of prescriptions were potentially low value (95% CI, 31.3%‐40.7%).
  • Most potentially low-value prescriptions (81.1%) had a guideline-based indication for short-term treatment but continued >8 weeks without a long-term indication.
  • More than half (59.2%) of potentially low-value prescriptions were written by only 18.9% (32/169) of primary care providers.

Limitations

  • Findings may not apply to other health systems.
  • Some prescriptions may have undocumented evidence-based indications.