Evaluation of Continuation of Stress Ulcer Prophylaxis at Hospital Discharge

Abstract

Purpose Stress-related mucosal disease (SRMD) can adversely affect patient morbidity and mortality. The use of stress ulcer prophylaxis (SUP) in patients with no risk factors for clinically important bleeding, however, is contributing to health care-related adverse events, drug interactions, and costs. The objective was to determine the percentage of hospitalized patients who receive SUP without an approved indication and to evaluate the financial impact of inappropriate prescribing as well as the risk for significant drug-drug interactions. Methods A retrospective chart review was performed of hospitalized adult cardiology, family medicine, and internal medicine patients between July 1, 2006 and June 30, 2007. Prescribing of acid suppressive therapy (AST) during hospital admission and indications for SUP were evaluated. Concomitant medications, cost of therapy, and discharge medications were assessed as secondary outcomes. Results Of the 4,603 patients admitted during the study period, 418 were randomly selected for study inclusion. Approximately 53% (221/418) of the selected patients received SUP during hospital admission, 93% (206/221) of whom had no indication for prophylaxis. Of those who continued AST at discharge (14%; 31/221), 84% (26/31) had no approved indication. Overuse of SUP resulted in 77 potential drug-drug interactions and an estimated 30-day outpatient cost of $37,950 for patients receiving these medications at discharge. Conclusion SUP is frequently prescribed to non–critically ill patients when the risk of SRMD is low. Use of SUP for patients who do not meet evidence-based criteria appears to contribute to increased health care expenditures, potential adverse events, and drug interactions.