General practice variation when initiating long-term prescribing of proton pump inhibitors: a nationwide cohort study.

P F Haastrup,D E Jarbøl,J M Hansen,J Søndergaard,R D Christensen,S Rasmussen

doi:10.1186/s12875-016-0460-9

P F Haastrup, D E Jarbøl + Show 4 more

Open Access

https://doi.org/10.1186/s12875-016-0460-9

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Abstract

BackgroundSuggestions of overprescribing of proton pump inhibitors (PPIs) for long-term treatment in primary care have been raised. This study aims to analyse associations between general practice characteristics and initiating long-term treatment with PPIs.MethodsA nationwide register-based cohort study of patients over 18 years redeeming first-time prescription for PPI issued by a general practitioner in Denmark in 2011. Patients redeeming more than 60 defined daily doses (DDDs) of PPI within six months were defined first-time long-term users. Detailed information on diagnoses, concomitant drug use and sociodemography of the cohort was extracted. Practice characteristics such as age and gender of the general practitioner (GP), number of GPs, number of patients per GP, geographical location and training practice status were linked to each PPI user. Logistic regression analysis was used to determine associations between practice characteristics and initiating long-term prescribing of PPIs.ResultsWe identified 90 556 first-time users of PPI. A total of 30 963 (34.2 %) met criteria for long-term use at six months follow-up. GPs over 65 years had significantly higher odds of long-term prescribing (OR 1.32, CI 1.16-1.50), when compared to younger GPs (<45 years). Furthermore, female GPs were significantly less likely to prescribe long-term treatment with PPIs (OR 0.87, CI 0.81-0.93) compared to male GPs.ConclusionsPractice characteristics such as GP age and gender could explain some of the observed variation in prescribing patterns for PPIs. This variation may indicate a potential for enhancing rational prescribing of PPIs.

Highlights

Suggestions of overprescribing of proton pump inhibitors (PPIs) for long-term treatment in primary care have been raised
For 90 556 (72.9 %) of the first-time users the prescription for PPI was issued in general practice
Six months after initial redemption of PPIs the cohort was subdivided into short-term and long-term users (Fig. 1)

Summary

Introduction

Suggestions of overprescribing of proton pump inhibitors (PPIs) for long-term treatment in primary care have been raised. This study aims to analyse associations between general practice characteristics and initiating long-term treatment with PPIs. Prescribing of proton pump inhibitors (PPIs) has increased significantly over the past decades and the vast majority is redeemed in primary care [1]. Patients are prescribed increasing quantities of PPI on an empirical background when initiating treatment [7]. Prescribing of PPIs for ambiguous reasons for more than a few weeks entails the risk of creating a vicious circle increasing the need for PPIs. moderation when initiating PPI treatment for unclear reasons is warranted

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