Initial proton pump inhibitor characteristics associated with long-term prescriptions in US veterans diagnosed with gastro-oesophageal reflux disease

Abstract

Objectives The objectives were to (1) determine initial proton pump inhibitor (PPI) prescriptions in US veterans diagnosed with gastro-oesophageal reflux disease (GERD); (2) assess initial PPI prescription factors associated with long-term PPI prescriptions at the national level; (3) determine healthcare use in patients with short- and long-term PPI prescriptions. Methods US veterans aged 18–90 years with a clinical outpatient diagnosis of GERD from 2003 to 2007 were eligible for the study. Analyses assessed differences in prescribing patterns and healthcare use by PPI prescription duration (short term (<6 months) versus long term (≥6 months to 2 years)). Multivariable logistic regression was used to determine the initial prescription factors associated with long-term PPI prescriptions adjusted for demographic and clinical characteristics. Key findings A majority of patients with GERD and initial PPI prescriptions (n = 177 394) were classified as having long-term PPI prescriptions (77.5%). A minority of patients received initial high daily dose prescriptions, and this differed slightly between short (18.3%) and long (16.2%) prescriptions (P < 0.0001). More patients received ≥90-day initial supply of medication in those patients classified with long-term prescriptions (71.4% versus 58.7%, P < 0.0001). Patients who provided a ≥90-day total supply of the initial prescription were more likely to be dispensed PPIs long term (odds ratio 1.71; 95% CI, 1.67 to 1.76) when adjusted for patient demographic and clinical characteristics. Patients with long-term PPI prescriptions had more overall healthcare encounters, predominantly of primary care origin. Conclusions The quantity of initial PPI prescriptions provided to Veterans does not reflect the guideline recommendations for GERD management and could affect long-term use of these pervasive medications.