Physicians’ Opinions of Stress Ulcer Prophylaxis: Survey Results from a Large Urban Medical Center

Abstract

Stress ulcer prophylaxis (SUP) has been increasingly prescribed for patients admitted to medical wards. The knowledge, attitudes, and practices of those in the healthcare profession regarding use of SUP in medical wards are understudied. A survey consisting of closed-ended questions and multiple-choice queries was handed out during grand rounds. One hundred people (39 attending physicians, 61 residents) completed the survey. More attending physicians (41 vs. 30%) believed SUP was indicated for patients treated in a non-intensive-care medical ward (P=0.2357). All residents preferred a proton-pump inhibitor (PPI) for SUP compared with 85% of attending physicians (P<0.05). Despite equal agreement that PPIs were not harmless, more attending physicians than residents agreed that using PPIs increased the risk of community-acquired pneumonia (P<0.05). More residents than attending physicians agreed on the use of SUP for patients suffering from major burns and for those with liver failure. In situations of respiratory distress not requiring intubation and in cases of steroid treatment for a chronic obstructive pulmonary disease flare, more attending physicians than residents felt SUP was required. Approaching a statistically significant difference, more attending physicians than residents felt that being too busy to question SUP indication and the perception of PPIs as harmless affected decision making. Despite the publication of guidelines, misuse of gastric acid suppressants continues to occur, even by attending physicians. More complete understanding of the need and occasion for SUP use should result in more cautious use.