The Use of Proton Pump Inhibitors in the Outpatient Setting

Abstract

Purpose: Determine how often PPIs are being prescribed without an appropriate ICD-9 code indication. Methods: All patients prescribed a PPI were queried from the East Orange VA outpatient database over a 90 day period. From this group, all patients concurrently taking NSAIDs or Steroids were excluded. The resultant group was then queried to see which ones had an ICD-9 code that would merit a PPI prescription based on FDA diagnoses for the use of PPIs. Over 100 ICD-9 codes were identified that would merit a PPI prescription. Results: The total number of patients on a PPI in our study was 4154. Of this group the number of patients on a PPI with an appropriate ICD-9 code was 2963 (71.4%). The number of patients on a PPI without an ICD-9 code was 1191 (28.6%). Conclusion: Our study showed that PPIs are being prescribed without clear indications. The overuse of PPIs in the outpatient setting may contribute to the increase incidence of osteoporosis. More recently, studies show that PPIs interfere with the activity of other medications, such as Clopidogrel. Thus, use of PPIs is worrisome for patients on multiple medications. Physicians in the outpatient setting need to be better educated about the harmful effects of PPIs, and should use other anti-acids before considering PPIs.Table: Results