gms | German Medical Science

Background: Despite substantial risks, proton pump inhibitors (PPI) are often prescribed without indication and/or with too high dosages. In this context we analysed the current situation in nursing home residents.

Materials and methods: From baseline data of the cluster-randomized, controlled EPCentCare study (BMBF grant) a secondary data analysis was performed to investigate adequate prescription of PPI concerning 1. indication as well as 2. correct dosages with regard to all latest valid a) guideline-recommendations and b) drug informations.

Results: Within 437 residents of 37 nursing homes in Saxony-Anhalt (Halle (Saale)), North Rhine Westphalia (Witten/Herdecke) and Schleswig Holstein (Lübeck), mean age 83±9.2 years, 71.9% female, prevalence of PPI-prescription is 44.2% (n=193). In 138 (71.5%) of these residents there is an adequate indication for PPI-prescription and in 52 (26.9%) there is no indication (plus 1.6% ambiguous cases). Yet, 54 participants (28%) with adequately indicated prescription reveal faulty PPI overdoses. In less than one third of adequate prescription the indications are according to the PPIs’ approvals, most are off label indications corresponding to guideline recommendations. Risk of inadequate PPI prescription without indication is associated with total number of prescribed drugs (OR) 1.32; 95% CI 1.18–1.62 (p=0.013). Number of chronic diseases reveal an elevated risk OR 1.9; 95 CI 0.16–1.14 (not statistically significant). There is no significant association with age, level of care, demential syndrom, prescription of psychotropic drugs, physicians’ consultation rates and local region.

Conclusion: Despite partly generous and liberal guideline recommendations, there seems to be an almost “Germany-wide” high prevalence of inappropriate PPI prescription in >55% – either inadequate or overdosed – in nursing home residents. Adequately ambulatory PPI prescription as implemented in our clinical setting is an urgently trans-sectorial imperative.