Proton Pump Inhibitor Prescribing Patterns In A District General Hospital

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Proton Pump Inhibitor Prescribing Patterns In A
District General Hospital

• C. A. Langley, J. F. Marriott and K. A. Wilson
• ASTON UNIVERSITY

C. E. Curtis and N. Ford QUEENS HOSPITAL, BURTON
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Aston University
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What drives prescribing?
PRIMARY CARE OR SECONDARY CARE?
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Introduction

• What drives PPI prescribing?
• Primary or Secondary care?
• Is there compliance with the National Institute
  for Clinical Excellence (NICE) guidelines on PPI
  prescribing?
• Is there variability in prescribing owing to PPI
  choice?

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Proton Pump Inhibitor Choice
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Proton Pump Inhibitor Choice
OMEPRAZOLE
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Proton Pump Inhibitor Choice
OMEPRAZOLE
ESOMEPRAZOLE
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Proton Pump Inhibitor Choice
OMEPRAZOLE
ESOMEPRAZOLE
LANSOPRAZOLE
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Proton Pump Inhibitor Choice
OMEPRAZOLE
ESOMEPRAZOLE
LANSOPRAZOLE
PANTOPRAZOLE
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Proton Pump Inhibitor Choice
OMEPRAZOLE
ESOMEPRAZOLE
LANSOPRAZOLE
PANTOPRAZOLE
RABEPRAZOLE
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Queens Hospital Burton

• Totally electronic centre
• Removal of barriers to secondary care audit
• Introduction of electronic guidelines
• Decision support specialist advice

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Profile of Queens Hospital

• Number of beds 496
• Budget 99/2000 62m
• AE attendances 45,000
• Finished consultant episodes 44,000
• Outpatients attendances 154,000
• Master Patient Index 800,000

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The NHS 6 Level EPR Model
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Electronic prescribing at Burton
HISS/EPR
PHARMACY
PAPERLESS BACKUP
Prescribing Drug Administration
WARD
Supplies and Interventions
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(No Transcript)
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Results (1)

• Assumption
• PPI administered lt24 hours after admission deemed
  to have been initiated in primary care
• 1518 inpatients received PPIs between April and
  December 2000 inclusive
• 1185 initiated in primary care
• 106 (8.9) endoscoped
• 333 initiated in secondary care
• 84 (25.2) endoscoped

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Results (2)

• Lansoprazole prescribed in
• 89.9 of patients for whom therapy was initiated
  in primary care
• 91.9 of patients for whom therapy was initiated
  in hospital
• Maintenance doses were prescribed in
• 22 of patients initiated in primary care
• 20 of patients discharged on a PPI

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Conclusions

• PPI use is not driven by secondary care admission
• Policy to prescribe a formulary agent is followed
  in both primary and secondary care
• Most patients prescribed a therapeutic rather
  than maintenance dose

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Future work

• The system now includes details of diagnosis
• Drug use audit can now be linked to diagnostic
  coding
• Facilitates a more precise assessment of NICE
  guideline concordance