Patterns of Proton Pump Inhibitor Continuation After Hospital Discharge and Their Relationship withDocumented Clinical Indications

Abstract

Proton pump inhibitors (PPIs) are commonly initiated during hospitalization and are commonly continued even post-discharge in the absence of a well-defined review plan. In this study, we have looked at the pattern of continuation of PPIs and its association with documented indications. We conducted a retrospective observational cohort study on 412 adults who received PPI prescriptions upon discharge from a tertiary care teaching hospital, with follow-up regarding PPI prescription for 6 months. The indications were categorized into documented ongoing, documented time-limited, and undocumented based on discharge and admission notes and continuation evaluated at 1, 3, and 6 months. The data analysis was done using descriptive statistics, chi-square test, and logistic regression on SPSS version 26.0. The documented ongoing indication was found in 51.2% of the participants, documented time limited in 20.1%, and undocumented in 28.6%. The overall rate of continuation was 77.2% at 3 months and 67.0% at 6 months. For those patients with no documented indication, 49.8% continued on PPIs after six months, accounting for 36.2% of six-month PPI use overall. In these patients, continuing PPIs was less common if there was a documented stop date or review plan in the discharge summary (21.9% vs 62.8%; p < 0.001), and lack of such a plan was the strongest independent predictor of continuation (adjusted OR 5.34; 95% CI 2.61–10.92). Continuing PPI therapy after discharge is commonly not associated with an indicated use and may be prevented by documenting duration/review at discharge.